Special Therapy Brings Relief to Patients With Chronic Back Pain

Many people with long-term back pain have tried physical therapy and medication, to no avail. A new study suggests they might “unlearn” their discomfort in weeks — using psychological therapy.

“For a long time, we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that,” said Yoni Ashar, who led the study while earning his PhD in the department of psychology and neuroscience at University of Colorado Boulder.

“This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain. Our study shows it works,” Ashar said in a university news release.

The study involved 151 men and women with back pain for at least six months who took part in a four-week psychological treatment called Pain Reprocessing Therapy. They had mild to moderate pain and underwent eight one-hour sessions in all.

According to the study results, two-thirds were pain-free or nearly pain-free after treatment. And most remained free of pain for one year.

“The magnitude and durability of pain reductions we saw are very rarely observed in chronic pain treatment trials,” Ashar said. Opioids have only moderate and short-term relief in many trials, he added.

About 85% of people with chronic back pain have pain for which tests can’t find a clear bodily source, such as tissue damage, the researchers said.

Misfiring neural pathways are partly to blame, according to the study. Different brain regions activate more during chronic pain than acute pain. Among chronic pain patients, certain neural networks are sensitized to overreact to even mild stimuli.

“The idea is that by thinking about the pain as safe rather than threatening, patients can alter the brain networks reinforcing the pain, and neutralize it,” said Ashar, now a postdoctoral researcher at Weill Cornell Medicine in New York City.

The goal of the treatment is to educate the patient about the role of the brain in causing chronic pain and to help them reappraise their pain as they move in ways they’d been afraid to. It also aims to help them cope with emotions that may increase their pain.

After treatment, 66% of patients in the treatment group were pain-free or nearly pain-free compared with 20% of the patients who got sham therapy and 10% of those who had no treatment.

And when people in the psychotherapy group were exposed to pain in a scanner post-treatment, brain regions associated with pain processing — including the anterior insula and anterior midcingulate — had quieted significantly.

The study focused on chronic back pain, so larger studies are needed in the future to see if the treatment would have the same results for other chronic pain.

“This study suggests a fundamentally new way to think about both the causes of chronic back pain for many people and the tools that are available to treat that pain,” said researcher Sona Dimidjian, a professor of psychology and neuroscience at CU Boulder. “It provides a potentially powerful option for people who want to live free or nearly free of pain.”

The report was published online in the journal JAMA Psychiatry.

Source: HealthDay

No Evidence Muscle Relaxants Can Ease Low Back Pain

Alan Mozes wrote . . . . . . . . .

Although tens of millions of Americans turn to muscle relaxants for lower back pain relief, a new Australian review finds little evidence that such drugs actually work.

That’s the conclusion of a deep-dive into 31 prior investigations, which collectively enlisted more than 6,500 lower back pain patients. Enrolled patients had been treating lower back pain with a wide range of 18 different prescription muscle relaxants.

But while the studies suggested that muscle relaxants might ease pain in the short term, “on average, the effect is probably too small to be important,” said study author James McAuley. “And most patients wouldn’t be able to feel any difference in their pain compared to taking a placebo, or sugar pill.”

Another concern: Beyond their ineffectiveness, “there is also an increased risk of side effects,” cautioned McAuley, director of the Centre for Pain IMPACT with the University of New South Wales’ School of Health Sciences in Sydney.

Such side effects can include dizziness, drowsiness, headache and/or nausea, in addition to the risk that patients will develop a lingering addiction.

McAuley said his team was surprised by the findings, “as earlier research suggested that muscle relaxants did reduce pain intensity. But when we included all of the most up-to-date research the results became much less certain.”

One problem is that much of the research “wasn’t done very well, which means that we can’t be very certain in the results,” McAuley said.

For example, none of the studies explored long-term muscle relaxant use. That means the Australian team could only assess muscle relaxant effectiveness during two time frames: throughout an initial two-week regimen and between 3 to 13 weeks. In the first instance, they found low evidence of an insignificant pain relief benefit; in the second instance, they found no pain intensity or disability relief benefit whatsoever.

McAuley’s take-away: “There is a clear need to improve how research is done for low back pain, so that we better understand whether medicines can help people or not.

“Low back pain is extremely common. It is experienced by 7% of the global population at any one time. Most people, around 80%, will have at least one episode of low back pain during their life,” McAuley noted.

But because it’s often very difficult to isolate a precise cause, many treatments — including NSAIDs, opioids, exercise therapy and/or counseling — aim to control pain rather than provide a cure. Muscle relaxants — prescribed to 30 million Americans in 2020 — fall into that category, McAuley said.

