Back pain that persists can be unlearned

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Like any other Saturday, Daniel Waldrip was mowing the grass in Boulder, Colorado, where he was raised. But the following morning, Waldrip, who was then in his late 20s, awoke with back pain so bad he was unable to get out of bed. He put it on the mowing. It was the beginning of 18 years of chronic pain that were treated unsuccessfully with physical therapy, chiropractic adjustments, acupuncture, and massage.

According to the World Health Organization, lower back pain is the number one contributor to disability in 160 nations. Pain medication only offers transient relief, while the majority of psychological treatments just diminish pain rather than completely eradicate it.

The pain was always present and a permanent part of Waldrip’s life, she told DW. “There were times when it felt like I was immobilised, just so much anguish, and there were other times when it was kind of bearable and it was okay.”

The 49-year-old had endured chronic pain up until his mid-40s, when he learned that his city was hosting a clinical trial for a brand-new therapy. The procedure was referred to as Pain Reprocessing Therapy (PRT).

Using a technique known as pain education, PRT tries to reorganise neuronal connections in the brain to deactivate pain and teach the brain how to respond to signals from the body more properly.

The ultimate objective is to lessen a patient’s dread of particular motions so that when they undertake them, they are confident they won’t hurt them.

Over the course of four weeks, each study participant received eight sessions of psychological therapy in addition to one telemedicine visit with a doctor.

Following the research, Waldrip experienced no discomfort at all for about a month.

“I haven’t had a single back issue since I finished the therapy, and it’s been three or four years now,” said Waldrip. “It completely revolutionised my life.”

How can pain become chronic, and what causes pain?
When we injure ourselves or become ill, pain acts as an alarm system to warn us and our bodies.

Nevertheless, a person’s experience of pain is produced in the brain, regardless of where they physically harm themselves.

The brain receives information from the nerves informing it that something has happened in the body. The brain then determines whether to produce a pain feeling depending on whether it perceives threat.

Pain serves as a warning signal that alerts a person to potential harm and fades away when it is no longer necessary. We refer to this as intense pain. It is a sudden sensation that develops as a result of a particular event, such as a burn, accident, surgery, or dental procedure.

However, chronic pain is defined as pain that lasts longer than three months despite treatment.

“It’s crucial that people have the ability to feel pain. Despite being essential for living, some people still experience pain after their bodies have healed “Professor and psychologist James McAuley at the University of New South Wales said (UNSW).

Even though experts have their views, McAuley said that it is still unknown what causes chronic pain or how acute pain develops into chronic pain.

However, they are aware that when pain progresses from acute to chronic, certain changes take place in the brain.

According to Steven Faux, head of the Rehabilitation Unit at St. Vincent’s Public Hospital, “the nerves are misfiring and informing the brain that the patient is experiencing pain or is at a risk of injury.”

Correct brain-body connection is studied
151 patients with chronic back pain participated in that Boulder, Colorado study that was conducted and reported in the Journal of the American Medical Association (JAMA) in January 2022.

It contrasted PRT with a placebo control group and a group receiving “usual care,” which included patients continuing to get physical therapy or take medication as usual to manage their pain.

According to lead study author Yoni Ashar, a clinical psychologist and neuroscientist at the University of Colorado, “What was particularly striking about the outcomes was that two thirds of people in the PRT group were pain free or nearly pain free at the end of treatment as compared to 20% of controls.”

Functional MRI scans of participants’ brains before and after the trial revealed PRT altered participants’ pain processing.

According to Ashar, “we noticed lower activity in a number of brain regions involved in processing pain, demonstrating that this treatment affects the brain and how the brain processes pain.”

A different trial that was successful in treating patients’ persistent back pain was published in August 2022 in JAMA. The strategy was created by McAuley at UNSW in Australia and enhanced brain-back communication.

The study split 276 participants into two groups, one of which had a 12-week sensorimotor retraining programme and the other of which underwent a 12-week sham treatment programme.

20% of the individuals experienced complete remission from their chronic pain, rating it at zero or one for a whole year.

The language we choose to describe pain can have an impact on healing
Giving them the assurance that they can move without worrying that they would damage themselves or make their discomfort worse is key to both studies. Some of those terms have associations with long-term misery.

Health providers could first examine the spines of patients with back pain when high grade scanning equipment was created in the 1980s. They observed ossifications, vertebrae that appeared to be deteriorating, and slipped or bulging discs.

We discovered all of that information and reasoned that we had discovered the cause of back pain, according to McAuley.

Only later did medical professionals understand that a patient could have a bulging spine and not have persistent pain.

However, as McAuley described it, “the horse had bolted” by that point. Because of the phrases we used, it became typical for some people to believe they would experience pain even when that wasn’t always the case.

According to certain research, people may score their pain more severely on a so-called pain scale when they are exposed to negative words, including the word “pain.”

That was highlighted in a 2019 study that discovered that subjects felt more pain before being exposed to damaging stimuli when pain-related and negative terms were used as opposed to when neutral words were used.

As a result, if someone did actually have chronic back pain and heard these words before seeing their spine on an X-ray scan, this might keep them stuck in a pain cycle unless they receive assistance to retrain their brain to think differently.

According to McAuley, “it does feel like we’re on the verge of a totally new way of thinking about and treating chronic pain.”

The most recent research on pain demonstrates that the brain and body’s communication can be improved, allowing patients who have endured years or even decades of pain to finally find relief.