Back pain, maybe surprisingly, is not actually all in the back. Your mind plays a very important role. Let’s take a look at how using the mind-body connection and approach could really make a big difference to your pain levels and to your quality of life.
Before I talk about how to manage and reduce back pain, it’s important to have an understanding of how the pain is being registered in your body. Pain is tough to define, because it varies so much from person to person and depending on the situation. For example, someone who is afraid of needles will likely experience more pain during a blood test than someone who is not afraid. And a mother grabbing a hot pan away from her reaching toddler will likely not notice the burn as much as someone who accidentally picks up the same hot pan.
When we experience pain, our pain receptors (nociceptors) send a message to our brain that something is wrong, that there is the potential for or actual tissue damage, and we process this information with our thoughts and emotions. At the same time, faster nerve signals are being sent so that you can react quickly to remove yourself from danger (by taking your hand off of the hot pan, for example).
Going beyond nociception and nerves, pain is what we perceive it to be. The International Association for the Study of Pain describes pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Note here the word “emotional”: pain touches more than the physical aspect of our bodies, and is best treated with this in mind.
If we are able to change the way we perceive pain then we are better placed to deal with the underlying problem, and better positioned to restore normality to our lives.
Stress and pain
A major contributing factor in our perception of events and situations, including pain, is our stress level. When we are stressed our body releases a hormone called cortisol. In the short term, this hormone helps us to manage difficult situations by providing more energy where it is immediately needed (to face threats); however, this energy is diverted from other, lower priority activities, such as the immune system. Over time, elevated cortisol levels can be detrimental to your health, and cannot only prevent full healing, but can cause other health problems. And hormone levels aside, the side effects of stress (clenched or tensed muscles, digestive issues, sleep troubles etc) can make it difficult to let go of existing pain..
Having an injury can be stressful – you may miss work days, there may be health bills to pay, you may need to make childcare arrangements – and when you are focusing on managing your life as well as your injury, it can be hard to find time to “just relax”. The techniques discussed here can help you to not only manage pain, but also to lower your stress levels without a huge time or financial commitment.
Techniques for pain relief
Cognitive Behaviour Therapy For Pain
Cognitive Behavioural Therapy (CBT) is a type of psychotherapy that focuses on shifting the behaviour and thought processes that underlie a specific problem (such as anxiety, depression, or a phobia). It is usually a short-term process (making it less costly than other types of therapy), and focuses on resolving specific problems by providing coping skills and reframing situations.
What does this mean for your pain? Well, if your back hurts after a long day on the golf course it probably won’t do much, but if you have chronic aches and pains it could be beneficial. A review of randomized controlled trials of CBT showed that it is effective at reducing pain experience, improving coping skills, and reducing behavioural expressions of pain. So while it may not completely stop your back from hurting, it can help you reassess your situation and manage the pain more effectively.
CBT sessions are usually interactive and goal-oriented; don’t expect to be laying on your back on a sofa talking about your childhood memories. You and your therapist will work together to set an agenda for the session, and once you have gotten through it you may receive a homework assignment. This is not a passive therapy, and will only be effective if you are willing to work towards your goal.
Meditation Relaxation Techniques
Various studies have found that meditation is effective at reducing the perception of pain and the symptoms of mood disturbances (depression, anxiety etc) that can come with chronic pain. But it goes beyond the placebo effect: one study published in The Journal of Neuroscience looked at the changes in brain activity in trial participants and found that “meditation reduced pain-related activation of the contralateral primary somatosensory cortex”, as well as the engagement of various regions of the brain related to modifying the sensory experience of pain.
What does this mean in English?
Simply put, it means that just being still and focusing on your breath for 20 minutes a day could help ease your back pain. If sitting still for 20 minutes sounds too challenging, start with 5. Find a seated position that is comfortable for your back (for example, cross legged on the floor, in a straight back chair, or on a meditation stool or cushion). Next, close your eyes and breathe slowly, taking deep breaths. Focus on each inhale as it enters your nose, and each exhale as it leaves your mouth. Notice the expansion of your diaphragm and belly. If your back pain is strong, you may find you can’t breath deeply just yet. This is fine. Continue as is comfortable for you to do. If thoughts wander in, and they probably will, acknowledge them and let them go — do not follow them. There are many guided meditation practices available online for free, which can be very helpful.
Try to practice your meditation daily, and work your way up to 20 minutes (or longer!). There are no hard and fast rules about when to do it. First thing in the morning will help you get your day off to a good start, and meditation before bed can help you sleep better. Ultimately, it’s about fitting it into your schedule. If the only time to practice is at your desk after your sandwich, so be it.
It may be easier said than done, but getting a good night’s sleep might be just what you need to ease your pain. Unrestful or interrupted sleep is associated with chronic pain, as well as conditions such as fibromyalgia and osteoarthritis. A study in the Journal of the Canadian Pain Society found that sleep deprivation could actually counteract the benefits of some pain medications, so while it may be difficult to fall asleep when your back aches, it is important to find a way to sleep soundly.
If you are having trouble falling asleep at night, try creating a bedtime routine. Turn off electronic devices at least 30 – 60 minutes before you go to bed, as the light can interfere with your melatonin (your sleep hormone) levels. That means no tablets or phones in bed! Make sure your room is dark and cool, and try to clear clutter out of your sleeping space. Some people find a warm bath right before bed helps them to relax.
This YouTube.com video reveals my 9 secret sleep strategies. Although it is targeted at women with Polycystic Ovary Syndrome (PCOS), this information is just as relevant whether you have this condition or not. I recommend you watch it – http://youtu.be/_SwBoo8mL2c
If you have trouble either falling asleep or staying asleep, and this problem lasts for an extended period of time, talk to your health professional about this.
(this is an excerpt from my book The Back Pain Relief Book)
Dr Rebecca Harwin
Chiropractor & Multi-book Author