• Researchers' novel mind-body program out

    From ScienceDaily@1:317/3 to All on Tue Sep 28 21:30:42 2021
    Researchers' novel mind-body program outperforms other forms of
    treatment for chronic back pain

    Date:
    September 28, 2021
    Source:
    Beth Israel Deaconess Medical Center
    Summary:
    Physician-scientists developed a 12-week mind-body program that
    takes a new approach to chronic back pain. The team demonstrated
    that this intervention was highly beneficial for treating back
    pain when compared to standard care.



    FULL STORY ========================================================================== Chronic back pain is the leading cause of disability worldwide. In the
    United States, patients spend up to $300 billion each year to treat
    the condition, according to a 2012 study published in the Journal of
    Pain. However, common therapies such as surgery and steroid injections
    intended to address physical origins of back pain have not been clearly
    proven to work in randomized clinical trials, and a growing body of
    evidence suggests that psychological factors may be associated with of
    some forms of back pain.


    ========================================================================== Physician-scientists from Beth Israel Deaconess Medical Center (BIDMC) developed a 12-week mind-body program that takes a new approach to
    chronic back pain. The novel intervention -- which is not yet available
    at BIDMC to the general public -- is based on an idea pioneered by the
    late John Sarno, MD, a professor of rehabilitation medicine at the New
    York University School of Medicine. In a new publication appearing in journalPAIN, the team demonstrated that the mind-body intervention was
    highly beneficial for treating back pain when compared to standard care,
    with 64 percent of research volunteers reporting being 100 percent pain
    free six months later.

    "The current paradigm of pain management focuses mostly on treatment of
    a physical origin of pain, however, in many cases of chronic back pain a physical source of pain cannot be identified," said corresponding author Michael W.

    Donnino, MD, a physician in the Departments of Critical Care and Emergency Medicine at BIDMC. "Our group focused on the hypothesis that non-specific
    back pain is the symptomatic manifestation of a psychological process, substantively driven by stress, repressed emotions and other psychological processes. The exact mechanism remains unclear, but an analogy could
    be made to other known effects of acute emotional states on acute
    physiological changes, such as how the emotion of embarrassment may
    result in the capillary vasodilation we know as blushing." Donnino and colleagues' experimental program, termed Psychophysiologic Symptom
    Relief Therapy (PSRT), is designed to address underlying stressors and psychological contributors to persistent pain as well as conditioned
    pain responses and fear avoidant behaviors. Treatment strategies include educating patients about the links between stressors and pain, as well as
    the relationship with emotions. Armed with this knowledge, participants
    learn healthier ways to process stress and express emotions. The program
    also focuses on desensitization or reverse conditioning to help patients
    break the associations that often are formed with triggers of pain such
    as bending or sitting.

    "Often these triggers are assumed to be cause of pain, but they
    are perhaps better described as associations that can be unknowingly conditioned in a way that is similar to how Pavlov conditioned dogs to
    salivate to a bell by pairing the bell with food," Donnino noted. "Our
    program works to reverse these conditioned responses and thus improve
    pain and pain disability." The program's final eight weeks focus
    on mindfulness-based stress reduction, or MBSR, the goal of which is
    to provide the tools to better process current and future stressors,
    while allowing time to practice the techniques from the first portion
    of the program.

    To assess whether PSRT can reduce symptoms and pain-related anxiety in
    patients with non-specific chronic back pain, Donnino and colleagues
    enrolled 35 participants, 18 to 67 years old with chronic back pain that
    lacked a clear physical origin. Participants were randomly assigned
    to receive either the novel 12-week PSRT intervention, eight weeks of
    MBSR only, or usual care under the guidance of their physicians without influence from the study team. All participants filled out pain-related questionnaires prior to the interventions and periodically up to six
    months after the interventions to assess changes in functional limitations
    or disability, back pain bothersomeness and pain-related anxiety.

    After just four weeks, researchers saw an astonishing 83 percent decrease
    in reported pain disability in the PSRT group compared to 22 percent and
    11 percent in the MBSR and usual care groups, respectively. With regard
    to pain bothersomeness over the same time period, the PSRT group had a
    60 percent drop compared to 8 percent and 18 percent decreases in pain bothersomeness for the mindfulness and usual care groups, respectively.

    The PSRT group was superior to both usual care and MBSR for the primary endpoint of pain disability at every interval and at the end of the
    six-month monitoring period. Moreover, at the end of the six-month period,
    64 percent of patients with chronic back pain in the PSRT group were
    completely pain free (reporting 0 out 10 on a pain scale) whereas only
    25 percent and 17 percent reported being pain free in the mindfulness
    and usual care arms, respectively.

    "Within four weeks, differences between PSRT, MBSR, and usual care were apparent across multiple domains including the primary outcome measure of functional disability as well as pain bothersomeness," Donnino said. "When patients recognize the relationship between the mind and their physical
    pain, this orientation sheds new light and provides them a basis to engage
    with the multifaceted program that works interchangeably to improve pain
    and disability.

    This study shows that our program has the potential to be highly
    beneficial when compared to both usual care as well as usual care plus additional treatments such as MBSR." Co-authors included Garrett
    S. Thompson, Shivani Mehta, Patricia Howard, Lakshman Balaji, Long
    H. Ngo, and Anne V. Grossestreuser of BIDMC; and Myrella Paschali,
    Robert Edwards, Sofie B. Antonsen and Suzanne M. Bertisch of Brigham &
    Women's Hospital. This work was supported by a philanthropic donation
    from Adam D'Angelo. The authors have declared no conflicts.

    ========================================================================== Story Source: Materials provided by
    Beth_Israel_Deaconess_Medical_Center. Note: Content may be edited for
    style and length.


    ========================================================================== Journal Reference:
    1. Michael W. Donnino, Garrett S. Thompson, Shivani Mehta, Myrella
    Paschali,
    Patricia Howard, Sofie B. Antonsen, Lakshman Balaji,
    Suzanne M. Bertisch, Robert Edwards, Long H. Ngo, Anne
    V. Grossestreuer. Psychophysiologic symptom relief therapy for
    chronic back pain: a pilot randomized controlled trial. PAIN
    Reports, 2021; 6 (3): e959 DOI: 10.1097/ PR9.0000000000000959 ==========================================================================

    Link to news story: https://www.sciencedaily.com/releases/2021/09/210928193827.htm

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