New Mind Body Study Brings Hope of a Cure for Back Pain Sufferers

clinical study brings mainstream science to mind-body medicine.

A majority of people in a novel mind-body intervention recovered from back pain, according to a new study published in PAIN. An impressive 64-percent of patients who participated in what doctors call Psychophysiologic Symptom Relief Therapy (PSRT) were 100-percent pain free six months after the pilot study began.

People in the PSRT group had significantly less pain, disability and anxiety than patients in the other two arms of the randomized clinical trial. Back pain sufferers were assigned to either 12 weeks of PSRT, eight weeks of mindfulness based stress reduction (MBSR) or standard care, which meant they continued their existing therapies. Only 25-percent of participants resolved their pain through mindfulness and 17-percent in the usual care arm.

Almost four times as many people experienced a back pain cure from Psychophysiologic symptom relief therapy than from standard care, six months after they started the program.

If you combine the number of people who were pain-free or almost pain free, it amounts to 73-percent of patients in the PSRT group. This means almost three out of four participants reported either no pain or a pain level of 1 out of 10, six months after starting the mind-body program.

“We had people who went from years of chronic back pain and reduced activity where they were not exercising to being back-pain free and jogging again,” says Michael Donnino, MD, principal investigator of the research team at Beth Israel Deaconess Medical Center, a teaching Hospital of Harvard Medical School. 

Back pain is the number one cause of disability in the world. Sufferers are often unable to sit, stand, exercise or work. The mind-body approach offered big gains for patients. In just four weeks, participants in PSRT experienced an unparalleled 83-percent decrease in disability, compared to a 22-percent decrease for the mindfulness group and an 11-percent reduction for the usual care group. 

Donnino believes the mind-body intervention fared well because patients were accurately diagnosed and treated for the underlying cause: the way stress and emotions activate the brain and nervous system, perpetuating the pain cycle. 

"In a lot of studies, you provide adjunctive care to help alleviate symptoms but it doesn’t change the diagnosis or get to the root cause,” says Donnino, a critical care and emergency medicine physician at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School. “This is a psychophysiologic process, meaning it's physiologic in that you’re feeling real pain or muscle spasms but the source is psychological. The brain is sending false danger signals, setting off this pain. The study suggests a new paradigm for nonspecific back pain.”

Percentage of patients who were pain-free over time. PSRT is Psychophysiologic Symptom Relief Therapy. MBSR is Mindfulness Based Stress Reduction and Usual Care means patients continued standard therapies. At 26 weeks, 64% of PSRT patients were pain free, compared with 25% in MBSR and 17% in usual care.

Researchers say patients first need to be checked for physical issues like infection, fracture or abscess. In most cases, common findings like arthritis and degeneration don’t cause chronic pain. Practitioners often point to these as culprits, even though studies demonstrate that asymptomatic people have the same age-related changes. In fact, 64-percent of adults without back pain have disc degeneration, bulges, protrusions and herniations, according to a study in the New England Journal of Medicine.

In double blind studies, surgery and steroids are not proven to be effective in eliminating back pain, and can cause side effects. Other studies have found that adverse childhood experiences, ongoing stress and depression increase a person’s risk for chronic back pain. The new mind-body intervention highlights the pivotal role that psychological stress has on the brain and nervous system. 

It also brings mainstream science to the work of John Sarno, who warned that modern medicine is overlooking the role of psycho-social factors in chronic symptoms.

A professor at New York University School of Medicine, Sarno helped thousands recover from persistent pain in more than 50 years of clinical practice and four books read by millions around the world. Sarno was revered by patients but not embraced by the medical establishment when he died in 2017.

The 11-person research team at Beth Israel Deaconess Medical Center built upon Sarno’s theories and added therapeutic strategies from internal medicine physician Howard Schubiner, who directs the Mind Body Medicine Program at Ascension Providence Hospital in Michigan.

“Even though this is a small study, it was randomized and the mind-body treatment was compared to a standard therapy of mindfulness,” says Schubiner, MD and author of the book Unlearn Your Pain, which was used in the study. “The results showed a very large effect size so that most people had dramatic results. This form of treatment should become the standard for non-structural back pain and other non-structural pain syndromes. And we are now learning that most of the people with chronic back pain do not have a structural cause for it.”

Instead, subconscious thoughts and emotions play a primary role in chronic symptoms. After all, emotions create a physical response in the body. Most people have experienced sweaty palms before a speech, a queasy stomach after sad news or a headache on a stressful deadline. When people are under high stress, and start to fixate on the pain, the brain gets stuck in a feedback loop. 

“If you’re strategically able to recognize what’s going on in your body, reduce that fear and return to activity, the pain goes away,” Donnino says. 

The mind-body intervention written up in PAIN has four parts:

01.  Education: Patients learn that symptoms are physical manifestations of repressed emotion. Psychophysiologic pain shifts in intensity and location in ways that structural pain does not. For instance, one man assumed that sitting caused his pain but realized that his back only hurt in heavy traffic. His anger was ramping up symptoms, rather than the position of his body. Another patient noticed back pain when walking into the workplace but not when leaving. These inconsistencies show a mind-body connection, since physical injuries don’t wax and wane in different settings. 

02. Desensitization: Participants slowly return to activities they want and need to do. They first visualize painful positions like sitting or walking, while staying present to body sensations with calming messages. Next, they resume activities in small steps, indifferent to any symptoms. This slowly retrains the brain and it stops creating the pain.

03. Emotional Expression: People link emotional stressors with the onset of symptoms, rather than assuming they slept the wrong way or did too much gardening. This includes small group discussions and writing exercises where participants can share emotional terrain they normally keep submerged. 

04. Mindfulness Meditation: As people investigate the vulnerable realm of emotions, it can trigger anxiety. Mindfulness Based Stress Reduction is introduced in the fourth week to help people observe body sensations and emotions in a non-reactive way. They also learn how to damp down self-pressure, which can activate the emotional brain.

One woman realized she’d been pushing herself to be the perfect mother and wife. As she learned to better accept herself, her back pain dissipated too.

Donnino turned to the mind-body approach after traditional therapies failed to relieve his own pain. In his early forties, Donnino experienced 16 weeks of debilliating back pain and leg tingling that left him unable to exercise, work or move much at all. He was on around-the-clock painkillers for what was diagnosed as possible sciatica, piriformis syndrome and pudendal nerve syndrome. Donnino had a dramatic response after reading Sarno’s iconic Healing Back Pain. 

“Within 24 hours of reading the book, my pain was cut in half and I stopped all the pain medications, around the clock ibuprofen and Tylenol,” said Donnino. “I’ve not taken those in eight years since.”

He then took Schubiner’s online course. After a few weeks, Donnino’s pain disappeared completely and has not returned. As an author of 230 manuscripts, Donnino is in a unique position to bring scientific research to the mind-body connection.

The pilot study involved 35 patients. The research team is now enrolling 150 people in a larger back pain study on a virtual platform. If results bear out, it could help pave the way for a new model in chronic pain. The old adage that something is “a pain in the back” may prove to be both literal and scientific.   

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