September 5, 2019

Chronic Back Pain? You May Find Relief With Behavioral Medicine

Understanding the brain’s relationship to pain

Older man with severe back pain

No pain, no gain? Not true for people suffering from chronic back pain. Instead, it’s the opposite: Back pain is one of the main causes of missed work (and missed paychecks).


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But could the key to coping with chronic back pain be in your mind? “We actually know that pain is not just a sensory, or physical, experience,” says psychologist Sara Davin, PsyD, MPH. “It is also an emotional experience.”

Dr. Davin explains how you can harness your pain management super-powers by understanding the very real connection between pain and your thoughts.

The 411 on the mind-back pain connection

To understand how it all works, think of pain’s purpose. Pain is your brain’s way of alerting you that something is wrong, whether it’s a stubbed toe or a slipped disk.

How your brain processes an injury, then shares that information, has a direct connection to the level of pain you feel. You’re aware of pain because your brain tells you it’s there. (Psst — your brain also controls your thoughts and emotions.)

“Pain is processed in the brain and the central nervous system. Both have areas connected to the sensory experience, but both also have areas connected to the emotional experience,” Dr. Davin explains. “The sensory and emotional go together to create the output of one’s experience of pain. So to comprehensively treat chronic back pain, we have to look at both sides.”


And while traditional treatments like medications and physical therapy can take the edge off, they often ignore the elephant in the room: your thoughts.

“Managing back pain with behavioral medicine strategies might even prevent the pain from becoming chronic,” Dr. Davin states.

What is cognitive behavioral therapy for pain?

CBT for pain is talk therapy’s more specialized cousin. It’s a behavioral medicine strategy that teaches people how to:

  • Make the connection between how they think about their pain and the way they interpret it.
  • Understand how pain impacts their emotions.
  • Choose coping skills to help with how they function and behave.

Still not sold? Dr. Davin gives this example: Someone who feels that their pain is unbearable may cope by lying in bed and isolating themselves from activities they value. “This cycle can go on and on,” she explains. “The person becomes more helpless and then, from a physical standpoint, becomes weaker. Naturally, they now have even more pain.”

With CBT, that helpless feeling (and associated pain) is kicked to the curb because pain psychologists teach people how to:

  • Pace activities so they don’t overdo it.
  • Practice relaxation and meditation to decrease pain and stress.
  • Soothe their central nervous system, which increases the feeling of pain when under stress.

The proof is in the pudding. Dr. Davin runs an interdisciplinary program that uses physical therapy and CBT to treat chronic back pain. Patients participate in this program for 4 to 10 weeks, depending upon their progress.


“Folks in the program were better when compared to physical therapy alone,” she reports. “We have consistently seen significant improvements across all quality of life measures, including how much pain interferes with someone’s life, levels of fatigue, anxiety and depression, plus improvements in pain-related disability.”

Interestingly, one of the metrics that improves the most in the program is how satisfied participants are in their social roles. “In our program we teach people how to start having fun again and connected with others,” Dr. Davin notes. “I suspect this is why we see people wanting to be more socially active after the program.”

3 ways to put this new knowledge into action

Here’s how you can incorporate behavioral medicine strategies into your back pain management:

  1. Find a good pain management doctor. “You want a doctor who helps you rehabilitate and regain quality of life, but who also thinks about pain beyond its physical components,” Dr. Davin says. “Patients often struggle with the behavioral piece and think it means that their pain isn’t real. But your pain is real — you just need someone to help you manage it better using behavioral medicine skills and strategies. Pain psychologists are trained to do this.”
  2. Get your research on. Dr. Davin suggests powering up your e-reader and searching for books that outline the basic strategies for cognitive behavioral therapy for pain. Your doctor may also recommend an online course or resources that offer science-based education about how to overcome chronic pain.
  3. Don’t neglect physical therapy. Dr. Davin emphasizes that physical therapy is essential to maximizing back pain relief. “A physical therapist who’s trained in pain and neuroscience education can explain why behavioral medicine treatments work, plus help you use them,” she says.

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