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Ease Back Pain with Your Mind?
Mindful meditation and cognitive therapy can beat standard therapies

04/22/2016 By Craig Weatherby and Michelle Lee
Millions of Americans live with chronic back pain.

And the frequency with which we suffer back aches is on the rise.

Back pain already prompts than one in 10 of doctor visits, making it the fifth most frequent reason.

Chronic lower-back pain afflicts more than over 100 million Americans, and is a leading cause of disability.

Last, but not least, back pain costs America about $106 billion annually: $86 billion for treatment plus $20 billion in indirect costs.

Do any conventional treatments work?
Routine back pain usually improves within three months, with or without  treatment.

But we're talking about chronic, serious back pain that can seriously impair work and home life.

Standard medical guidelines recommend physical therapy and non-prescription pain relievers.

If the problem persists, physicians usually refer patients to specialists, who often order MRI scans and recommend surgery.

In 2013, researchers from Harvard Medical School published an evidence review – "Worsening Trends in the Management and Treatment of Back Pain"– and it makes depressing reading.

As they wrote, "Back pain treatment is costly and frequently includes overuse of treatments that are unsupported by clinical guidelines.” (Mafi JN et al. 2013)

Unfortunately, when it comes to chronic back pain, no conventional or alternative therapy is proven to provide lasting relief.

Surgery can make matters worse, non-prescription drugs can have serious side effects over time, and opiates carry the risk of addiction.

Sadly, there's little evidence of substantial, lasting benefits from physical therapy, massage, chiropractic therapy, or various forms of exercise.

Mind-body therapies for back pain
More and more doctors and patients are turning to mind-body techniques.

Emerging evidence shows that psychological factors can play a significant role in worsening or easing pain.

And growing evidence suggests that cognitive therapy can substantially ease back pain ... as well as its adverse effects on mood and mobility. 

Cognitive behavioral therapy (CBT) is a technique often used to help depressed or anxious patients change negative thoughts and behaviors.

CBT is based on the idea – backed by common sense and evidence – that people's thoughts shape their perceptions of and responses to pain. 

By eliminating negative thoughts and behaviors, people with chronic pain can change their awareness of discomfort and develop improved coping skills.

Despite evidence that CBT can ease pain and associated distress and disability, few people who report chronic back pain receive this therapy.

And because CBT relies on the presence of a trained practitioner, it can be costly and difficult for patients to gain access.

The new study we're covering today compared the benefits of CBT against a more easily accessible technique called mindfulness-based stress reduction or MBSR.

Crucially, it also compared CBT and MBSR to conventional pain management therapies, which don't include any mind-body approach. 

Before we examine the results of the new clinical trial, let's take a closer look at mindfulness-based stress reduction.

What is mindfulness-based stress reduction?
Mindfulness-based stress reduction or MBSR employs meditation and awareness of the body, and may include gentle yoga.

Developed in 1979, MBSR it is now now offered at more than 200 medical facilities around the world, including leading universities.

The MBSR program selected for the new study was typical in that it taught patients to focus on physical and emotional sensations in the moment, letting thoughts pass by.

MBSR can be learned in a group setting or at home, and doesn't rely on a licensed practitioner for regular practice.

Compared with cognitive behavioral therapy, these advantages make MBSR easier to learn, access, and afford.

New clinical trial finds promise in mindful meditation
The hopeful new study appeared in the Journal of the American Medical Association or JAMA.

Its encouraging results suggest that mindful meditation rivals cognitive therapy for easing chronic pain, and that both approaches can beat conventional therapies.

A Seattle-based team from the University of Washington recruited 342 adults with chronic low back pain, ranging in age from 20 to 70.

They then randomly divided the participants into three groups:
  • 8 weeks of CBT (cognitive behavioral therapy)
  • 8 weeks of MBSR (mindfulness-based stress reduction training)
  • Control group: Conventional therapy with no mind-body component
The researchers measured the volunteers' back pain using the patients' own reported discomfort levels, and tests for functional limitations due to pain (Cherkin DC et al. 2016).

All the participants were surveyed and tested at the outset of the study, and four more times over the course of the trial: at 4, 8, 26, and 52 weeks. 

At 26 weeks, 61% of the MBSR group and 58% of the CBT group showed meaningful improvements in range of motion and ability to perform normal, day-to-day tasks.

In contrast, only 44% of "usual care” recipients showed meaningful improvements – a statistically significant difference.

And 45% of the MBSR and CBT groups reported less daily disruption and irritation ("bothersomeness”) compared with only 27% of the control group.

Better yet, the MBSR and CBT groups continued to enjoy less pain and disruption one year after the start of the study.

As the researchers wrote, "… these findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.” (Cherkin DC et al. 2016)

It makes sense to try physical therapies before you turn to surgery, with its high risks and costs.

But it seems equally smart to simultaneously try psychological approaches such as CBT or MBSR.

You may find that one or both of these mind-body methods can bring significant relief from chronic back pain.

And this is clearly one case where the old saying "it can't hurt to try" truly applies.

Sources
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