HOW TO BEAT BACK PAIN FOR EVER

In a series that could transform your life, two experts reveal their ingenious new approach to ease chronic aches

PERSISTENT back pain is the leading cause of long-term disability in Britain, yet in around 85 per cent of cases the cause can’t be identified. But the good news is there is plenty you can do to ease it. Physiotherapist David Rogers and Dr Grahame Brown, of the Royal Orthopaedic Hospital in Birmingham, have developed a unique programme to tackle chronic back pain. Here, beginning a two-part series for Good Health, they reveal the techniques that could change your life.

Anyone who’s suffered from persistent back pain will know just how profoundly it can affect your life. It can dog your waking hours and infiltrate your sleep, restricting your ability to socialise or work. It can lead to financial worries, relationship difficulties and undermine your confidence and mood. We’ve been running 12-hour courses (three hours a week) to help patients just like you. The majority arrive with no confirmed diagnosis but a medicine cabinet full of painkillers that don’t seem to work, and in a state of misery, anxiety and desperation.

We’re convinced that these psychological features — completely understandable after months, even years of unrelenting pain — are significantly contributing to the problem.

So while you might be desperate for a physical explanation or diagnosis, the truth is that your pain is very likely to have more to do with changes in your nervous system and how your body and brain respond to those changes, and what you think about your pain, than any injury or damage — such as a slipped disc — you might have suffered.

This doesn’t mean persistent back pain is ‘all in the mind’ — far from it.

But we feel it’s important to recognise that psychological elements (such as anxiety about the pain) feed into the physical, to create a complex series of chemical reactions in your body which can significantly increase your pain, which then make your anxiety worse.

It’s a vicious circle, turning up the volume in your nervous system — like an amplifier pumping out loud music — which turns up the pain.

This approach to pain is known as a ‘biopsychosocial’ approach, encompassing the biological, psychological and social factors that lie behind it.

And it works: we see much better outcomes than we could ever have achieved with other treatments such as physical manipulation, injections or just handing out exercise sheets.

So what does a biopsychosocial approach actually mean?

The ‘biological’ part refers to the physical changes that occur in your nervous, hormone and immune systems, as well as muscles, tendons, bones and joints, and can lead to persistent pain.

So, on top of whatever acute pain you might have started out with, any stress you feel will be triggering the release of the hormone cortisol, which diverts extra oxygen to the muscles and slows down digestion — the problem is, persistent back pain keeps cortisol levels raised, which can lead to poor sleep, fatigue and depression.

Long-term pain can also affect the immune system, resulting in changes in special proteins called ‘cytokines’, which in turn can increase the sensitivity of the nervous system and tissues, making you feel worse.

This response can be activated not just by actual events, but also by the brain’s interpretation of events: so if you think something is really bad (for instance, your back pain), those thoughts and feelings can lead to an immune response which then deepens your pain. The prolonged stress of persistent pain can also keep you in a heightened state of alert, with adrenaline pumping around your body.

This can trigger muscle tension — in the neck and back — and muscle cramps, all of which lead to more and different pain to be added into the mix.

An over-stimulated nervous system might easily regard this pain as an additional potential threat, firing danger signals through the body, further increasing stress and pain.

HOW THE LIGHTEST TOUCH CAN HURT

UNRELENTING pain will inevitably leave you feeling fed up, angry, annoyed and frustrated — the ‘psychological’ effect of pain.

ongoing negative thoughts about your back pain will change the balance of chemicals released in the brain and, in doing so, affect the nerve impulses between different nerve cells (neurons).

Thoughts like ‘my MRI scan can’t pinpoint what’s wrong’, or ‘I’m not sure my GP believes how much pain I’m in’, or ‘I’ll never run again’, can be very threatening to a brain that’s concerned about your survival.

These thoughts — driven by fear, anger and/or depression — act like a computer virus corrupting messages.

The pain sensors in your back keep sending danger messages to your brain long after the tissues have healed, and your brain keeps sending ‘watch out!’ messages to your body.

As a result, the nervous system can rapidly start to rewire itself into a destructive pattern, becoming incredibly efficient at sending danger messages to the brain — and the brain adapts by growing more neurons to alert us to danger.

