Even when you have back pain that is being medically treated, it helps to understand the psychological factors that impact your pain-and treatment outcomes.

Why chronic back pain is connected to your “head”
When your physical movement is compromised it can cause emotional and psychological distress which can worsen the pain. Chronic back pain depletes healthcare resources, affects our work, diminishes self confidence and affects personal and interpersonal relationships. When we’re in pain, we suffer physically and emotionally. But if you are anxiety-prone, have catastrophic thinking or expect the worst, this can make the pain far worse.

Psychological vulnerabilities can influence your brain and intensify the pain. Some studies1 suggest that people with nonspecific low back pain with the highest levels of pain-related distress are more likely to interpret pain from harmless cues, which may contribute to the perpetuation of chronic pain states. There seems to be a link between anticipating pain and continuing with pain cycles and disability.

Often, if you have these preconditioned emotional responses or attitudes you also have abnormalities in brain chemistry, particularly in dopamine levels. Brain function in emotional control, anxiety and attention are affected. The result is a cycle of pain feeding into disregulated brain function eventually leading to all-consuming pain.
It’s not just pre-existing attitudes that exacerbate back pain management. Pain itself can rewire your brain. Initially when pain first occurs, it impacts your pain sensitivity brain circuits. But over time, continued pain in the brain switches from pain circuits to circuits that process emotions. Emotions like anxiety become pervasive.

What you can do to break chronic back pain
Fortunately, there are some psychological therapies that can be really helpful. The treatment with the greatest supporting evidence (for all chronic pain syndromes) is mindfulness. MBSR (mindfulness-based stress reduction) reduces depression, anxiety and pain for people suffering2 from a variety of illnesses. In particular, MBSR improved emotional control by increasing blood flow to the prefrontal cortex. Practicing mindfulness improves activating brain pathways by developing the skill to quiet the mental noise and focus on the breath.

There are other forms of psychological treatments that can be helpful. Cognitive-behavioural therapy (CBT) can be especially helpful in addressing and treating anxiety and depression. It can even prevent an acute injury from progressing to chronic back pain.

Hypnotherapy may help relieve pain as well. Cognitive-behavioural therapy and hypnosis have weaker evidence to support efficacy in treating back pain but some research suggests that deep relaxation and hypnotic suggestion can go a long way as alternatives to pain-killing drugs.

Another effective approach that can help relieve back pain is progressive muscle relaxation technique. This technique involves exercises that help tune you into your body, developing more awareness of your body and by tensing and relaxing your muscles section by section.

It’s not about ignoring the pain
When you consider that physical changes in the body can have an effect in the brain, it is clear that treatment approaches which deal with the psychology of pain and pain management make sense. It is important to look at the medical symptoms and changes that contribute to low back pain. But it is also worth exploring the relevance that brain biology has on brain-based changes related to low back pain.

¹ https://pubmed.ncbi.nlm.nih.gov/26844417/
² https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754498/


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