Psychological Treatments Are a Balm for Back Pain
For people in agony from lower back pain, biofeedback or cognitive-behavioral therapy can actually reduce feelings of pain by about 30 percent, according to a new study, and may even be more effective than drugs or surgery.
"When I started researching these therapies 26 years ago, we all thought they might help people manage their pain, perhaps help them to go about their lives," says the senior author of the study, Robert Kerns, a psychologist at the Veterans Administration Connecticut Healthcare System and a professor at Yale University. "Now it's clear they affect the intensity of the pain itself. There's a real and important reduction in pain and suffering."
Pain intensity was one of the key measures Kerns and his colleagues examined in the study, which appears in the January issue of Health Psychology. They reviewed 22 previous studies of people with chronic lower back pain. Some in these studies were getting psychological treatments, while others–with similar severity of disease–were being treated with more conventional means such as analgesics or even surgery. This allowed the researchers to compare the effects of the treatments. Pain intensity was determined by patients' self-reports.
The effect of cognitive-behavioral therapy appeared stronger than anything else, Kerns reports. That approach teaches patients to divert their attention from pain and to think about it in a less alarming manner. For instance, pain often triggers waves of fear because we associate a sudden twinge with damage to bone, muscle, or skin. But in chronic pain the sensations can occur independently–the nerves seem stuck, like a needle trapped in a groove on a record–and there is no body damage. Once the patient realizes there is no physical wound, the fear is reduced, along with the reaction of alarm that accompanies it.
Biofeedback also had a big pain reduction effect. Feedback makes patients aware of bodily reactions that otherwise occur subconsciously. Sensors can detect muscle tension and signal it as a rising musical tone, for example, so patients can learn to avoid that tone and thus learn to relax their muscles. This gives people in pain a greater sense of control over their bodies.
Other pain researchers applaud the study. "In my opinion, treatment like this has always been more effective than back surgery or drug interventions," says neurologist Norman Harden, director of the Center for Pain Studies at the Rehabilitation Institute of Chicago. "It's good to have the research now to back up what I've seen clinically." Cognitive-behavioral therapy or biofeedback, he adds, seems even more effective when it's part of an interdisciplinary treatment program that includes things like physical therapy. "You get patients who are afraid to move, and the rigidity makes their pain worse. The psychological interventions can help break this fear, and they can move into physical therapy, and they start to feel better."
The challenge, Kerns says, is that such interventions are not widely available. Insurance companies, for instance, often don't reimburse patients for these treatments. Another problem is that psychological pain specialists don't practice in many communities. "So we have to encourage patients in pain to seek these treatments out," he says. The results, for some people, can be life-changing.
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