5 Mental Strategies to Improve Your Back Pain

Your back pain can be both very real and in your head at the same time. Here are five ways to approach the mental aspect of your back pain to get real-world results.

Nobody wants to hear that their chronic pain is in their head. Yet if you live with chronic back or neck pain, you’ve probably heard it more than once – maybe even from your doctor.

If you think you’re being dismissed or invalidated, consider this: Your pain can be very real and in your head. Literally. Neuroimaging studies show that certain areas of the brain are activated in people with chronic pain.

Back pain mental strategiesYour back pain can be both very real and in your head, so it makes sense to treat both the physical and mental aspects.

That’s not the only way we know the brain plays a big role in how you experience pain. We also know:

  • Pain, depression, and anxiety activate similar parts of the brain.
  • Some psychiatric drugs relieve pain, and some pain relievers alter your mental state.
  • Clinical depression can cause physical symptoms, including back pain.
  • Chronic pain can lead to depression.

So, don’t be insulted if your health care provider suggests a psychological intervention for your back pain. There’s a lot of evidence to support this approach.

“Psychological help for chronic pain is not as much about how to reduce the pain as it is about how to reduce the dominance, interference, and impact of the pain. It's about how to get your life back,” says Steven C. Hayes, PhD, a Foundation Professor in the Behavior Analysis Program at the University of Nevada in Reno – and one of the world’s leading experts on learning to thrive despite pain.

Consider these five examples of evidence-based, psychological approaches to reduce back pain. They may be the difference between taking on the day with confidence or wincing your way through.

1. Cognitive behavioral therapy (CBT)

Experts consider this well-studied approach the gold standard of psychological interventions for pain. It can reduce pain, improve function, and improve quality of life.

CBT teaches you to modify specific thoughts and behaviors. You may work on pain coping strategies, relaxation skills, goal setting, and shifting your views about pain.

The benefits often extend way beyond your time in therapy. Two years after a two-week, intensive course of CBT, patients continued to take fewer pain relievers than they did before CBT, according to research published in the journal Pain and Therapy.

2. Mindfulness Meditation

When you think of meditation, do you imagine someone sitting on the ground with crossed legs, hands resting on knees, OMMMMM-ing? You wouldn’t be wrong, exactly; that’s how meditation has been depicted from ancient wall art to popular media.


Back pain mental strategies meditationMeditation can--but doesn't have to--look like this.

One modern approach is much different, though. Mindfulness meditation can be done anywhere, in any position that’s comfortable – and there’s a lot of evidence that it can soothe back pain. Start by intensely focusing your thoughts and feelings on the present moment. On your own or with a therapist, you may also incorporate breathing methods or guided imagery.

A study in the journal Pain suggests that mindfulness meditation may be especially useful in older adults, who may not be able to get the physical activity that we know improves pain levels. In a group of older adults who participated in eight weeks of a mindfulness program (averaging four days a week for 30 minutes at a time), physical function and pain acceptance both improved.

3. Mindfulness-based Stress Reduction (MBSR)

MBSR is an eight-week program that teaches you formal mindfulness meditation techniques, including basic stretches and postures. Among the many things you’ll learn is how to separate the physical and psychological aspects of pain.

Hundreds of medical centers across the world offer MBSR as a treatment option for a range of disorders, including chronic back pain. Research shows it can reduce pain intensity and improve function in people with arthritis as well as back or neck pain from other causes.

MBSR may even be effective for fibromyalgia, which can cause such intense, widespread pain that you may not feel well enough for basic tasks like showering. A study in the North American Journal of Medical Sciences found that MBSR improved wellbeing, pain, sleep, and fatigue in participants with fibromyalgia. More than half of them reported significant improvement.

4. Acceptance and Commitment Therapy (ACT)

ACT teaches you acceptance and mindfulness strategies, together with commitment and behavior strategies, to change the way you experience pain. Numerous studies have validated this approach, which the American Psychological Association considers a “well-established” treatment for chronic pain.

“People [may] resist seeing a psychologist when they think it means that the pain is ‘in their heads,’ but they are more receptive when they realize the true message is more like ‘your life is in your hands,’” says Dr. Hayes, who developed ACT decades ago. However, you don’t need to see a therapist to get started with ACT. You can start with an ACT self-help book such as Dr. Hayes’ A Liberated Mind; or Living Beyond Your Pain, by JoAnne Dahl and Tobias Lundgren.   

“If that resonates, you can seek out professional help, knowing more about what [you] are likely to receive,” Dr. Hayes says. The Association for Contextual Behavioral Science website can help you find a therapist with expertise in ACT.

5. Change Your Expectations

This may seem too simple to work, yet researchers consistently demonstrate the significance of our expectations on our experience of pain. In one study of hundreds of chiropractic patients, those who expected their back pain to improve were 58% more likely to than those who didn’t expect good outcomes.

There’s more to this mental strategy than manifesting a good outcome through the power of positive thinking. Your beliefs about pain also influence your actions – or lack thereof. For example, when you think physical activity will make your back hurt more, you’re less likely to be active. Scientists refer to this as “fear avoidance.”

If you can’t turn off the worry on your own, a trained mental health professional can help. For most people with back and neck pain, gentle physical activity is crucial; in fact, avoiding it contributes to chronic pain and disability.


Updated on: 02/09/21
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