New Research: Back Pain May Be All In Your Head

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If you suffer from chronic low-back pain, mindfulness might be your answer. New research suggests the trifecta of meditation, yoga, and mental body scanning may be a better painkiller than drugs, physical therapy, and other standard treatments.

In one of the largest studies of its kind, 342 adults who’d been battling low-back pain for an average of seven years were divided into three treatment groups. The first group participated in mindfulness-based stress reduction (MBSR) for two hours once a week over the course of eight weeks. Along with guided meditation and group yoga, this included body scanning, which means mentally inventorying each body part to assess how it feels at that moment. They were also encouraged to practice MBSR on their own for 45 minutes.

The second group underwent cognitive behavioral therapy, or CBT, also once a week for two hours. This psychotherapy technique, usually led by a trained professional, aims to raise your awareness of negative and false thoughts so you can approach situations with more clarity and respond more effectively.

The remaining participants received neither treatment. Instead, they continued doing whatever they had been to manage the pain, be it physical therapy, OTC painkillers, or prescription drugs.

After six months, MBSR was the clear winner. Sixty-one percent of that group reported significantly less low-back pain than when the study began. For example, everyday physical tasks, like getting in and out of a car, hurt a lot less than they previously did. CBT wasn’t quite as effective but still worked very well, as 58 percent of participants experienced big-time pain reduction. Both of these groups fared far better than the control group. Just 44 percent of those folks felt their pain subside after six months.

“We tend to view pain as largely physical when, in fact, the mind plays a much more important role than we realize,” says Daniel Cherkin, senior investigator at Group Health Research Institute in Seattle. He says chronic pain — discomfort lasting longer than three months or well past when an injury should’ve healed — is occasionally caused by an unidentified underlying condition. “But more often than not, it’s the effect pain has on the mind that makes it persist,” Cherkin says. “We get locked into certain ways of reacting to pain after a while.”

Because both MBSR and CBT involved many different components, the researchers couldn’t tease out exactly why both had such profound effects, only that they worked. “Both techniques allowed participants to view pain through a different lens than being something physical,” Cherkin says. “It may be just that using your mind in whichever fashion gives you some sense of control over the problem.” The group aspect may also have helped because it builds a sense of community. “In a group, you can share experiences, get new ideas for how to think about pain, and learn tricks that others find useful,” Cherkin says.

Another perk: Unlike prescription and NSAID painkillers, mind-based therapies don’t come with negative side effects. Also, MBSR and CBT can benefit you beyond just pain management, such as in dealing with stressful work situations or staying calm in a crisis. “If you really take in these relaxation techniques,” Cherkin says, “and you adopt an approach of increasing awareness and decreasing reactions, you’ll probably use them for many other aspects of life.”

While it is possible to try these therapies on your own, Cherkin says they’re more effective when you get proper training from a professional. CBT is widely used and more likely to be covered by health insurance than MBSR. However, now that more research is showing the benefits of meditation and yoga, it too is becoming more available, and insurance providers are increasingly willing to subsidize it.

If you don’t have access to a MBSR group or a CBT expert, you can try components of these therapies on your own. Carolyn McManus, a physical therapist and MBSR trainer who instructed the participants in this study, suggests finding a guided meditation app or looking for one online.

Then take 10 minutes every morning or evening, find a quiet space, and follow the instructor’s lead on focusing on your breaths and centering your mind. “It’s common for the mind to wander, and it’s important to not be troubled by that,” McManus says. “Just accept that your mind is wandering, don’t judge it, and return to your breath.” Also accept that you’re a beginner at this, she adds, and try not to begrudge yourself for not getting it “right” immediately. If 10 minutes feels unbearable, start with five minutes and work your way up from there.

Body scanning may be a bit easier to do without assistance. Essentially, you lie down on your back and focus intently on one body part at a time, starting with your toes and traveling slowly upward to the crown of your head. Take at least 10 minutes to survey your entire body. The point of this is to learn how to feel the sensation of pain but not react to it. “When people feel something unpleasant, they tend to get upset, worried, or angry — all of which can make pain worse,” says McManus. Body scanning also helps you get better at identifying what precedes flare-ups. “Usually, when pain is coming on you get tenser, but you don’t notice it, so you persist with behaviors that make it worse,” she explains. But if you can pick up on cues earlier on, you’ll choose your physical activities more wisely.

If yoga sounds appealing, the various styles that are best to practice depend on the root cause of your pain. Certain styles and poses may be great for muscular problems, while others may be better for post-surgery aches. (You should probably talk to your doctor, physical therapist, or trusted yoga instructor to determine what's best for you.) In general, though, McManus suggests gentle poses, such as cat-cow. “Get on all fours, gently press your mid-back up to the ceiling, come back to neutral, and then slowly lower your belly down to the floor,” she says. “This pose gently flexes and arches your spine.” She also recommends child pose, a restorative position on all fours where you extend both sets of fingertips forward and draw your butt back to your heels.