When I was a junior doctor, I dreaded the back pain clinic. You had a few minutes with each patient to talk through their months of debilitating pain. There was little to offer in terms of relief. Fast forward and back pain is only getting worse. A report from the University of Washington in Seattle found that while people live longer, they feel healthy for fewer years because of backache. So what can help relieve pain and reduce the annual 10m days lost from work each year in the UK due to backache?

It depends on the cause, but exercise, spinal manipulation and painkillers such as codeine (a weak opiod) and paracetamol are often recommended. Taking opiods for years can make people dependent and invariably causes constipation. Guidance from Nice, which is being updated, also recommends cognitive behavioural therapy (CBT) – training to change how people think and behave when they have pain, which is notoriously hard to come by.

Now mindfulness-based stress reduction (MBSR) can be added to the mix, following the first trial comparing this treatment with usual care or cognitive behavioural therapy. In a study of 342 adults aged 20-70, randomly and equally allocated to each treatment group and having suffered with back pain for an average of 7.3 years, those given mindfulness training found it easier to get out of chairs, go upstairs and had less pain than those given usual care. In the MBSR group, 61% felt more able to move around without pain than the 44% who carried on with their usual care. CBT was equally as good as MBSR at reducing pain. The effects lasted for at least a year.

So what is MBSR, and is it worth trying if you have chronic back pain?

The solution

MBSR reduces the stress and negative impact of backache by changing how the mind processes pain. MBSR in this study involved two-hour group sessions once a week for eight weeks in which people were taught meditation, yoga and body awareness. An early exercise has people lie on a mat for 10-20 minutes, focusing on one part of the body at a time, becoming aware and “accepting of any sensations”. If you can try MBSR, you might as well: there are no side-effects and it seems to carry on working.

Dan Cherkin, of the University of Pittsburgh School of Medicine and the lead author of the research paper, believes that training the mind may have longer-lasting effects than manipulating the spine. Research even suggests that MBSR may cause physical changes in regions of the brain that regulate emotion, memory and self-referential awareness. Cherkin acknowledges that MBSR may be as hard to come by as CBT, but says there are online courses and adds that MBSR-founder Dr Jon Kabat-Zinn’s classic book Full Catastrophe Living could help. Of course, none of this implies that back pain is in the mind. It is worth noting that MBSR is also being looked at in breast cancer, to see if it not only reduces distress but improves survival.

Dr Luisa Dillner

  
RECONNECT TO YOUR HEART AND ENJOY YOUR DAY

  
Definitely!

  
If there are obstacles, it cannot be space,

If there are numbers, it cannot be stars,

If it moves and shakes, it cannot be a mountain,

If it grows and shrinks, it cannot be an ocean,

If it must be crossed by a bridge, it cannot be a river,

If it can be grasped, it cannot be a rainbow.

These are the six parables of outer perception. 

Milarepa 

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Happiness is the result of inner maturity. It depends on us alone, and requires patient work, carried out from day to day. Happiness must be built, and this requires time and effort. In the long term, happiness and unhappiness are therefore a way of being, or a life skill. 

Matthieu Ricard

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Each Individual is master of his or her destiny: It is up to each person to create the causes of happiness.

The 14th Dalai Lama

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  The better we understand the nature of mind, the more deeply we will be able to see into the endless chain of cause and effect that is karma. This understanding not only allows us to avoid or reduce the negative actions which harm others or ourselves and the suffering caused by these, but also lets us cultivate and increase positive actions which create well-being and happiness. 

Kalu Rinpoche

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Actions may be positive or negative according to the intention that underlies them, just as a crystal refracts the colours of its surroundings.

Dilgo Khyentse Rinpoche

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BMINDFUL AT BEDTIME

Good advice before going to sleep at night. 

Sitting on the side of your bed or lying down in bed, take a few minutes and bring your attention to your breathing. Allow yourself to notice any underlying mood or energy that is running, expanding your awareness into them, bringing them into focus with a sense of allowing and acceptance. Gradually release them, little by little, as you let each breath out. Become aware of any thoughts and feelings that are about with curiosity and kindness, and also let them go, bit by bit, with each out-breath. Once your mind is calmer, expand your attention into the body with each breath. Allow yourself to relax with a sense of acceptance and ease, as you prepare to go to sleep. This is the end of your day, a time to gain rest and nourishment. Mindfully put down all of those things that you have taken-up during your day. You can pick them up again tomorrow, if they still apply. 

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Just like space

And the great elements such as earth,

May I always support the life

Of all the boundless creatures.

And until they pass away from pain,

May I always be the source of life

For all the realms of various beings

That reach unto the ends of space.

Shantideva 

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