The first effective treatment for back pain which changes how the brain and back communicate has been developed by scientists.
The 12-week course which focuses on the nervous system rather than pain killers and manipulation leaves twice as many people pain-free as conventional treatment.
The basic principle comes from a simple concept that sometimes mind can overcome matter, and since back pain has been the number one cause of the Global Disability Burden for the last 30 years, even it bears looking into.
Researchers say the system, called sensorimotor retraining, changes how people think about their body in pain, process sensations from their back and how they move their back as they go about daily lives.
People who did it said they were happier, their backs felt better and they reported having a better quality of life, and improvements were still felt a year later, even while most existing treatments for back pain do not help people for long.
The findings were published in the Journal of the American Medical association.
The main difference is that sensorimotor retraining sees back pain as a problem in the nervous system that can be changed, rather than a disc, bone or muscle problem.
The treatment is based on research that shows the nervous system of people who suffer from chronic back pain actually behaves in a different way to people who have had a recent injury to their lower back, and includes this education as part of the 12 weeks.
The team say that, because people are told their back is vulnerable and needs protecting, this changes the way the back and brain communicate so their back is given messages that it is vulnerable.
It becomes weaker in the process and the team hope their treatment can stop this self-fulfilling pattern by correcting two problems common in back pain: a hypersensitive pain system, and bad communication between the brain and back.
The authors say people can see their back and brain are not communicating well and slowly learn to train their brain and body to fix the problem.
Normally back therapies focus on fixing something in the back straight away—such as injecting a disc, loosening up joints or strengthening muscles.
For the study, 276 people were split into two groups- one who did the therapy for 12 weeks and another who were given bogus therapies for the same amount of time, both of which were delivered by trained physiotherapists, exercise psychologists and other experts.
“If you compare the results to studies looking at opioid treatment versus placebo, the difference for that is less than one point out of 10 in pain intensity, and it is only short term and there is little improvement in disability,” said study author Professor James McAuley from the University of New South Wales.
“We see similar results for studies comparing manual therapy to sham (therapy) and exercise to sham (therapy).”
Their findings are similar to those published earlier this year in PAIN, which detailed a proposed mechanism whereby pain signals still move from the body to the brain, but the individual does not feel as much ownership over those pain sensations, so their pain and suffering are reduced.
“One of the central tenets of mindfulness is the principle that you are not your experiences,” said senior author of the PAIN paper, Fadel Zeidan, PhD, associate professor of anesthesiology at UC San Diego School of Medicine.
“You train yourself to experience thoughts and sensations without attaching your ego or sense of self to them, and we’re now finally seeing how this plays out in the brain during the experience of acute pain.”
It’s an exciting new line of inquiry into an age old problem.