What if there was a way to reduce back pain just by using your mind?
A new study says that's possible. The study, published this week in JAMA, finds that the practice of mindfulness can be an effective treatment option for chronic back pain.
I'll dig into what mindfulness is, why it's been shown to help people manage chronic pain and why it's not yet a mainstream treatment option.
What is mindfulness?
Mindfulness is the practice of paying attention to your thoughts and feelings without judging them.
You can practice mindfulness formally, during meditation, or informally, during your daily activities. You can do it with some simple techniques like focusing on your breath; noticing the sights, sounds and smells around you; and recognizing that your thoughts and feelings are fleeting and don't define you.
Research has found that practicing mindfulness can increase positive emotions and reduce negative emotions and stress.
What can mindfulness do for pain?
Experts at Group Health Research Institute in Seattle wanted to see if mindfulness could also reduce back pain.
They enrolled 342 adults with chronic back pain in the study. People were randomly assigned to three groups:
One group enrolled in a Mindfulness-Based Stress Reduction course, an eight-week course based on mindfulness principles that was developed by Dr. Jon Kabat-Zinn in 1979.
A second group underwent cognitive behavioral therapy, which is training to change pain-related thoughts and behaviors.
A third group continued with their usual care, which included options like opioids, physical therapy and chiropractic appointments.
They found that people who practiced either mindfulness or cognitive behavioral therapy saw greater improvements in their back pain than those who continued with their regular care.
The researchers say this proves that mindfulness is an effective treatment option for chronic back pain. It builds on previous research that has also proven that mindfulness can reduce pain.
Why would a mental practice be effective in reducing physical pain?
This is a complicated question that needs more research, says Dr. Madhav Goyal, a physician in Northern California and an assistant professor at the Johns Hopkins University School of Medicine.
He hypothesizes that mindfulness helps people to observe what they feel in a detached manner. For example, he says, imagine someone gets bad migraines. When she feels one coming on, she could react by worrying that the pain will ruin her day — or she could avoid becoming attached to the feeling of pain.
"Being able to observe the migraine coming on without all of that extra baggage might help to reduce the effect of the migraine on their day," Goyal says.
Dr. Steve Hickman, who directs the Center for Mindfulness at UC San Diego Health, recounts how mindfulness training helped one of his patients manage his pain. He says the patient had upper back, neck and arm pain from an accident. Hickman says the patient fought with his pain — until he learned mindfulness.
"I learned in the practice of mindfulness ... that it was possible for me to dance with it," Hickman recalls the patient telling him. "He still has the chronic pain, but he was dancing with it rather than fighting with it, and that made all the difference for him."
Does mindfulness work for all pain?
Here's an important caveat: I emailed one researcher to request an interview about the benefits of mindfulness. It turns out he's in the hospital recovering from major lumbar spine surgery.
"Just because you can cope with back pain using contemplative techniques, doesn't mean you should," he writes. "It's really important to be examined by a competent physician to see whether the pain is indicative of underlying organic processes of a degenerative nature."
Is mindfulness catching on as a treatment option for chronic pain?
While there is growing evidence that mindfulness can help people deal with chronic pain, there are some real barriers to it becoming a mainstream option.
There are likely lots of places in the Los Angeles area to take a Mindfulness-Based Stress Reduction course, but other communities have fewer options. Dr. Goyal says there are no places for him to refer his patients for mindfulness training within 50 miles of his office in Vacaville.
But even if courses are available, they are often expensive and might not be covered by insurance. Painkillers, meanwhile, are more likely to be covered by insurance — even though the country is now in the midst of an epidemic of addiction to the drugs.
"There is more of a social problem, where our reimbursement policies are in conflict with what has been found to be safest and most effective," says Dr. Dan Cherkin, lead author of the JAMA study and a senior investigator with Group Health Research Institute.
Do you use mindfulness to manage your pain? Tell us about it in the comments section below or email us at Impatient@scpr.org.