NEW HELP FOR ACHING BACKS

Old advice: pain pills, high-tech tests, injections and surgery. The latest science: harness your brain, lace up your trainers and go low-tech

Af ter Mar ty Huggins fractured her lower back four years ago, she says she spent “two years lying on a fuzzy brown sofa in our family room. I was afraid I would hurt my back if I moved even a little.” The pain forced the 65 year old to retire from her job as a physical education teacher, and she stopped going to the gym completely. But despite countless visits to special ists and doctors, who performed tons of tests, gave her dozens of steroid shots, and regularly offered her opioid pain relievers, nothing helped.

What did it take for Huggins to finally tame her pain? She changed her brain.

She star ted by researching chronic pain-management and rehabilitation programmes. Huggins enrol led in several classes on how the brain and body interact. She learned how to relax with mindfulness meditat ion and to tame her fear and anxiety about her back pain with cognitive behavioural therapy ( CBT). She also discovered the importance of good sleep and overcame her hesitation to start exercising again. Huggins even began taking an antidepressant, not because she was clinically depressed but because the medication helped turn down the volume on the pain messages sizzling through her nervous system.

Huggins is now able to go hiking, boating and fishing with her husband. “You really can calm your body down and change your brain to lessen the pain,” she says. I’ve never spent another whole day on that sofa!”

Could the cure for chronic and short-term back pain start with simply changing your attitude? Low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time. Billions of dollars are spent on

treatments such as high-tech scans, spinal cord injections, opioid painkillers and surgery. And yet the evidence continues to mount that these approaches may not help – and could even make things worse.

In the first study of long-term opioid use for back pain, published in March 2018 in JAMA, participants who took opioids had higher pain levels a year later compared with those who took paracetamol or a nonsteroidal anti-inflammatory.

“Long-term use of opioids can actually worsen pain, along with causing dependence,” says Dr Xavier Jimenez, medical director of the Cleveland Clinic Chronic Pain Rehabilitation Programme. Meanwhile, the latest research from prominent pain experts is revealing how surprisingly effec

COULD THE CURE FOR BACK PAIN START WITH CHANGING YOUR ATTITUDE?

tive low-tech strategies can be. In a 2016 University of Washington study, for example, 342 people with chronic lower-back pain were randomly divided into three groups. Patients in one group got ‘usual care’ – whatever treatment and advice their individual doctors provided. Along with receiving any medical care needed, a second group practiced mindfulness meditation and yoga and the third went to CBT classes for eight weeks. About 44 per cent of people in both the meditation and the CBT groups had significant pain improvement after six months, compared with just 26 per cent of the ‘usual care’ group.

“Mind-body therapies and physical therapy are often as effective, or more effective, than surgeries and injections, despite seeming less ‘medical,’” says Dr Jimenez. “They’re also safer.”

They’re not recommended in every case, of course. Some pain does require more invasive and immediate treatment. If your back pain comes with bowel or bladder problems, or if you have progressive muscle weakness in your legs – for instance, if your knees keep giving out or you keep tripping – call your doctor right away or go to the emergency department.

“If the pain radiates down your leg or causes numbness and tingling in your leg or foot, see your doctor. It could be a compressed nerve root that needs attention,” says Professor Anthony Delitto, an expert in nonpharmacological management of pain.

Back pain that lasts 12 weeks or more is considered chronic. If the cause isn’t obvious (a fall or a car accident, for example), don’t just treat the symptoms with, say, an nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. It’s important to work with your doctor to figure out what’s going on. “Pain can

be a signal of ongoing tissue or nerve damage or spinal problems that need to be addressed,” says pain scientist and psychologist Beth Darnall.

If your back pain is new, continue your daily activities, but take it easy when exercising. Most of the time, you’ll start feeling better within three days. Once you’re on the upswing, talk to your doctor about incorporating the following strategies to help you stay pain-free.

Exercise on Your Own or in Physical Therapy

Walking and other activities can improve your back by strengthening muscles, relieving tension and stress, helping with weight control, and – bonus! – triggering the release of feel-good brain chemicals. In a 2013 Israeli study of 52 non- exercisers

aged 18 to 65 with lower-back pain, a treadmill-walking programme did as much as back exercises to bolster supportive ‘core’ muscles and improve the patients’ ability to perform day-to-day activities.

Don’t like walking? “Try an elliptical trainer, a bike, swimming, or any other activity that’s fairly easy on your back but lets you move,” Professor Delitto suggests. “If you feel some discomfort, try to continue for ten to 15 minutes. Then reassess how you feel a few hours later. Chances are, you’ll feel better than before your exercise session.”

Other research suggests that yoga may be as good as physical therapy for chronic lower-back pain. In fact, yoga and tai chi are among the non- drug therapies that the American Col lege of Physicians recommends back-pain sufferers try before turning to pain relievers, especially prescript ion- strength ones. In one recent national survey of people with back pain, 90 per cent who tried yoga or tai chi experienced relief, compared with 64 per cent who simply followed their doctor’s advice.

If you’re nervous about exacerbating your back pain when you exercise, ask your doctor for a referral to a physical therapist. In a May 2018 study, researchers found that people with lower-back pain who tried physical therapy before other treatments were 89 per cent less likely to need opioids and 15 per cent less likely to end up in the emergency department.

Harness Your Mind

Pain scientists are looking closely at an all-too-common mindset called catastrophising. “It’s normal to protect your back when it hurts,” Professor Delitto explains. “But for some