Many physical health problems have a psychological component, and this is particularly true of pain.
We know from countless studies that our minds play an extraordinarily important role in how we experience chronic pain like that associated with lower back problems.
People with chronic pain who are lucky enough to see a specialist are often surprised to find they are being offered psychotherapy rather than simply more painkillers.
The research supporting this is good. Just last week a study was published which showed a four-week course of psychological therapy can dramatically reduce chronic back pain for many patients for at least a year.
We’ve known about the psychological component in our experience of pain for nearly 80 years.
During World War II an American anaesthetist named Henry Beecher was treating soldiers who had been severely injured in battle — many had legs blown off or shrapnel embedded in their bodies —when he noticed that more than half reported little or no pain and did not request analgesia.
What puzzled Beecher was that, in peacetime, almost all his patients requested painkillers for far less severe injuries. It was then he realised he had not accounted for one thing: the power of the mind.
He realised that, for the soldiers, a severe injury was actually good — it meant they would be discharged from the Army and could return home. For civilians, however, it was bad — a disruption to their life and routine that could mean financial hardship.
Beecher realised that it’s not necessarily the magnitude of the injury that predicts how a person experiences pain, but the circumstance in which it occurs.
Since then we have come to understand more and more about the mind and pain and, as a result, we have developed psychological treatments to help people with chronic pain.
I know from personal experience that back pain can be incredibly debilitating, as myself and both my parents have suffered it over the years. When your physical movement is limited because of pain, this impacts on your mood and this, in turn, worsens the pain.
Other factors, such as your coping strategies and general outlook on life, also play a role. If you have anxiety or a tendency to feel hopeless or overwhelmed, then feeling pain will increase these feelings, and this can make the pain worse.
However, it’s important to emphasise that, while our minds play a role in how we experience pain, you should not trivialise it — chronic pain is very disabling.
While the study from last week involved a full, in-depth four-week course, there are still simple things everyone with back pain can do to start addressing symptoms:
- Don’t just lie there. Years ago, doctors advised bed rest for back pain. We now know that this doesn’t help — get up and do as much exercise as you can tolerate. Even if this is just walking to the shops. It aids in building muscles and stopping joints from seizing up. Exercise also helps release endorphins which boost our mood and relax us. If in doubt, ask your GP to refer you to a physiotherapist who can assess you and give you safe exercises to do at home.
- Try progressive muscle relaxation. Depending on the exact cause, this can be helpful. It’s a technique whereby someone reduces anxiety levels by focusing on parts of their body which are tense and consciously relaxing them. There are lots of free resources on the internet to help guide you through the process.
- Try mindfulness. This involves focusing on the here and now to reduce stress levels. There are some great apps, such as Headspace, which offer guides.
- Breathe. Find a quiet place, settle down and take a breath in for three seconds, hold for three seconds, then breathe out for three seconds. Do this continuously for five minutes and, as you do it, focus on the air moving in and out of your lungs.
- Reach out to friends. Back pain can be isolating as it can impact on your usual day-to-day activities. Human contact and connections are inherently mood-boosting and stress-reducing. Schedule a daily phone call or coffee with a friend — even if it’s just for 15 minutes.
- Hug someone. Physical contact activates the parasympathetic nervous system, which helps to minimise the stress response triggered by chronic pain.
- Get a pet. They provide a distraction, a sense of purpose and encourage you to get up and — especially with dogs — get out of the house. Alternatively, try to borrow one or inquire about pets as therapy. Simply stroking a pet can help with pain.
- Beware of ‘catastrophising’. We all have a tendency to look on the gloomy side when we’re in pain. We tend to imagine the worst. But this can make pain even worse, so try to monitor yourself for this type of thinking and challenge it. Cognitive behavioural therapy can help with this.
- Try not to make predictions. Psychologists call this ‘fortune-telling’, and it’s common with chronic pain. Anxiety about pain triggers feelings of fear that it will never end. Try to identify this and remind yourself that you don’t know what will happen in the future.
This article was written by Dr. Max Pemberton and was originally published on www.dailymail.co.uk on 4 October 2021.
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