Be Mindful in Treating Lower Back Pain

If you have lower back pain, you have company.

Research finds that about 80 percent of people will experience low back pain in their lifetime, and back or spine problems are the second most common cause of disability in the U.S., after arthritis. For many, the pain can make it difficult -- or impossible -- to work, inhibit daily function, interrupt sleep and diminish quality of life. "Patients with any kind of chronic pain, often feel they can't control their condition, so they are constantly looking for solutions," says Megan Hood, an assistant professor of behavioral sciences and a clinical psychologist at Rush University Medical Center in Chicago.

In scrambling for relief, however, many overlook the the role of the brain and the impact psychology has on the pain a person experiences and thereby, experts say, miss an opportunity to decrease that discomfort. Low back pain can result from myriad causes, be it a spinal disc injury, sciatica -- or some other nerve damage -- overexertion, an accident or for reasons unknown. "Even after we do an MRI [and with] all the modern tests we have, it's only the minority of cases where we can very, very confidently know the sources of the pain," says Dr. Patrick Roth, chairman of the department of neurosurgery at Hackensack University Medical Center in Hackensack, New Jersey, and author of, "The End of Back Pain." But, whatever the cause -- known or not -- it's the brain that processes pain.

[See: 11 Ways to Cope With Back Pain.]

"Physical pain is real," says Dr. Srini Pillay, a psychiatrist at McLean Hospital, a psychiatric hospital in Belmont, Massachusetts, and a part-time assistant professor of psychiatry at Harvard Medical School. "Just because your psychology is connected to pain, does not mean you're making it up. What it means is you have other ways of managing the pain," he says -- in addition to medications and medical interventions, including surgery. "Oftentimes we find that the best treatment for people is a combination of medical treatment and psychological treatments or psychological strategies to help people manage chronic pain in particular," Hood says.

For those with persistent back pain, Pillay recommends first seeing a primary care provider to discuss what types of care may be needed. And, experts say, there are simple steps individuals can take to begin addressing the psychological aspects of pain.

To start, Pillay says, it's important to recognize the role psychological distress can play, according to research, in worsening the pain. "The first thing that I would say is identify catastrophic thinking," he says, like that you'll never be able to stop the pain. "This doesn't mean that they're exaggerating the amount of pain that they're experiencing, but they might be exaggerating how inaccessible that pain is to their own psychology," he says. "So what I mean by that is, No. 1, identify whether you believe that your pain can be influenced, and to start out, it's important to believe in the possibility of your pain getting better."

Though some distress is a natural response to pain -- and many do live with pain -- experts say there really is power in positive thinking. "It's not just tricking yourself -- it's that when you believe that the pain can be made better, it improves the activation of the reward center in the brain, which involves the chemical dopamine," Pillay says. "It also improves your ability to control the pain by controlling your emotions, and to control your attention in a way that can decrease the pain that you're experiencing."

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Relaxation strategies, like deep-breathing, can also be helpful in regaining a sense of control and to relax muscles, which can decrease pain, Hood says.

Experts say it's also important to get back to your routine -- to doing the things you enjoy -- to the extent possible, as soon as possible, and to deal head on with fears about pain that limit being active. "Exercise is the absolute best treatment for low back pain, for a variety of reasons," Roth says, adding that it's good for the mind and body. "The best is core strengthening -- in particular, isometric core strengthening, which means strengthening of core by not putting your back through a lot of range of motion," he says. Good exercises for this include planks and squats, focusing on low or no weight and high reps.

Conversely, when people slow down because of their pain, it can be self-propagating, leading to an entrenched mindset that they shouldn't be active which, clinicians say, can worsen pain. There are very few instances where exercise wouldn't be advised, Roth says, such as when a person has a compression fracture or where the spine is unstable from an obvious injury or if an individual experiences significant leg pain in addition to back pain. However, seeing a doctor and getting an MRI, as needed, can rule out such issues.

Given that stress and tension are known to cause and increase the pain people experience, such as in the neck or back, factors that might at first blush seem superfluous, like diminished job satisfaction, should be considered as well, Roth asserts.

Pillay says some patients who experience persistent low back pain may benefit from psychotherapies like mindfulness-based stress reduction to improve emotional control and reduce pain. This approach, which involves focusing on the present moment, has been shown to reduce symptoms of depression and quell anxiety. "Anxiety keeps your attention on that pain," Pillay says, adding that heightened focus can increase the intensity of the pain. "When your attention is disrupted, that can also make your anxiety worse, which becomes a vicious cycle." Pillay and Hood say -- among other possible approaches -- that cognitive behavioral therapy may help identify thought and behavior patterns that contribute to low back pain.

The point isn't to ignore physical sources of pain, experts say, but to expand your thinking about how to address it. "I in no way want to imply that if you have a disc injury, you should ignore the injury and meditate your way into painlessness," Pillay says. "You still need to treat the cause. But recognize that whatever medication you're [taking], having these kind of hope-based approaches, belief-based approaches and mindfulness-based stress reduction may, in fact, alleviate the pain even more than what's being used."

[See: Apps to Mind Your Mental Health.]

Roth adds that patients should practice healthy skepticism when it comes to any medical solution offered to treat back pain. "Consider the possibility that you are far more adaptable than you are vulnerable most of the time," he says, reiterating exercise as a key to combat pain. "Focus your energy on ways of living with it."

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.