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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