Is Cognition the Key to Chronic Back Pain Relief?

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There is a form of back pain—chronic benign pain—that doesn’t respond well to common treatments like surgery, exercise, and medication. But new treatments are in the works as  researchers and other medical practitioners pursue a cognitive—instead of a structural—approach to back pain relief.

According to Spine-health, chronic pain may take two forms: (1) pain with an identifiable cause such as degenerative disc disease, spinal stenosis, or spondylolisthesis; and (2) “chronic benign pain,” which has no identifiable cause.

The former gets better after treating the injury or problematic spine structure causing it. The latter may originally have a tangible cause but continued to persist even after the structural problem has been addressed.

Chronic benign pain has baffled many for a long time until researchers discovered that brain activity could shift as a short-term back pain transitions into chronic pain.

When pain shifts your brain

study conducted by the Feinberg School of Medicine reveals that persistent pain can cause large-scale changes in brain activity with the transition from acute and sub-acute pain to chronic pain.

Acute and sub-acute back pain is usually short-term and lasts only 4 to 12 weeks. When it persists beyond 12 weeks, it becomes chronic.

Numerous cases of chronic pain do not get resolved even after structural issues have been addressed whether through medical, surgical, and complementary intervention. A possible reason is that the problem is no longer physical but already cognitive.

At its first onset, pain activates brain activity in limited “pain-sensitivity” brain circuits. As pain persists for months, the brain activity detours to “emotion-related” circuits as its occurrence diminishes in the “acute pain-sensitivity” circuits.
In many cases of chronic back pain, a person continues to experience pain even after external triggers are no longer present. Moreover, stressors like strained relationships and pressure at work can also intensify pain sensations. In such cases, the nervous system may send pain signals in the absence of injury because pain is no longer being triggered by these; they’re triggered by emotions.
chiropractor treating a patient

A change of mind

Research reveals that mindfulness has an impact on chronic lower back pain. It can diminish fear of pain, change a person’s perspective about pain, and reduce the negative influence of pain.

Dr. Julie Fritz, the Associate Dean for Research at the University of Utah’s College of Health, also discovered that among various back pain interventions, it is cognitive and emotional factors, such as coping mechanisms and mindset toward the pain, that shows positive results for pain alleviation.

Mindfulness is a type of meditation that individuals do to pay attention to their present thoughts, feelings, and sensations without interpreting or judging any of these as “right” or “wrong.” It uses techniques like breathing, gestures, and imagery to help relax the body and reduce stress.

Cognitive therapy helps individuals influence their thought patterns. They are taught how to recognize negative thoughts and feelings towards pain, and how to transform these into healthier thoughts that can help them manage their pain better.

To test the benefits of mindfulness-based stress reduction and cognition behavioral therapy, the Journal of the American Medical Association conducted training for 342 adults who are suffering from chronic back pain. The recipients of the mindfulness training and cognitive therapy reported a 44 percent and 45 percent meaningful reduction in pain, respectively. The training sessions were conducted weekly for eight weeks.

The medical community recognizes the need for better alternatives to chronic back pain treatment. Exploring the effectiveness of a cognitive approach is one of them. For instance, Dr. Beth Darnall’s team at Stanford University in California is recruiting members for a study that will randomly test cognitive behavioral therapy on patients of opioids to find the best way to transition patients out of pain medication.

The search for relief for chronic benign pain has been going on for decades. The discovery that brain activity plays a crucial role in it took us one step closer. Hopefully, there will be more sophisticated medical breakthroughs in the future. In the meantime, mindfulness training and cognitive behavioral therapy are promising alternatives to explore.

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