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Chronic Back Pain? Try This Mind-Body Approach First

Date: September 19, 2016      Publication: Health Insider      Source:  Daniel C. Cherkin, PhD, Group Health Research Institute, Fadel Zeidan, PhD, Wake Forest School of Medicine      Print:

Millions of Americans have chronic back pain—it’s the number-one cause of disability, and it’s notoriously tough to treat.

Pain meds often don’t alleviate the pain and can cause serious side effects, including dependency. In particular, there’s a strong medical consensus that opioid-based drugs should be the last resort for treating chronic back pain.

So what’s the best first resort?

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A new study makes a strong argument that you should consider a special kind of mindfulness training. It’s not the only option, by far, but it may be the one that can help the most people. It uses no drugs…no torturous exercises…and it’s free.

USING YOUR MIND TO CONTROL PAIN

In the new study, researchers from the Group Health Research Institute in Seattle studied two approaches—cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR). With CBT, the patient learns how to change his pain-related thoughts and behaviors, usually with the help of a therapist. It’s already a well-established approach for chronic back pain and other kinds of chronic pain.

MBSR—a combination of meditation, body awareness and yoga—hasn’t been studied as extensively for chronic back pain. With this kind of mindfulness training, you’re taught to focus on your breathing while staying aware of your thoughts and physical sensations yet viewing them without judgment or engagement. As you become aware of the present moment, you learn to accept how you feel. You may still feel some physical pain sensations, but your mind has learned how to tone them down dramatically so that they bother you much less. “Mindfulness helps people change the way they think about, and respond to, pain,” says lead study author Dan Cherkin, PhD, senior scientific investigator at Group Health Research in Seattle. “Mindfulness meditation helps people detach from their pain. It’s almost like reprogramming how we experience and respond to pain.”

The study was a randomized controlled trial of 342 people between the ages of 20 and 70 who had long-term back pain—on average, they’d been suffering for more than seven years. Each patient was offered a two-hour training session, once a week, for eight weeks. They were surveyed about their pain levels before and after those eight weeks—and again at 26 weeks and 52 weeks. The results were compared with outcomes for similar patients who got “usual care,” meaning whatever their own physicians recommended.

The results were moderate in size but significant, especially when compared with other treatments for chronic back pain. Both CBT and MBSR proved superior to usual care. The differences…

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  • At 26 weeks, about 61% of the patients trained in MBSR and 58% of those trained in CBT had a significant improvement on a scale that measured disability—compared with only 44% of those who got usual care.
  • Pain got better, too. At 26 weeks, about 44% of those who took the MBSR course, and 45% of those who took the CBT course, reported clinically significant pain improvement. Only 27% of those who got usual care said their pain levels improved.
  • For both MBSR and CBT, the improvements—reduced disability and pain—were sustained at 52 weeks.

The study confirmed that CBT is a promising option. But there’s a big drawback to CBT—not everyone can find a nearby CBT-trained therapist…or afford one. The cost of CBT training ranges from $120 to $200 a session, and up to 16 sessions may be needed. Insurance may cover part or all of the cost. (To learn more about finding a CBT therapist, go to the Association for Behavioral and Cognitive Therapies.)

What’s new in this study is the evidence that mindfulness training has essentially the same benefits as CBT for back pain, says Dr. Cherkin. From a practical standpoint, MBSR could benefit a much broader group of people than CBT.

Here’s why…

  • You can learn it yourself. Mindfulness meditation is something people can learn on their own without the help of a therapist—for example, through a free, guided meditation from the UCLA Mindful Awareness Research Center. In many locales, you can also learn mindfulness meditation in a free or inexpensive local class by searching the Internet. Or you can buy a series of MBSR CDs for $24 (or as MP3s for $20) from Jon Kabat-Zinn, PhD, former director of the Center for Mindfulness in Medicine, Health Care and Society at University of Massachusetts, who developed MBSR. The program doesn’t have to be specifically geared toward pain, experts say.
  • You don’t have to be a perfect student. One of the encouraging things about this study is that the benefits happened even though most people didn’t go to all their sessions. Only 51% of the participants in the study actually attended at least six of the eight MBSR sessions. Yet the benefits were still significant.
  • The back pain relief gets better with time. One of the most promising results of this study is the evidence that the pain relief benefits persisted at least up to 52 weeks for those in the mindfulness meditation group.“With mindfulness meditation, the benefits don’t plateau—they get stronger over time,” says Fadel Zeidan, PhD, an assistant professor of neurobiology and anatomy at Wake Forest School of Medicine in Winston-Salem, North Carolina. CBT’s benefits may also get stronger with time, according to other studies, notes Dr. Cherkin, but other approaches such as massage, yoga and acupuncture, which can also help with chronic back pain, tend to gradually lose their effectiveness once you stop doing them. Once you learn mindfulness meditation, Dr. Cherkin says, you can elicit the benefits in just a few minutes—while you’re waiting on line at the supermarket, for example.
  • Interestingly, the benefits of MBSR are not due to a mindfulness meditation–induced release of the body’s natural painkilling chemicals, which was previously a theory, according to a 2016 study from Wake Forest. “Meditation significantly alters the experience of pain by allowing people to accept it,” explains Dr. Zeidan. “They still feel it, but they see it more objectively, as more neutral. They’re able to regulate their emotional response to pain more effectively, quieting down the pain signal.”

Another benefit: You’ll get healthier in other ways. In the latest study, the mindfulness group had fewer symptoms of anxiety and depression. Meditation, including MBSR, has cognitive, emotional, cardiovascular, cancer-protective and even longevity-promoting benefits. To learn more about meditation, see Bottom Line’sSkeptic’s Guide To Meditation: This Will Make You a Believer.” To learn more about nondrug approaches to back pain relief, see Bottom Line’sGuide to Drug-Free Back Pain Relief.

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Source: Daniel C. Cherkin, PhD, senior investigator, Group Health Research Institute in Seattle, lead author of study titled “Effect of Mindfulness-Based Stress Reduction vs. Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults with Chronic Low Back Pain: A Randomized Clinical Trial” published in JAMA.

Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina.