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By: Yoni Ashar
Most people with chronic back pain naturally think their pain is caused by injuries or other problems in the body, such as arthritis or bulging disks. But our research team has found that thinking about the root cause of pain as a process that’s occurring in the brain can help promote recovery. That’s a key finding of a study my colleagues and I recently published in JAMA Network Open, a monthly open-access medical journal.
We’ve been studying a psychological treatment called pain reprocessing therapy that may help “turn off” unhelpful and unnecessary pain signals in the brain. To do this, we carried out a study in which some people were randomly chosen to receive the pain reprocessing therapy treatment, while others were given a placebo injection into their backs.
We included 151 adults aged 21 to 70 years old with chronic back pain. We found that 66 percent of participants reported being pain-free or nearly pain-free after pain reprocessing therapy, compared with 20 percent of people who received a placebo.
These results were remarkable because previous trials of psychological treatments rarely caused people to report full recoveries from chronic pain. So we needed to better understand how this treatment worked: What changed in people’s thinking that helped them recover from chronic back pain?
Why It Matters
Chronic pain is one of the biggest health problems today. It’s the leading cause of disability in the United States, and it has an economic cost greater than that of diabetes or cancer.
The most common chronic pain condition is back pain. Many patients—and doctors—are focused on identifying different back problems that they suspect may be causing the pain. So they try all sorts of treatments, often to no avail.
A growing number of scientists now believe that many cases of chronic back pain are caused primarily by brain changes. Pain can originate with an injury, but then the pain system can get “stuck” and keep firing long after injuries have healed.
Pain is the brain’s alarm system, letting us know about injuries or other threats to our body. Much of the time, the system works well, accurately warning us that a part of our body is injured and needs to be protected. But when a person has been in pain for months, years, or even decades, pain processing pathways are more likely to fire, and brain regions that usually aren’t involved in pain start to be involved. Chronic pain also leads to increased levels of activity in glial cells, which are part of the brain’s immune system. All these changes in the brain then serve to entrench the pain, making it persist.
People, very understandably, think that if their back hurts, there must be a problem in the back—even though we researchers know this often isn’t the case.
It’s critical to note that just because the signal originates in the brain, the pain isn’t any less real. But to treat it effectively, one needs to accurately identify the root cause.
How We Do Our Work
In our study, we asked people to tell us in their own words what they think is the cause of their chronic back pain. It’s a simple question, but few studies have asked their participants to describe the source of their pain.
Participants in our study described injuries, weak muscles, arthritis, and other bodily factors as the causes of their pain. Almost no one mentioned anything about the mind or brain.