When I was a junior doctor, I dreaded the back pain clinic. You had a few minutes with each patient to talk through their months of debilitating pain. There was little to offer in terms of relief. Fast forward and back pain is only getting worse. A report from the University of Washington in Seattle found that while people live longer, they feel healthy for fewer years because of backache. So what can help relieve pain and reduce the annual 10m days lost from work each year in the UK due to backache?
It depends on the cause, but exercise, spinal manipulation and painkillers such as codeine (a weak opiod) and paracetamol are often recommended. Taking opiods for years can make people dependent and invariably causes constipation. Guidance from Nice, which is being updated, also recommends cognitive behavioural therapy (CBT) – training to change how people think and behave when they have pain, which is notoriously hard to come by.
Now mindfulness-based stress reduction (MBSR) can be added to the mix, following the first trial comparing this treatment with usual care or cognitive behavioural therapy. In a study of 342 adults aged 20-70, randomly and equally allocated to each treatment group and having suffered with back pain for an average of 7.3 years, those given mindfulness training found it easier to get out of chairs, go upstairs and had less pain than those given usual care. In the MBSR group, 61% felt more able to move around without pain than the 44% who carried on with their usual care. CBT was equally as good as MBSR at reducing pain. The effects lasted for at least a year.
So what is MBSR, and is it worth trying if you have chronic back pain?
The solution
MBSR reduces the stress and negative impact of backache by changing how the mind processes pain. MBSR in this study involved two-hour group sessions once a week for eight weeks in which people were taught meditation, yoga and body awareness. An early exercise has people lie on a mat for 10-20 minutes, focusing on one part of the body at a time, becoming aware and “accepting of any sensations”. If you can try MBSR, you might as well: there are no side-effects and it seems to carry on working.
Dan Cherkin, of the University of Pittsburgh School of Medicine and the lead author of the research paper, believes that training the mind may have longer-lasting effects than manipulating the spine. Research even suggests that MBSR may cause physical changes in regions of the brain that regulate emotion, memory and self-referential awareness. Cherkin acknowledges that MBSR may be as hard to come by as CBT, but says there are online courses and adds that MBSR-founder Dr Jon Kabat-Zinn’s classic book Full Catastrophe Living could help. Of course, none of this implies that back pain is in the mind. It is worth noting that MBSR is also being looked at in breast cancer, to see if it not only reduces distress but improves survival.
