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Is Back Pain Killing Your Chance for Life Change?

Chronic discomfort can lead to bad decisions about all areas of your life


by Sarah Mahoney

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Most Americans are way too familiar with an aching back. For millions, back problems—or more specifically, fear about those problems—may be standing in the way of change, making them feel hesitant about everything from pursuing a new career to trying a new style of sit-ups.

Experts say that anywhere from 60% to 80% of the population will have a back problem at least once in their life, with as many as 20% in persistent and chronic pain. Now a study at the University of Pittsburgh Medical Center is hoping to try a new approach with a specific group—people with relatively mild back issues. The researchers hope that teaching them to look at their pain differently will diffuse the fear. The big idea is that a more proactive approach to back issues will keep people healthier and prevent their back issues from getting worse.

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The $14 million trial, comparing two approaches to back pain in an effort to avoid surgery, will eventually include 60 primary-care clinics. One group of patients will be assigned to “usual care”: doctors respond with what they think is best. The second group will see doctors as well as physical therapists who deliver cognitive behavioral therapy, coaching patients to put their back pain into perspective. “They’ll be reassured that they won’t become more and more injured, but that they will very likely recover,” says lead investigator Anthony Delitto, Ph.D., chair of the department of physical therapy in Pitt’s school of health and rehabilitation sciences. “The evidence favors recovery.” 

It’s important because people often dread their injury getting worse. “One of the issues is that people with even mild back pain tend to catastrophize,” he says. “Let’s say they bend down to pick up a pencil and hurt their back badly enough to warrant a trip to the doctor. They’re likely to say, `Well, I won’t do that again,’ when really more movement may be better.” 

The research is important, he says, because once people move into what is considered chronic back problems (a period of three months or more with pain at least 50% of the time) “most of the interventions aren’t very effective. It would be much better if we could keep people from crossing into the chronic pain category.” And if you’re losing sleep over back problems, try Life Reimagined’s 4 days to better sleep program.

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There’s no need to enroll in a clinical trial to see if your back could use a little talking to. The big clue, Delitto says, is if back pain—or concern about hurting your back—has stopped you from doing something you enjoy, or influenced a decision. “People will often say they’re considering taking a desk job to protect their back, and that’s not a good idea. Being too sedentary isn’t helpful. Or they’ll tell me they’ve given up cycling or running. But it’s not usually necessary. With the right adjustments, most things can be made safe for people with milder back issues.”

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