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Stanford University School of Medicine

Stanford expert on back pain: “The important thing for people to know is that it’s treatable”

September is Pain Awareness Month and later this month, Stanford will host a Free Back Pain Education Day. The event, sponsored by the Division of Pain Medicine, offers community members the opportunity to come to campus and hear about current back pain management strategies and the latest research. The event will also be live-streamed via YouTube for people unable to make it in person.

In anticipation of the Sept. 13 event, I sat down with Beth Darnall, PhD, a pain psychologist at Stanford’s Pain Management Center, and one of the day's speakers. I was interested to understand why back pain is such a critical health problem worldwide and what people living with back pain can do to manage their pain.

Back pain is a leading cause of disability in the U.S. and other countries. Why is chronic back pain so common?

I think there are many different reasons why back pain is the number one pain condition. The back seems to be the place that's really most related to the development of chronic pain and debility from chronic pain. Pregnancy can either trigger or flare back pain, but there are a multitude of reasons: aging (there is degeneration of the spine), obesity (when people gain weight, it puts additional load on the spine), activity levels, and influence of posture. Dr. Sean Mackey will be talking about some of the reasons why back pain is the most prevalent pain condition in the world at the event.

[Back pain] is something that almost everyone will experience at some point in their lifetimes, so it’s really relevant to all of us, whether we have pain now or not.

Why have a community event about back pain now?

There has been increasing global and national attention to chronic pain in terms of its impacts and costs to society. In the United States alone, 100 million suffer from pain on a regular basis, and that is associated with costs of $635 billion dollars annually. That includes treatment costs and loss of productivity.

What we also know is that the incidence and prevalence of chronic pain has been increasing, despite the fact that theoretically, we have better treatments. So then the question is why. While we have a multitude of treatments available, we haven’t been focusing on back pain as comprehensively as we really should. We need a broader approach to the treatment of pain. This was recently outlined in the National Institute of Health’s National Pain Strategy (Note: Mackey co-chaired the oversight committee).

Some people may be under the misconception that the best way to treat back pain is simply with a pill… While medication can be one helpful component, the best way to treat back pain is with a comprehensive approach that involves self-management strategies.

Is there any way to prevent chronic back pain before it starts?

Yes, there are things that people can do to prevent the onset of back pain. General fitness principals are really helpful. Staying fit, staying active, having good core strength, having good muscle tone - all of this can really help one’s musculoskeletal system be as healthy as possible. Exercise is a great way to prevent back pain and treat back pain.

Interestingly, one of the predictors for someone having back pain in the future is a psychological factor called pain catastrophizing. Pain catastrophizing is essentially how we think and feel in the context of pain, [for example] when someone experiences pain, whether or not they tend to ruminate on the pain, whether they have trouble focusing on other things besides pain, or if they feel very helpless in the context of their pain. These types of responses predict whether someone will develop back pain in the future.

It turns out that this increased attention to pain and also the emotional distress component of catastrophizing amplify the experience of pain in the central nervous system. We can actually help reduce a person’s pain experience and their suffering by treating how a person naturally responds to pain.

The important thing for people to know is that it’s treatable. That’s what a lot of my research focuses on: brief interventions to treat catastrophizing and help people learn various skills to have better control over their pain experience and ultimately reduce their suffering.

Prescription pain medication addiction is a national problem; people dealing with chronic pain often are at risk of developing an addiction. Is there any way we can prevent this problem?

Everything we’re showcasing at the event is focused on giving people education and resources related to non-pharmacological interventions. There are a multitude of treatments available, and we’re going to be discussing many of them in detail. That’s really one of the main purposes of putting together this event: to help give people access to pain management solutions that are non-opioid.

We’re not putting forward that opioids are wrong for everyone, but it’s to everyone’s advantage to optimize non-opioid management strategies, particularly in the context of back pain. The research suggests that [opioid painkillers] are not optimally effective for back pain. For that reason, it’s particularly helpful for people to know and really maximize various strategies for them to self-manage their symptoms without medications.

Previously: Study: Effects of chronic pain on relationships can lead to emotional distressFinding relief from lower back pain, National survey reveals extent of Americans living with pain , Stanford researchers address the complexities of chronic pain and The problem of prescription opioids: “An extraordinarily timely topic”

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