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Easing your chronic back pain — with and without medication

0 2 years ago

Is your back always aching? About 40 percent of people 18 and over and almost half of older adults experience this, typically in the lower back, according to a 2019 survey of almost 32,000 people.

Back pain is considered chronic if it continues for more than 12 weeks. In older adults, chronic low-back pain may be overtreated with inappropriate medications such as muscle relaxants or opioids, says Yury Khelemsky, program director of the pain medicine fellowship program at the Icahn School of Medicine at Mount Sinai in New York. It may also be undertreated, he says.

As it turns out, some of the most effective back pain strategies for those of us in this age group require no medication.

But you might not know this. “Older adults may not be offered behavioral treatments for pain due to an assumption that they won’t be interested, or a perceived stigma associated with such services,” says Sara Davin, a psychologist at the Center for Spine Health at Cleveland Clinic. “But these are the people that can really benefit from these treatments.”

To help you ease chronic back discomfort, here’s a look at the research behind nondrug treatments, and advice on how to use medication effectively.

The power of the mind

Research suggests that talk therapy may help you retrain your brain so you experience less pain and can cope with it better. “This isn’t suggesting that your pain is not real or that it’s ‘all in your head,’” says Tor Wager, professor in neuroscience and director of the Cognitive and Affective Neuroscience Lab at Dartmouth College in Hanover, N.H.

A study published last September in the journal PAIN Reports, for example, looked at psychophysiologic symptom relief therapy (PSRT), which addresses stress and other psychological issues that can contribute to persistent discomfort, and helps break associations that may set off pain, such as bending or sitting. This study found that 64 percent of back pain sufferers who tried PSRT reported being pain-free 6½ months later.

Also promising is pain reprocessing therapy (PRT), which “teaches people to perceive pain signals sent to the brain as less threatening,” Wager says. In a study published in JAMA Psychiatry, 66 percent of participants with chronic back pain reported much less or no pain after four weeks of the therapy.

Because PSRT and PRT are relatively new, and considered experimental, they are not always easily accessible or covered by insurance. Other talk therapy often is — and may be available in programs where patients work with a team of experts.

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