Back Pain Treatment I
What is your approach to a patient with back pain and what are the most important things all back pain patients should know?
Elaine Borgen, Psy.D.:
Elaine Borgen is a psychologist in the Division of Preventive and Behavioral Medicine at UMass Medical Center, in Worcester, Massachusetts
When treating back pain, most of the medical profession focuses on diagnosis and treatment with medical intervention (e.g. prescribing medication, injections, surgery, physical therapy, etc.). I try to provide patients with behavioral tools that THEY can use on their own, anytime, anyplace. I try to help empower patients to learn to take a self-management approach to their back pain. I always make it clear that these techniques are not meant to replace medical interventions but rather to compliment them.
When patients first realize that they are experiencing back pain "that won't go away", they typically experience a variety of responses including: denial (there must be a cure), anger (externalizing the blame and/or cause) and depression (a sense of loss regarding their previous way of life). My job is to help assist them through the process of accepting the responsibility for managing their pain experience and becoming ready to do something about it. I try to help them understand that by accepting the pain, they're not giving in to it, but rather learning to control the pain!!
It's really a "whole life approach" and that's why our program is called "Living Well with Back Pain". It's not meant to cure the pain, but rather to help a patient and their family live better despite the back pain. And when surgery is necessary, I help patients to prepare for surgery by altering their lifestyle, such as by smoking cessation, managing anxiety and using self-hypnosis techniques to promote a speedy recovery with the use of fewer narcotics.
- Understanding how the use of relaxation and self-hypnosis techniques affect their experience of pain.
- Cognitive techniques aimed at managing a patient's tendency to "catastrophize" and worry themselves into deeper levels of depression or anxiety and pain.
- Coaching regarding managing lifestyle factors such as sleep, use of stimulants (caffeine and nicotine), exercise and a healthy diet.
These are the "realities" that all back pain patients should know:
- Unless you're one of the minority that surgery can "cure", your chronic back pain is unlikely to ever go away completely.
- There are things that you can do to decrease your pain and its emotional side effects.
- Pain medications only work for so long and only does so much (same with injections). Most other treatments have side effects. There are ways to manage pain without negative side effects, and to feel more in control and less out of control because of the pain, while also improving quality of life.
- Learn to be your own advocate and ask for what you need. No one else can tell you what you are feeling in your body. You are the expert of your experience, but you need to effectively communicate this to your providers. People experience "white-coat" syndrome and forget to ask questions and be assertive. Prepare for your doctors appointments, including making a list of questions.
- Manage what you are putting into your body, caffeine, nicotine, food, as well as what you are doing with your body, like appropriate exercise and relaxation techniques. You can learn to reduce the pain by increasing the things that help: breathing techniques, pacing activities, applying heat or ice, stretching, moderate exercise, healthy diet, restful sleep, and decreasing the things that hurt: overly strenuous exercise, lifting, extended body position, caffeine and nicotine. If you're not sure which factors are instrumental, try keeping a pain log for a few weeks.
- The cognitive piece - People with chronic pain can find themselves developing a catastrophizing style of thinking. If you think this way, it becomes a self-fulfilling prophecy. You need to manage your thoughts that influence your pain experience.