Most people with chronic back pain naturally think that their pain is caused by an injury or other problems in the body, such as arthritis or a bulging disc, but our research team has found that a process occurring in the brain is responsible for the pain. Thinking about the root cause can help promote recovery. This is a key finding of a study conducted by me and my colleagues, recently published in JAMA Network Open, a monthly open-access medical journal.
We are studying a psychological treatment called pain reprocessing therapy that may help turn off ineffective and unnecessary pain signals in the brain. To do this, we conducted a study in which some people were randomly selected to receive pain relief therapy treatment. While some were given a placebo injection in their back.
We included 151 adults aged 21 to 70 suffering from chronic back pain. We found that 66% of participants reported feeling pain-free or almost pain-free after pain reprocessing therapy, compared to 20% of those who received a placebo.
These results were notable because in previous trials of psychological treatments rarely did people report complete recovery from chronic pain, so we need to better understand how this treatment works: in people’s thinking. What changed that helped him recover from chronic back pain?
why it matters
Chronic pain is one of the biggest health problems today. It is the leading cause of disability in the US, and its economic cost is greater than that of diabetes or cancer. The most common chronic pain is back pain. Many patients—and doctors—are focused on identifying various back problems that they suspect may be causing the pain, so they try all kinds of treatments, but often to no avail. .
A growing number of scientists now believe that many cases of chronic back pain are primarily caused by changes in the brain. Pain may originate from an injury, but then the pain system may become “stuck” there and continue to cause pain long after the injury has healed. Pain is the brain’s alarm system, which tells us about injury or other dangers to our body.
Most of the time, the system works well, accurately alerting us that a part of our body is injured and needs to be protected. But when a person remains in pain for months, years, or even decades , then the pain processing pathways are more likely to no longer do their job properly, and brain areas that are not normally involved in pain begin to get involved.
Chronic pain also increases activity levels in glial cells, which are part of the brain’s immune system. All these changes in the brain serve to “deepen” the pain, causing it to persist. People, very naturally, think that if they have back pain, there must be a back problem – even though we researchers know that is often not the case. It is important to note that just because the signal originates in the brain does not make the pain any less real. Pain is always real, no matter what but to treat it effectively, it is necessary to accurately identify the root cause.
how we do our work
In our study we asked people to describe in their own words what they thought was causing their chronic back pain. This is a simple question, but some studies asked their participants to describe the source of their pain. The participants in our study attributed their pain to injuries, weak muscles, arthritis and other physical factors. Almost no one mentioned anything about the mind or brain.
A main goal of pain reprocessing therapy is to help people think differently about the causes of their pain. When we treated participants with pain reprocessing therapy, almost half of the reasons people reported pain were related to the mind or brain. He said that things like anxiety, fear or nerve pathways were the cause of his pain. The more people came to this understanding, the more their back pain reduced. We believe this change in understanding reduces fear and pain avoidance, which may reduce pain pathways in the brain and promote healthy, pain-reducing behaviors such as exercise and socialization.
Ask your health providers, or check out these online resources that can help you assess whether the brain is playing a role in chronic pain. Accurately identifying the underlying cause of pain is the first step towards curing it.