The solution to chronic back pain could lie in your brain

Telegraph

3 days ago

A million people in Britain are presently unable to work owing to neck or back issues. 'Back pain' is a term that neatly hides the havoc wreaked by a herniated disc or trapped nerve. It's a simple phrase for a torturous problem, one that can often be disabling.
It may surprise you, then, to hear that a solution to back pain could lie not in our spines but in our heads. A recent clinical trial has shown that an eight-week course of either mindfulness or cognitive behavioural therapy (CBT) can reduce back pain significantly in people who currently take opioid painkillers, and who haven't responded to other forms of treatment. Such improvements can last for up to a year, the study found.
The links between what happens in our brains and bodies when it comes to pain are mysterious to most. But after working to treat chronic pain using these therapies for more than 25 years, Mabel Martinelli, a psychologist from the Cambridge Centre for Cognitive and Behavioural Therapy, knows that our thoughts – when harnessed – can relieve pain just as effectively as any drug.
'We find that with long-term back pain, there are always beliefs tied to it, about how the pain might limit our lives or get worse in the future,' Martinelli explains. 'The role of CBT is to interrupt this relationship between pain, thoughts and feelings. When we change our beliefs about the pain we feel, the pain changes too.'
Courses of CBT and mindfulness-based therapy are now offered on the NHS as standard care for those suffering from back pain. Here are five tips from Martinelli's practice that can help you to manage your symptoms.
1. Keep a pain diary
The thoughts that trigger or increase back pain vary by person, as do the emotions they provoke. Research suggests that ruminating on your back pain – thinking about it over and over again – can make it feel both more intense and more life-limiting. Writing them down can help process that and put an end to rumination.'Try jotting down the negative thoughts you have and getting into a conversation with them, about what you can do to better look after yourself in the future.'
2. Work on accepting that back pain is part of your life for now
One of the worst elements of back pain is its continuous presence in our lives, no matter what we do. It's normal to feel anxious, down or angry because of it. Depression and anxiety can both cause a predisposition to and worsen back pain. 'Research shows that in men, anger is closely related to back pain. Struggling to manage anger can both cause and worsen pain because it leads to increased muscle tension, but of course, the pain makes many men angrier too,' says Martinelli.
In order to reduce the pain you suffer, it's important to accept the position you're in, says Martinelli, however bad it may be. 'Notice the struggle and name it,' says Martinelli. 'When you feel yourself fighting the pain, say 'this is me struggling'. That small act of awareness can shift how you respond.' It can also be helpful to use metaphors to change the relationship that you have with the pain (see the three specific suggestions from Martinelli below).
Things may well change for the better in the future, 'but in the moment, it's important to accept how you feel and not try to change it or run away from it. This only makes the pain worse.'
3. Getting outside can be a powerful distraction
'Don't underestimate the power of connecting with nature,' says Martinelli. It might sound woo-woo but there's science to support the proposition that the great outdoors can boost wellbeing and bring you into the present, distracting you from worries about the future and reducing pain. Multiple studies have demonstrated that exposure to green space reduces pain and improves quality of life in people suffering with chronic pain conditions, including back pain.
Even watching nature scenes on a screen can relieve pain, research suggests. A recent neuroimaging study from the University of Vienna and the University of Exeter, showed that nature helps because 'the brain is reacting less to information about where the pain is coming from and how intense it feels', said Max Steininger, who led the study. 'So try to make five minutes to get out for a quick walk around the park when you can,' says Martinelli. 'Over time, doing this regularly will help to reduce the pain you feel in your everyday life.'
4. Pay attention to when you're worrying about the pain – and stretch
When pain arises, we often respond by turning on a mental 'struggle switch' – resisting, fighting or trying to push the pain away. This response tends to make things worse by layering frustration, fear and tension on top of the pain. When we learn to notice this instinct and gently turn the switch off, the pain might still be present, but we're no longer adding emotional suffering to it. This shift makes space for calm, choice and greater self-compassion.
Back pain is 'a signal from the body that something has gone wrong in how we're treating it', says Martinelli. Those of us who work at desks are used to hearing that we should get up and stretch every half an hour, and go for a quick walk every hour or so, but few of us actually do. Part of the work of mindfulness and CBT is to show patients how important it is to take a minute for this kind of self-care.
This is best practised when you have negative thoughts about your pain and the future, Martinelli says. Instead of becoming distracted by them, 'take that time to stretch, as when you're having negative thoughts, your body tenses up, and having a quick stretch will relieve that and get your mind back into the present moment'.
5. Schedule deep breathing into your day
It's easier than you might think to practice mindfulness and feel the benefits: just five minutes of deep breathing, practised three times a day, can be enough to relieve pain. Combining this with having your morning coffee or tea can be a great way to build the habit, says Martinelli.
'Start your day with a hot drink and pay attention to all the things you like about it and how calm you feel before your day starts up,' Martinelli recommends. 'This sets a positive intention for the day and gives you space from negative thoughts that might be aggravating your pain.'
How to use CBT to break out of negative thought patterns and relieve pain
Mabel Martinelli
People living with chronic back pain often develop certain beliefs or thought patterns about their pain – for instance, that it will inevitably get worse and continue to limit what they can do. These thoughts can become automatic and powerful, increasing distress and making the pain feel worse.
That's where CBT comes in: it helps people to notice these thoughts, challenge unhelpful patterns, and develop more flexible ways of thinking. There are three metaphors I use often to help people relate to their pain in a new way:
Think about pain as quicksand: the more we struggle against it, the more stuck we feel. But when we stop fighting, we can find ways to float.
Imagine the ocean and the surfer: pain is like the waves – we can't stop them, but we can learn to surf.
See pain as a heavy backpack: pain is a burden, but carrying it while still walking toward what matters is possible.