Given that muscle relaxants provide neither a cure nor pain relief, there’s “a clear need to develop and test new effective and cost-effective treatments for people with low back pain,” he said.

In the meantime, McAuley says a move is underway to “de-medicalize” lower back pain treatment by embracing techniques that focus on alternatives to medicine or surgery.

For example, “we know that people with low back pain should avoid staying in bed,” he noted, “and they should try to be active, and continue with usual activities, including work, as much as they can.

“People with recent onset low back pain should be provided with advice and education about the low back pain,” McAuley added. “[And] they should be reassured that they do not have a serious condition, and that their low back pain is very likely to improve over time, whether or not they take medicines or other treatments.”

He and his colleagues reported their findings in the July 7 issue of BMJ.

“The problem is, back pain has so many causes,” said Dr. Daniel Park, an associate professor in the department of orthopedics with Oakland University’s William Beaumont School of Medicine in Rochester, Mich.

So when it comes to treatment, “there is no one-size-fits-all,” stressed Park, who is also a spine surgeon at Beaumont Hospital-Royal Oak.

Still, Park thinks that when it comes to muscle relaxants, “there probably is a place for short-term benefit to help patients manage severe pain.”

For example, he suggests patients with “muscle strain from overdoing it,” or those with a herniated disc may actually benefit from short-term muscle relaxant use.

But patients with garden-variety back pain from a degenerative disc? Not so much.

Regardless, long-term pain relief is unlikely, regardless of the source of the problem, Park noted.

“Long-term, therapy and core strengthening will be much more beneficial,” Park said, while every effort should be made to identify the specific cause, and to minimize the risk for a chronic condition, permanent damage and enduring discomfort.

Source: HealthDay

Got Sciatica? Stay Active and Start Early on Physical Therapy

Amy Norton wrote . . . . . . . . .

For people with back pain caused by sciatica, it might be a good idea to start physical therapy sooner rather than later, a new clinical trial suggests.

Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back, through the hip and down the back of the leg. It’s often the result of a bulging spinal disc that compresses the nerve.

In general, people with sciatica should try to remain active and not take to bed, said study author Julie Fritz, a physical therapist and associate dean for research at the University of Utah’s College of Health, in Salt Lake City.

But it’s one thing to tell patients to stay active, and another to give them targeted exercises to deal with the condition, Fritz said.

So her team looked at whether starting physical therapy fairly soon after a sciatica diagnosis could speed people’s recovery.

On average, the 220 study patients had suffered sciatica pain for about a month. Half were randomly assigned to four weeks of physical therapy (PT), while the rest took a wait-and-see approach.

Six months later, patients who’d received early PT were reporting less disability in their daily activities, compared to the comparison group, the researchers report in the Oct. 6 issue of the Annals of Internal Medicine.

That does not mean everyone with sciatica should start PT right off the bat, according to Fritz.

“There really is no magic-bullet, slam-dunk therapy for everyone,” she said.

Some people with sciatica feel better within weeks, without any special intervention, while others have lingering pain. Even in this trial, 45% of patients in early PT said they were feeling “a great deal better” one year later. That was better than the comparison group, at just under 28% — but it also meant a majority did not feel that degree of improvement.

Unfortunately, Fritz said, there’s no way to predict which sciatica patients stand to benefit from early PT.

Low back pain is complicated, said Dr. Salvador Portugal, a physical medicine and rehabilitation specialist at NYU Langone Orthopedic Center in New York City.

Even when the source can be pegged to sciatica, there can be different “pain generators” for different people, said Portugal, who was not involved in the study.

And pain is not only physical, he pointed out, but involves psychological factors. People who become depressed or anxious, or tend to “catastrophize” pain, or become fearful of physical activity can be at risk of lasting pain.

“Some patients are afraid that physical activity will worsen the pain,” Portugal said. “But the opposite is true. You want to remain active.”

There are cases, he noted, where patients are in such severe pain that it makes sense to hold off on PT and use pain medication until exercise becomes more doable.

And while Portugal agreed there is no one-size-fits-all therapy for sciatica, he said the new findings do show the value of remaining physically active — in “a controlled way.”

While some sciatica patients fear activity, he noted, others adopt a “no pain, no gain” attitude. “That’s not what we want, either,” Portugal said.

For the trial, Fritz’s team recruited 220 patients ages 18 to 60 who had sciatica pain for less than three months.

