Doctor’s 3-step plan for sustained pain relief

Like so many Americans, I have suffered bouts of low back pain throughout my life. Doctors are not immune, unfortunately. These have come on either because of strain from too vigorous exercise without ample warm-up, length of time sitting in poor posture at the office or car, and perhaps most often from stress-related issues.

Manual therapies help symptoms

I am a vocal advocate for the use of manual therapies to reduce pain, with the hope of being able to avoid altogether analgesic and anti-inflammatory pain relievers. Therapies that are terrific for helping lengthen constricted muscles, improve blood flow, work through adhesions of fascia and scar tissue, and includes sports massage, Active Release Technique (ART), Positional Release (PR), Rolfing, Muscle Energy Technique (MET), among others. Additionally, self-care therapeutic methods like stretching, foam rolling and yoga gar far in helping improve body function, reduce pain, and improve range of motion.

These manual therapies are terrific for correcting somatic (body) issues in the meantime. What I mean is that they won’t “cure” the problem and thus keep the pain away, by themselves. They are a means to improved quality of life while one is also addressing the pain issue with mind-body techniques. Let’s look at why this two pronged approach is essential to long-term correction and relief.

The mind-body connection

The mind plays such a huge role in how the body responds to external issues related to work, relationships, money, family and so on and holds these stressors in the musculature of the body. This creates muscle tension, trigger points, limited range of motion, reduce oxygen and nutrients moving through the tissue, and causes pain. Many don’t realize that psychological stress, emotional upset, repressed anger and rage, all get “locked” in the body and restrict its normal biological and physiological functions, often creating physical pain issues that can become chronic and ruin lives.

Often people find it difficult to relax, breathe naturally and allow the release of mental/emotional issues when they are in pain. Indeed, the pain response is so overwhelming at times that all one can do it manage their way through it. That is why I advocate for utilizing manual therapies to help relieve the body tension, pain and range of motion issues so that you will be “freed up” enough to fully commit to and engage in a mind-body therapy that addresses the potential mental/emotional trigger causing the problem.

For those of you who may be unsure about the effectiveness of mind-body approaches to pain, let’s look at a study recently published in the journal JAMA Internal Medicine.

Study: Mind-Body vs. Health Education for Low Back Pain

Researchers conducted a randomized clinical trial was carried out on mind-body programs for older adults who suffer chronic low back pain.

The study was important in assessing a way to reduce the need for analgesics in low back pain treatment among older adults to reduce their side effects. Moreover, the researchers wanted to determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP.

Often the restrictions of primary care concern limited time with patients on office visits. This often negates the ability of the health care provider to demonstrate or teach patients exercises (physical or mind-body) to help their pain. Often, the patient is prescribed NSAIDs and/or sent to physical therapy. But this is not the most cost-effective or efficient means of correcting the problem. Given the limitations of PCP office visits, the provider often offers health education information.

The clinical trial compared the results of a mind-body program for low back pain with those of a health education program. The trial lasted from 2011-2014 with a 6 month follow up completed in 2015. Participants consisted of 282 adults ages 65 and older with functional limitations owing to their chronic LBP and chronic pain of moderate intensity.

The mind-body and health education groups received 8-week group programs followed by 6 monthly sessions. The mind-body program utilized was modeled on the Mindfulness-Based Stress Reduction (MBSR) program, while the health education program was based on the “10 Keys to Healthy Aging” program.

By six months, the mind-body group with the “most severe” pain self-reported improvements in back pain by a reduction of 1.8 points on a Numeric Pain Rating Scale. The conclusion:

“A mind-body program for chronic low back pain improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability.”

Considering the findings

The results of this clinical trial are important. First, because they show that health education is not enough to reduce pain. Also, it reflects that long-term use of analgesic pain medications is not a healthy model for pain relief. Moreover, we see that although there was short-term relief and functional improvement, it was not sustained over longer period of time. Why?

My experience in this area as researcher, practitioner and pain sufferer for decades, leads me to several conclusions, which also bring us back to the opening paragraphs of this article.

1. There are both physical and mental/emotional components to pain, especially chronic pain. Thus, addressing one area and not the other will not provide the depth and trajectory of results over the long term.
2. Mind-body programs are terrific at relieving pain, but for only as long as one is regularly engaged in them. This is especially true of programs based on mindfulness, which help lower blood pressure, relax the body, slow respiration, and quiet the mind.
3. If the underlying emotional issues are not also accounted for, and corrected, the issues will trigger pain and functional impairment.

Conclusion

For a chronic pain condition, like low back pain tracked in the above study, a more comprehensive approach needs to be utilized. Why there are so many studies comparing two singular approaches baffles me, when the human mind and body are so vast and complex.

We can find deeper, long term sustained relief if we address the following three basic areas:

1) The need for immediate somatic pain relief and return of function;

2) The need for mind-body practice that relaxes the body, reduces stress, improves blood flow and calms the nervous system; and

3) The need for a way to acknowledge, address, and resolve long-held psychological issues relating to repressed emotions, stress, anger and rage.

Part one is effectively addressed with methods mentioned above, including massage and bodywork, yoga, stretching and foam rolling.

Part two is effectively addressed with mind-body approaches, including mindfulness meditation, yoga, tai chi, and biofeedback.

Part three is effectively addresses with psycho-somatic (mind-body) approaches that truly address the emotional component of pain, including the Tension Myositis Syndrome (TMS) method, the Sedona Method, EMDR and Emotional Freedom Technique (EFT). More of these can be found in an article I wrote here and here.

All in all, mind-body approaches to pain are great ways to know yourself better and achieve results without relying on pain medications. But at least the three areas above need be addressed in unison for lasting results. But therein lies the answer, it only takes time, planning, and commitment. Give it a try!