Dec
Low back pain stands as the second most prevalent cause of disability in the United States, affecting over 80% of individuals at some point in their lives. Common triggers for low back pain include disc injuries, sciatica, heavy lifting, or other non-specific back injuries.
Despite its widespread occurrence, responses to this often-debilitating condition vary among individuals. Interestingly, even if two people share the same level of pain, their reactions to it can significantly differ. This divergence can be attributed, in part, to distinct psychological attitudes and outlooks.
Understanding the psychological factors influencing low back pain, even when undergoing medical treatment, can be beneficial. Equipping oneself with this knowledge empowers individuals to take proactive steps to address not only the physical aspects of pain but also its psychological impact on the brain.
Why chronic back pain is connected to “your head”
Physical limitations can give rise to psychological distress, and this distress, in turn, can exacerbate pain. Individual health beliefs and coping strategies play a pivotal role in shaping both the level of distress and the trajectory of pain. For example, individuals prone to anxiety, harboring pessimistic expectations, and engaging in catastrophic thinking may experience heightened pain. These psychological vulnerabilities can induce changes in brain function, particularly in the regulation of dopamine, disrupting normal processes related to emotional control, anxiety, and attention. Consequently, individuals find it challenging to manage distress, leading to increased anxiety, negative expectations, and a narrowed focus on the pain, making it all-encompassing.
Moreover, it’s not solely pre-existing attitudes that contribute to the worsening of back pain. The pain itself has the potential to rewire the brain. Initially impacting pain-sensitivity brain circuits, persistent pain shifts related brain activity from “pain” circuits to those involved in processing emotions. This shift is why emotions like anxiety often become prominent in cases of chronic back pain, complicating emotional control further.
What you can do to tame chronic back pain
Fortunately, certain psychological therapies prove highly beneficial for managing back pain. These therapies aim to mitigate pre-existing psychological vulnerabilities, alter perceptions of pain, and address psychological factors like anxiety and anticipation that contribute to its persistence.
Among the treatments with robust supporting evidence, mindfulness stands out. A recent study showcased the efficacy of mindfulness-based stress reduction (MBSR) in reducing back pain and enhancing emotional control by increasing blood flow to the frontal lobe. An eight-week course in MBSR may even ameliorate anxiety and depressive symptoms. Mindfulness involves activating a relaxation pathway in the brain by focusing on breathing and deliberately disregarding mental chatter. This activates the “unfocus” circuit, known as the default mode network. However, in chronic pain patients with disrupted circuitry, MBSR may be less effective.
Cognitive-behavioral therapy (CBT) is another impactful psychological treatment. Available in group or individual sessions, either in-person or through virtual platforms, CBT is beneficial even for a single episode of back pain and can prevent its progression to chronic status. Hypnosis is another option, though it possesses weaker evidence compared to MBSR. However, if MBSR proves ineffective, trying CBT and hypnosis is worthwhile.
For cases rooted in specific causes, low back pain can find relief through progressive muscle relaxation. This technique focuses on reducing anxiety by developing awareness of how the body can be tensed and then relaxed.
Moreover, there is evidence suggesting that combining psychiatric medication with psychotherapies may yield more significant benefits than either treatment alone.
But it’s not simply “mind over matter”
Certainly, acknowledging that low back pain can have psychological aspects doesn’t diminish its significance. The idea of “mind over matter” is outdated, as the mind and the physical brain are intricately connected. Changes in mindset are closely tied to alterations in the brain’s biology, particularly concerning low back pain. Embracing this perspective underscores the potential for improving brain function and mitigating pain through mindset and brain-based interventions.
