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The type of back pain you have determines what treatment will be effective. If your pain has been present for a year or more, other factors besides a back injury or arthritis need to be addressed. Chronic back pain is often complicated by pain that is generated from the brain even in the absence of an injury or tissue damage.
After a year, pain can become mistakenly programmed in the brain to continue. Unlike a back strain that heals in a few weeks, brain-generated pain can perpetuate itself for years. The medical term for brain-generated pain is nociplastic pain.
The brain processes pain as both a physical and emotional experience. As pain becomes chronic, it is increasingly associated with the emotion-related brain circuits and less related to the pain signal-related circuits. For example, the brain activity in an individual with back pain for a few weeks is limited to the brain areas that process pain signals. Whereas, the brain activity in a person with back pain for years also involves emotion-related circuits.
As a result, pain is triggered not only by pain signals but also by emotion-related factors such as fear of pain, intense emotions, stress, depression, and anxiety. This is why addressing emotion-related factors is important when treating long-standing back pain.
Pain Relief for Back Pain
Two therapies that address the emotion-related factors of chronic pain are mindfulness meditation and pain reprocessing therapy.
1. Mindfulness Meditation
Mindfulness meditation teaches you how to better regulate thoughts and emotions. It promotes a detached awareness—the ability to detach from your immediate experience and be an objective observer. You become separate from your emotions and thoughts; they are not all tangled into one. This effect reduces the pain you perceive.
A 2022 study found a mindfulness meditation program reduces perceived pain levels by 30 percent. Brain imaging showed that mindfulness meditation reduced the communication between the parts of the brain responsible for relaying pain information and the parts that generate self-awareness. Study participants had awareness of self and awareness of pain, but they were not mixed into one. The weaker connectivity between the two areas reduces the pain experience. Think of this pain communication as if the self were not answering pain’s phone calls.
2. Pain Reprocessing Therapy
Pain reprocessing therapy (PRP) teaches people how chronic pain differs from acute pain. Chronic pain doesn’t necessarily mean further injury or harm is happening; it may reflect erroneous programming in the brain. When this happens, treatment that addresses the emotion-related factors helps. PRP addresses these factors.
PRP educates patients on the emotion-related factors that can trigger and worsen chronic pain. The factors include the fear of pain, difficult emotions, stress, depression, and anxiety. This deeper understanding of chronic pain improves a patient’s ability to manage the pain and reduce it. Reducing the emotion-related factors turns down the volume or intensity of the pain.
A 2022 study looked at the effectiveness of pain reprocessing therapy for treating chronic low back pain. After PRP, patients reported a significant reduction in pain intensity and disability compared to the control group. The reduction in pain was maintained a year after the study ended.
What You Can Do
The first step to getting help for longstanding back pain is making sure your provider knows how to diagnose brain-generated pain. Providers with training in this area can be found at pain specialty centers, physical medicine and rehabilitation doctors, and pain psychologists. If a provider’s office only offers procedures for pain, they are not the right fit because procedures don’t work for brain-generated pain.
Chronic Pain Essential Reads
A clinical measure that screens for brain-generated pain is the central sensitization inventory (CSI). A score of 40 or higher on the CSI (within a range of 0 to 100) suggests a significant amount of symptoms are from this pain type. The inventory is available for free at the link above. After completing it, show your provider so they may tailor your treatment.
Learn more about chronic back pain treatment in my book, Sunbreak: Healing the Pain No One Can Explain.
