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CBT for Lower Back Pain

Understanding the brain’s important role in chronic lower back pain may spell relief.

THE STATISTICS ARE clear: You have experienced or will likely experience low back pain at some point in your lifetime. For most people, occasional episodes of back pain are an uncomfortable nuisance that usually resolves in a matter of days. But for others, the pain can last a lot longer.

Any back pain that has endured for three months or more is considered chronic. The National Institutes of Health estimates that approximately 20% of people who suffer episodes of lower back pain end up chronically affected by it. Does 20% not sound all that significant? Well, in America alone, it equates to millions of people who are experiencing constant pain that hinders their ability to live otherwise healthy and active lives. The U.S. is also facing an opioid addiction epidemic that makes strong pain relief medication extremely risky for some people. So, many research and medical communities are turning to alternative therapies that focus on where all pain originates – the brain.

The perception of pain, while variable from person to person, is often described on a severity scale. A zero means you have no pain, and a 10 is used to describe the worst possible pain ever felt. Along with the intensity of pain is the word used to describe “how” it is experienced, i.e., burning, sharp or throbbing. Have you ever wondered how pain is generated? Whether it’s in your spine, your foot or your pinkie finger, pain is driven by the brain. When you get hurt, nerve cells called nociceptors send pain signals through the spinal cord and up to your brain. The brain uses that information to decide what to do with the message it has received. It’s a complicated system. But the bottom line is this: The brain chooses both how you will experience pain and how you will cope with the pain you’re experiencing. What about people who seem to have a higher “pain tolerance” than others? Research has increasingly revealed that brains can be trained to cope better with the pain the body is experiencing, including episodes of lower back pain.

The idea that better coping with pain is teachable is the premise of something called cognitive behavioral therapy, or CBT. Rather than an applied “treatment,” like medication or acupuncture, CBT is a psychological treatment. It includes multiple meetings with a licensed therapist (a pain psychologist, for example). The therapist helps identify the negative thoughts and feelings associated with the low back pain you’re experiencing. He or she then teaches you to change those thoughts into helpful thinking that promotes a healthy action or response to the pain. The concept with CBT is that you do have control over changing negative thoughts into positive ones, which may help in reducing both the intensity and experience of pain. Research has shown that CBT can help chronic low back pain sufferers deal better with pain. However, it isn’t necessarily a pain “cure.”

Pain, no matter where you feel it, is your body’s way of telling you that something is wrong. In the case of low back pain, there are many causes, from spine problems to nerve conditions. To appropriately tackle the pain, the reason it’s present in the first place must be addressed. The role of a spine specialist is to evaluate, examine and expertly diagnose an individual’s back pain and recommend treatment options to minimize or eliminate it.

In some cases, the total elimination of pain may not be possible. Whether it’s prolonged nerve damage or another underlying issue, unfortunately, there are some people who may never be able to live a completely pain-free life. These are the people who can most significantly benefit from CBT. Taking control of lower back pain by not allowing it to control you is no small undertaking. But with a commitment from you, the right approach and caring providers who know your goals, it truly is possible.

Neel Anand, M.D., Contributor

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