Why going to the psychologist may be a good idea if we are tormented by back pain

He closes the computer after a long day at work and finds it hard to sit up. He goes to pick up his children’s or grandchildren’s toys from the floor and notices how an electric shock runs down his spine. She turns in bed and her lower back complains. If this happens frequently, and for at least three months, it’s clear: she suffers from chronic back pain. Maybe it’s a good idea then to start a psychological therapy.

Chronic back pain: a common evil

Back pain (especially in the lower back) is one of the most common chronic pain. It affects hundreds of millions of people around the world and is one of the most common reasons for going to the emergency room.

That being the case, it is surprising that there is no drug capable of eliminating this problem at its root: if there were a pill or ointment that would end acute pain, it would not become a chronic problem. It is therefore worth asking: why is it not enough?

Pain is in our body, but also in the mind

The answer is clear as well as complex: although it is the back that hurts, the discomfort is not physically in the back. The International Association for the Study of Pain (IASP) defines pain as a “biopsychosocial” experience, in which the brain is the orchestra conductor that defines its intensity, frequency, and duration.

This experience created by the brain is, to a large extent, enhanced by stress, which can be physical (as a result of poor posture at work or having lifted weights inappropriately) or psychological (problems with colleagues that create muscle tension, insomnia…), among others. And it works in reverse, too: People with chronic pain experience higher rates of depression, anxiety and insomnia than healthy people, helping to fuel a vicious cycle that can be difficult to break out of. What can we do?

what science says

First of all, it is always recommended to rule out a physical cause when in doubt. For example, a herniated disc or a pinched spinal nerve can cause a lot of pain and require medical attention—and sometimes surgery—to relieve it. Once this is dismissed, we can consider chronic back pain as primary. Or in other words, as a disease itself, and not the consequence of another ailment.

If this is the case, the scientific evidence supports the benefits of psychological interventions. In a recent meta-analysis, which included nearly 100 studies with more than 13,000 participants, researcher Kwan-Yee Ho and colleagues found that the use of psychotherapy in conjunction with physical therapy had significant effects in improving physical function and reducing the intensity of pain in people with low back pain. These researchers also found that programs that included education and behavioral therapies maintained long-term effects.

In another similar study, with more than 10,000 patients, the German anesthesiologist Johannes Fleckenstein and his collaborators studied the different effects of physiotherapy if it was applied alone or accompanied by psychological treatment. Thus they found that physical exercise programs in combination with cognitive-behavioral therapy produced the most significant clinical effects.

What do these psychological therapies consist of?

There are several approaches. It is advisable to start by evaluating the patient’s needs, her values ​​and objectives. The next step is to offer an explanation of the neurobiology of pain; for example, why it is not equal to physical damage or how the brain helps us to modulate it.

Afterwards, possible strategies with two objectives will be discussed. On the one hand, it is about allowing the patient to do more activities that are important to him, such as going to work, going out dancing with friends or playing with the grandchildren. The other goal is to deal with pain episodes in a complementary or alternative way to medication.

The techniques will depend on the approach (for example, cognitive-behavioral or acceptance and commitment therapy) and the specific case. Some common techniques are: learning to become aware of the body, diaphragmatic breathing, meditation, hypnosis, emotion regulation, improvement of life habits (including physical activity and sleep), etc.

In many cases it will also be advisable to attend physiotherapy, where specific exercises can be taught and techniques such as pain management with cold and heat, electrostimulation or manual techniques can be applied.

Looking at the future

Maybe one day, when science advances enough, we can change our backs to a bionic, the same way we replace a part on our car when it breaks down. Until then, we must continue to investigate the best ways to care for your back and relieve pain.

In this sense, the IASP has declared 2023 as the year of integrative mind-body therapies, recognizing that purely medical treatments are not enough and the effectiveness of multidisciplinary approaches must continue to be investigated. In addition, the World Health Organization is finalizing clinical practice guidelines for back pain that aim to facilitate the implementation of evidence-based practices. (YO)