Chronic back pain is a complex condition that involves more than just the physiological structures surrounding the spine—it also involves the mind. If you experience severe back pain that won’t go away despite treatment, the most recent guidelines on treating low back pain from the American Pain Society recommend that you address your mind as well as your body.
How can your mind affect back pain? One reason is that psychological distress has been linked to a greater likelihood of both developing back pain and experiencing a slow recovery. For instance, in a Swedish study, people who tended to “catastrophize” (meaning they assumed the worst in any given situation) had significantly worse back pain. And in a study conducted in the United States, people who reported higher levels of anger and psychological distress also reported higher levels of chronic back pain. These and other findings underscore the need for an integrated, multidimensional—some might say “holistic”—view of back pain, with the recognition that it can involve much more than mere muscle and bone.Most people are familiar with the “fight-or-flight” response. When confronted by a threat— be it physical or emotional, concrete or imagined—noradrenaline and adrenaline are released. These and other related hormones trigger a complex cascade of reactions, leading to a state of physiological and psychological hyperalertness.
The difficulty comes when this heightened state of “red alert” becomes our default setting. Stress is an inescapable fact of modern life. We now know that if we’re hyperaware of and hyper-responsive to the multitude of stressors we face on a daily level, we start to “burn out” and become susceptible to a number of ailments, including depression and heart disease. On the musculoskeletal level, the fight-or-flight response causes muscles to tense in preparation for action. If this response is not deactivated, muscles can go into painful spasms.
While stress-relaxation techniques can’t make a tense situation disappear, they can help you consciously release any muscle tension you may have accumulated in anticipation of or response to the situation.
Here are some techniques to consider:
- Breathing exercises. One breathing technique that can quiet the fight-or-flight response is known as “2:1 breathing.” Try a pattern of inhaling to the count of three and exhaling to the count of six. Repeat several times.
- Body scan. Begin by either lying or sitting down. Do several cycles of 2:1 breathing. Once you feel relaxed, conduct a full mental sweep of your body, as though you were undergoing a deliberate and complete X-ray. Go slowly but steadily, noting any areas of tightness or tension. Once you’ve finished the scan, return to those tight or tense areas and let your attention linger there. Consciously “breathe into” those areas for several breathing cycles and imagine the muscles relaxing. The body scan takes time, but if done on a regular basis, it can help you become aware of the early warning signs of an impending back attack. In particular, it can help you become aware of your individual “signal spots,” those places that hurt when your back first begins acting up before a full-blown attack strikes you. You can then take action, pacing yourself appropriately.
- Meditation. This has been found to reduce stress and counteract the fight-or-flight response. One meditation technique is known as “taking the one chair.” Imagine yourself in a room in which there is only a single chair. Sit on the chair and observe your thoughts and emotions pass in front of you. Remember that you are occupying the only chair in the room, so your thoughts have no place to rest. Allow them to come and go without getting caught up in them, then watch them as they glide out of the room.
- Exercise. Exercise (particularly meditative exercise such as yoga, walking, swimming or Tai Chi) is also a potent stress reducer. Be sure to ask your doctor for guidelines relevant to your individual condition, just in case you should steer clear of a particular type of exercise.
- Another approach to consider is seeing a therapist for cognitive behavioral therapy (CBT). A 2010 review from the Cochrane Collaboration found that CBT is moderately effective at reducing low back pain in the short term. This type of therapy is aimed at modifying the thought patterns and emotional reactions a person has toward the experience of pain. Believe it or not, learning to practice thoughts like “Yes, I am feeling pain right now, but that doesn’t mean everything is hopeless,” can actually make the subjective experience of pain less distressing and more manageable.