Answer to chronic back pain relief may not be in our backs but in our heads, CU Boulder research suggests
A walk in the park shouldn’t yield 15 years of pain, but it did for Lindsay Lord. When she was 10 years old, a kid on a swing crashed into her.
“It knocked me out,” Lord says. “I remember I had a lollipop in my mouth.”
When she came to, she began a long journey in search of relief for her lower back pain: orthopedists, chiropractors, physical therapists, spas, massages—name a treatment, she tried it. In between the treatments, she faced a deluge of different diagnoses, but no respite for 15 years.
That is, until she found help from an innovative lab at the University of Colorado Boulder.
The Cognitive and Affective Neuroscience Lab at CU Boulder is wrapping up the largest study of its kind for a way to treat chronic back pain (CBP)—a treatment without surgery or drugs—but instead a change in the pain-sufferers’ thinking.
And the results, while still unpublished, so far look promising with a “dramatic reduction” in chronic pain, according to Jonathan Ashar, a PhD candidate in psychology at CU Boulder and one of the researchers.
If successful, this research could help many of the 261 million Americans who, according to the American Chiropractic Association, will face back pain at some time in their lives. What’s more, the research might ease the opioid crisis; earlier this year the American Medical Association reported that back pain is one of the most common reasons physicians prescribe opioids even though there’s no evidence that opioids actually treat the problem.
In 2017, the study began welcoming Lord and others like her who may have “healed physically” but continued to suffer CBP.
“Oftentimes, CBP persists even after the body has healed,” Ashar says. “This is about how the brain processes input from the body—the pain is essentially a false alarm in these cases and there’s no threat to the body.”
Asher explains via an analogy: “If there’s a fire (threat) at a school, the alarm rings (equal to pain in humans), firefighters come and put out the fire. The threat is gone, but sometimes the fire alarm keeps ringing (the pain continues). Over our evolution, we’ve come to see that pain equals harm, but now we’re learning sometimes pain is a false signal, it’s just stuck in the on position.”
In the study, researchers first examined CBP sufferers for physical reasons for their pain. If none was found, subjects began eight, 50-minute psychotherapy sessions over four weeks with Alan Gordon, a psychotherapist who specializes in treating chronic pain.
Gordon used a relatively new treatment called pain reprocessing therapy (PRT). “The premise is to teach the brain to interpret signals from the body accurately,” Gordon says. “The brain sees these signals as dangerous, but if we teach the brain that these signals aren’t actually dangerous, the brain flips off those signals, and the pain goes away.”
That’s apparently what happened to Lord during her PRT sessions. “I was able to wrap my mind around it and to realize there wasn’t a real reason for the pain,” Lord says. To keep the pain at bay, she now tells herself, “You’re trippin’; it’s not real.”
Today, at age 27, Lord says the pain is 99 percent gone and she has kept it away, which was the case with most subjects, researchers say.
Both Gordon and Ashar say chronic pain sufferers should feel a renewed sense of hope.
The brain sees these signals as dangerous, but if we teach the brain that these signals aren’t actually dangerous, the brain flips off those signals, and the pain goes away.”
“There’s a paradigm shift happening in science that’s being disseminated out to practitioners—much of it is about the brain—treatments are still being worked out, (but) in some cases psychological treatment can lead to complete reduction in pain,” Ashar says. “Before, that reduction was about 30 percent. So we believe chronic back pain can be significantly reduced.”
Gordon adds the CU Boulder study and others related to brain-body treatments could be a tipping point for more acceptance and use of PRT.
“Now there’s a lot of new research on the brain … and that can lead to us to start training an army of practitioners and start a certification program (for PRT),” Gordon says. “I believe 40 million of the 50 million people in chronic pain in this country don’t have to be in pain.”
Gordon sees a day when people will bypass therapy and relieve their pain on their own. “They can deactivate the danger signals on their own—learn the techniques themselves without being in therapy,” Gordon says. In fact, Gordon has just co-authored a book called The Way Out, due out in 2020 and designed to help readers treat themselves.
Ashar agrees people will likely be able to treat themselves but adds more research is needed. “Researchers need to replicate our results in other settings, with other kinds of pain and with other therapists. If more research turns out favorable, work will begin to make treatment scalable.”
As for Lord, she’s just grateful for having been in the study and learning a new way to think about pain.
“I think this definitely has potential to help people move through their pain … and enjoy their lives more,” she says.