CBT and Back Pain

Someone recently sent me this old but terrific article in Best Life from psych blogger extraordinaire Jonah Lehrer, about the psychology of chronic back pain.

This narrative might sound suspicious—there's no shortage of phony treatments for chronic back pain—but a growing body of scientific evidence supports it. Chronic back pain is now predominantly seen as a disease of the nervous system, not the spine. It's a problem suited for psychologists and neuroscientists, not surgeons. The best treatments are often the least invasive.

Lehrer goes on to discuss the scientific basis for current thinking on the relationship between emotional and physical pain.

Dr. Carragee analyzed the psychological evaluations of his patients. He soon discovered that a person's emotional state—and not the anatomical state of his back—was the best predictor of back pain. As Dr. Carragee notes, "The structural problems were really overwhelmed by the psychosocial factors. Almost without exception, people without any of these mental or social risk factors were able to deal with their backache. But people with a psychological problem had a much tougher time doing that. For them, the pain was often crippling and catastrophic."

In Cognitive-Behavioral Treatment of medical conditions, we frequently start with monitoring exercises that are intended to help an individual identify the links between their emotional and physical experiences.  For some people, stress and anxiety manifest through seemingly obvious channels: they may feel jittery, restless, fatigued, unable to relax, or any combination thereof.  For others, however, emotions are expressed in ways that don't seem, well, emotional.  But once an individual can identify the links between their emotional life and their physical health, it often allows us to improve them both.