The end result is that your pain experience can become stronger and your back hurts more as t ime passes.

you can become over-sensitised, so that even the lightest touch can become painful as the rewiring takes hold and the area becomes increasingly sensitive.

As long as the brain continues to regard the pain as a threat, it will produce danger-alert signals to keep the danger messages going — even when the tissues have healed and any inflammation has subsided.

REWIRE YOUR NERVOUS SYSTEM

PATIENTS also come to fear movement — sometimes because it hurts, often in case it hurts — and this can cause muscles to tighten, distorting posture and creating more pain.

So how do ‘social’ factors fit into our approach? These are the circumstances that may influence your recovery such as the attitudes of your work colleagues, friends and family to your constant pain and immobility, or your fearful reaction to stories you might have read online, or the inevitable frustration of having to endure a long wait to see a specialist.

All this creates tension and anxiety, which floods the body with yet more stress hormones.

Pain is a bully: physical bullying has psychological effects, and psychological bullying has physical consequences. The good news is that just as your nervous system

can turn up the danger messages it can also turn them down.

We all have the ability to rewire our nervous systems, breaking thought patterns and habits that are harmful, and developing new patterns and habits that are healthy for our nervous system and promote recovery.

By making several small changes across different aspects of your dayto-day life you should be able to make a huge difference to your level of pain and ability to function.

One of the most important first steps is to get moving again — something many people with persistent back pain deeply fear.

But movement — one small step at a time — is key to recovery, as we will explain fully next week. But there are also simple steps you can do now.

THE FIRST STEP TO RECOVERY

ONE of the key parts of our approach — and its effectiveness — is the idea of ‘marginal gains solutions’. These are tiny changes in many different aspects of your life that work together to make a big difference. Because persistent pain involves so many factors, one small change feeds into another to address the biological, psychological and social aspects in very subtle ways, but all at the same time.

If pain has been a nagging and debilitating part of your life for months, even years, the first positive step you can take right now, without any need for expert supervision, is to find time in your day — every day — for ‘active relaxation’.

This time to wind down the nervous system will neutralise the ‘danger-alert’ messages that have been exacerbating your pain.

So find something restful and relaxing that works for you — it might be singing, chatting with friends, fun exercise, gardening, solving puzzles — then ring-fence time to do it and stick to your plan.

Watching TV, playing computer games or any kind of screen activity does not count. You might think that’s a great way to unwind, but studies show they maintain or induce even higher levels of physiological stress.

Breathing techniques might sound like mumbo-jumbo, but controlling your breathing really can have a powerful relaxing effect.

They’ve been shown to help stimulate nature’s pain relieving pathway and the more you practise, the better you get at it and the more benefit you will derive as neural connections are strengthened.

Get good at it, and you can learn how to reduce the pain, and how to shift your attention from worrying or ‘catastrophising’ thoughts (such as the idea your pain will never get better, or that you will never work again). It can be enough to help you nip a flare-up of pain in the bud before it takes over your life. Better still, it is free and comes with no side-effects.

BREATHING TIP THAT CAN HELP

WHEN we ask people who have been on our courses what has helped them most, by far the most common response is the 7:11 breathing technique.

Even years later, we are told that it is this skill that proves most effective over time. You can do this simple breathing exercise anywhere and at any time. You might need to build up to an exhale that extends to 11 counts, but as long as your exhale is longer than your inhale you will be effectively stimulating the part of the nervous system that triggers a relaxation response.

This is enough to make your blood pressure go down, your heart rate to slow and to reduce your state of emotional arousal. The deeper relaxation also allows blood to flow into chronically tight and oversensitive muscles that are contributing to your pain.

Start with five minutes once a day, but if you are in pain and have been for a long time, or are feeling very tense and stressed, aim to build to 30 minutes twice a day. Regular practising will enable your nervous system to ‘rewire’ itself and, while you are doing this, active healing will be going on.

EXTRACTED from Back to Life: How to Unlock Your Pathway to recovery (When Back Pain Persists) by david rogers and Grahame Brown, published by Vermilion on august 4 at £12.99. to order for £9.74 (valid to august 1; P&P free for orders over £15), visit mailbookshop. co.uk or call 0844 571 0640.