The leading cause of disability in the world is chronic back pain. According to a study published in The Journal of Pain (2012), Americans spend $300 billion annually to treat their condition. Common treatments such as surgery or steroid injections to treat back pain have not been proven effective in randomised clinical trials. Furthermore, there is increasing evidence that psychological factors could be associated with some types of back pain.
A 12-week mind-body program was developed by Beth Israel Deaconess Medical Center's physician-scientists. It focuses on a new way to treat chronic back pain. This innovative intervention, which isn't yet available at BIDMC for the general public, is based upon an idea by John Sarno MD, a professor of rehabilitation medicine from the New York University School of Medicine. The team published a paper in journal PAIN that showed the mind-body intervention had a superior effect on back pain treatment to standard care. Sixty percent of the research volunteers reported feeling pain-free six months later.
The current paradigm of pain management is focused primarily on treating a physical cause of pain. However, many chronic back pain cases cannot be identified as a physical cause of the pain," stated Michael W. Donnino MD, a doctor in the Departments of Critical Care and Emergency Medicine of BIDMC. Our group proposed that non-specific backpain is a manifestation of a psychological process. This psychological process is substantively driven stress, repressed emotions, and other psychological processes. Although the exact mechanism is still unknown, it could be compared to other known effects on acute physiological changes such as embarrassment, which may cause capillary vasodilation, also known as blushing.
Psychophysiologic Symptom Relief therapy (PSRT) is an experimental program developed by Donnino and his colleagues. It addresses psychological and underlying stressors that can lead to persistent pain, as well as fear avoidance and conditioned pain responses. The treatment strategies include teaching patients about the relationships between emotions and stressors. Participants are able to learn better ways of expressing emotions and stress. This program also helps patients to desensitize or reverse condition their pain triggers, such as sitting or bending.
Donnino stated that these triggers can often be thought to cause pain. However, they could be described as associations that can unknowingly be conditioned in a manner similar to Pavlov's conditioning of dogs to salivate on a bell by pairing it with food. Our program reverses these conditioned responses to improve pain and disability.
The final eight weeks of the program are devoted to mindfulness-based stress reduction (or MBSR). This program aims to give you the tools you need to deal with stressors now and in the future, while also allowing you to continue practicing the techniques that were taught in the first part.
Donnino and his colleagues recruited 35 patients aged 18-67 with chronic back pain without clear physical origin to assess whether PSRT could reduce pain-related anxiety and symptoms. Randomly, participants were assigned to either the 12-week PSRT intervention or eight weeks of MBSR alone. They also received usual care under the supervision of their doctors without any influence from the study group. Participants completed pain questionnaires before and six months later to evaluate any changes in their functional limitations, disability, back pain bothersomeness, and anxiety.
Researchers saw an amazing 83 percent drop in pain disability reported by the PSRT group in just four weeks, compared to the 22 percent and 11% in the MBSR, and usual care groups. The PSRT group saw a 60% drop in pain bothersomeness during the same period, compared to the 8 percent and 18% decreases in pain bothersomeness in the mindfulness and usual-care groups, respectively.
At every interval and after the six-month observation period, the PSRT group outperformed both MBSR and usual care for primary endpoints of pain disability. The PSRT group had 64 percent of chronic back pain patients who reported painlessness at the end. This compares to the 25 percent and 17% respectively in the usual care and mindfulness arms.
Donnino stated that "within four weeks differences between PSRT and MBSR were evident across multiple domains, including the primary outcome measure for functional disability as well pain bothersomeness." This orientation helps patients see the connection between their mind and physical pain. It also gives them the basis to use the multifaceted program to improve pain and disability. Our program is superior to usual care and combined with additional treatments like MBSR. This study has shown that it can be very beneficial.
Garrett S. Thompson and Shivani Mehta were co-authors. Anne V. Grossestreuser, Anne V. Grossestreuser, Long H. Ngo and Lakshman balaji of BIDMC, Myrella Paschali and Robert Edwards were also involved. Suzanne M. Bertisch was a Brigham & Women's Hospital staff member. Adam D'Angelo donated a philanthropic gift to support this work. The authors declare no conflicts of interest.