Half were randomly assigned to four weeks of PT, which included exercise, manual therapy and individualized home exercises. The other half stuck with “usual care,” which included an education pamphlet on staying active.

Six months later, both groups were showing an improvement on a standard questionnaire that asked about difficulties with daily activities such as walking, sitting and lifting objects. But the improvement was greater in the PT group.

In the real world, even if people want PT, there can be obstacles, Fritz said. Not everyone has time to fit the sessions in, and insurance coverage varies.

Knowing when to start PT is tricky, too. “A fair number of patients will get better on their own pretty quickly,” Fritz said. “So we’re trying to balance. We don’t want to over-treat, and we don’t want to miss this window of opportunity where intervening can help recovery.”

On average, Fritz noted, patients in the PT group had only about five sessions. “That suggests a potential benefit of early PT is that it requires less effort to gain a benefit,” she said.

Source: HealthDay

Study Links Diabetes and Back Pain

People with diabetes have a 35 percent higher risk of experiencing low back pain and 24 percent higher risk of having neck pain than those without diabetes, a review by University of Sydney researchers has found.

Their findings, based on meta-analyses of studies that assess the links between diabetes and back or neck pain outcomes, were published in PLOS ONE.

Most adults experience low back pain during their lives and almost half suffer neck pain at some stage. Diabetes is an increasingly prevalent chronic condition; an estimated 382 million people live with type 2 diabetes, the most common form of this metabolic disease.

There was insufficient evidence in the review to establish a causal relationship between diabetes and back or neck pain, the paper’s senior author Associate Professor Manuela Ferreira from the University’s Institute of Bone and Joint Research said. But the findings warrant further investigation of the association.

“Diabetes and low back pain and neck pain seem to be somehow connected. We can’t say how but these findings suggest further research into the link is warranted,” Associate Professor Ferreira said.

“Type 2 diabetes and low back pain both have a strong relationship with obesity and lack of physical activity, so a logical progression of this research might be to examine these factors in more detail. Our analysis adds to the evidence that weight control and physical activity play fundamental roles in health maintenance.”

The paper also found diabetes medication could influence pain, possiby via its effect on blood glucose levels, and this connection should also be investigated. It also recommended health care professionals should consider screening for unknown diabetes in patients seeking care for neck pain or low back pain.

“Neck and back pain, and diabetes, are afflicting more and more people,” said co-author and collaborator Associate Professor Paulo Ferreira from the Faculty of Health Sciences and Charles Perkins Centre. “It’s worth committing more resources to investigate their interrelationship. It may be that altering treatment interventions for diabetes could reduce the incidence of back pain, and vice versa.”

Source: The University of Sydney

Today’s Comic

An Expert’s Guide to Avoiding Back Pain

Back pain is a common problem in the United States, but there are ways to protect yourself, an expert says.

“The back is a complex structure with many delicate parts, but with good judgment and healthy lifestyle habits — including proper lifting, good posture and exercise — it’s possible to avoid common back pain caused by strained muscles,” said Dr. Lawrence Lenke. He is director of spinal deformity surgery at the Spine Hospital at New York-Presbyterian in New York City.

For more complicated spinal problems such as scoliosis, stenosis, fractures or injuries, medical intervention is usually necessary, Lenke said.

“But each person with or without spinal problems can benefit from adopting healthier lifestyle habits to keep your spine as strong as possible,” he said.

Lenke offered this advice:

  • Maintain a healthy weight, don’t smoke, do stretching and strengthening exercises that increase back and abdomen flexibility, and get regular cardiovascular exercise. If your job involves a lot of sitting, get up and walk around every 15 to 30 minutes.
  • Maintain good posture even while sitting. Don’t slouch or hold your head too far forward. Be sure your feet are supported, hips are level with or slightly above the knees and your spine is slightly reclined. There should be a small arch in the lower back.
  • When sitting at a computer, your shoulders should be relaxed and away from the ears. Your elbows should be at the sides, bent to about 90 degrees, and your wrists should be neutral — not bent up, down or away from each other. Your head should face ahead without being too far forward.
  • When using a mobile device for non-voice activities, hold it up instead of bending your neck to look down. At just 45 degrees, the work your neck muscles are doing is equal to lifting a 50-pound bag of potatoes.
  • When lifting, make sure objects are properly balanced and packed correctly so weight won’t shift. Keep the weight close to your body. And take your time. Bend at the hips and knees and use your legs to lift. Maintain proper posture with your back straight and head up.

Source : HealthDay