If you’ve ever struggled with low back pain, you know that it can be
surprisingly debilitating, even if the discomfort is short-term. You may
find it difficult to grocery shop, do housework, play sports, or even
tie your shoelaces. When back pain is chronic, lasting 12 weeks or
longer, it can impair quality of life and physical function, and
contribute to or worsen stress, anxiety, and depression.
While people dealing with chronic back pain are often
directed to physical therapy, research shows that psychological
approaches that teach strategies to manage your experience of pain can
help. So, would combining these approaches do more to ease the pain? A
recent systematic review of multiple studies suggests that it might.
How big is this problem, and what did this study find?
Worldwide, low back pain is a leading cause of disability
and affects more than 560 million people. In the US, four in 10 people
surveyed in 2019 had experienced low back pain within the past three
months, according to the Centers for Disease Control and Prevention.
- physical function, such as standing, climbing stairs, and managing personal care
- fear avoidance, because fear of pain can lead people to
avoid movement, which contributes to the cycle of muscle weakening and
further pain
- pain intensity, measured by pain scores from validated rating scales.
The review revealed that physical therapy plus psychological
approaches, such as pain education and cognitive behavioral therapy,
more effectively improved chronic low back pain than physical therapy
alone. More specifically:
- For improving physical function and fear avoidance, pain education programs in conjunction with physical therapy offered the most sustained effects.
- For improving pain intensity, behavioral therapy combined with physical therapy offered the longest-lasting benefits.
The study shows the advantages of an interdisciplinary
approach to chronic low back pain. Integrating behavioral therapy and
physical therapy helped people achieve better function, reduce the cycle
of avoidant behavior, and reduce the intensity of their pain. In their
daily lives, this may lead to more productive workdays and better sleep,
as well as enabling people to participate in more social activities,
which boosts overall well-being.
What else should you know about this study?
The authors define chronic, nonspecific low back pain as pain
between the bottom of the rib cage and buttocks crease, without an
identified structural cause like spinal stenosis, cancer, or fracture.
However, "nonspecific" is a controversial term. Many experts
on back pain believe that further evaluation might determine specific,
multiple factors that contribute to pain.
How do psychological therapies help with pain?
Psychological therapies can help people reframe negative
thoughts and change pain perception, attitudes, and behaviors. Examples
of approaches that aim to reduce pain-related distress are cognitive
behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), biofeedback, and pain reprocessing therapy (PRT). A recent study evaluating PRT
showed that psychological treatment focused on changing beliefs about
the causes and consequences of chronic low back pain may provide
substantial, long-lasting pain relief.
Neuroscience has demonstrated that the brain and body are
always connected, and pain is a combination of medical, cognitive,
emotional, and environmental issues. Strategies to manage pain
effectively must address your body and brain by integrating physical and
psychological therapies, such as with functional restoration programs
and working with a pain psychologist. Gaining a better understanding of
pain, and treating all factors contributing to your chronic pain, can be
empowering and healing.