Chronic back pain is the leading cause of disability worldwide. According to a study published in the American Journal of Medicine in 2012, patients in the United States spend up to 300 billion U.S. dollars each year to treat this disease. Pain MagazineHowever, common therapies such as surgery and steroid injections aimed at addressing the physical origin of back pain have not been clearly proven in randomized clinical trials. There is increasing evidence that psychological factors may be related to some forms of back pain.
Doctors and scientists at Beth Israel Deaconess Medical Center (BIDMC) have developed a 12-week mind and body plan that uses a new method to treat chronic back pain. This novel intervention—not yet available to the public at BIDMC—is based on an idea pioneered by the late John Sarno, MD, professor of rehabilitation medicine at the New York University School of Medicine.In new publications appearing in journals pain, The team proved that compared with standard care, physical and mental intervention is very beneficial for the treatment of back pain, and 64% of the study volunteers reported 100% painless after six months.
The current pain management paradigm mainly focuses on treating the physical source of pain, but in many cases of chronic back pain, the physical source of pain cannot be determined. The hypothesis that our group focuses on is that non-specific back pain is a symptom of a psychological process, which is essentially driven by stress, depressed emotions, and other psychological processes. The exact mechanism is not yet clear, but it can be compared to other known effects of acute emotional states on acute physiological changes, such as how embarrassing emotions cause the telangiectasias we call blushing. “
Michael W. Donnino, MD, corresponding author, BIDMC intensive care and emergency department physician
Donnino and colleagues’ experimental program, called Psychophysiological Symptom Relief Therapy (PSRT), aims to address the underlying stressors and psychological factors that cause persistent pain, as well as conditional pain responses and fear avoidance behaviors. Treatment strategies include educating patients about the connection between stressors and pain, as well as the relationship with emotions. Armed with this knowledge, participants will learn healthier ways to deal with stress and express emotions. The program also focuses on desensitization or inverse regulation to help patients break the associations usually formed by pain triggers such as bending or sitting.
“Usually these triggers are thought to be the cause of pain, but they may be better described as unknowingly in a way similar to how Pavlov made dogs salivate on bells by pairing bells with food. Make adjustments to the association,” Donnino famously. “Our plan is dedicated to reversing these conditioned responses, thereby improving pain and pain disability.”
The last eight weeks of the program focused on mindfulness-based stress reduction or MBSR, with the goal of providing tools to better deal with current and future stressors, while allowing time to practice the techniques of the first part of the program.
In order to evaluate whether PSRT can reduce the symptoms and pain-related anxiety of patients with nonspecific chronic back pain, Donnino and colleagues recruited 35 participants, aged between 18 and 67 years, with chronic back pain, but did not specify The origin of the body. Participants were randomly assigned to receive a new 12-week PSRT intervention, only 8-week MBSR, or receive routine care under the guidance of a doctor, regardless of the research team’s influence. All participants filled out pain-related questionnaires regularly before the intervention and within six months after the intervention to assess changes in functional limitation or disability, back pain distress, and pain-related anxiety.
After only 4 weeks, the researchers found that the reported pain disability rate in the PSRT group had dropped by an astonishing 83%, while the MBSR and routine care groups had dropped by 22% and 11%, respectively. Regarding the pain distress during the same period, the PSRT group decreased by 60%, while the mindfulness and routine care groups decreased by 8% and 18%, respectively.
The primary endpoint of pain and disability in the PSRT group at each time interval and at the end of the six-month monitoring period was better than conventional care and MBSR. In addition, at the end of 6 months, 64% of patients with chronic back pain in the PSRT group were completely painless (reporting 0 points and 10 points on the pain scale), while only 25% and 17% reported that they were in mindfulness and daily life, respectively. Care.
“Within 4 weeks, the differences between PSRT, MBSR and conventional care were obvious in multiple areas, including the main outcome measures of functional disability and pain distress,” Donnino said. “When patients recognize the relationship between mental and physical pain, this direction will bring new enlightenment and provide them with a basis for participating in a multifaceted program that can be used interchangeably to improve pain and disability. This research It shows that our plan has the potential to be very beneficial compared to routine care and additional treatments such as MBSR.”
Beth Israel Deaconess Medical Center
Donino, MW, Wait. (2021) Psychophysiological symptom relief for chronic back pain: a pilot randomized controlled trial. Pain report. doi.org/10.1097/PR9.0000000000000959.