Back and Neck Pain

June, 2006

Scope of the Problem
Estimates indicated that at any given time, 15%-20% of Americans have back pain, and 70% have had back pain at least once in their lives (Atlas & Deyo, 2001; Lipman & Jackson, 2000).

Back pain is the second leading cause of absenteeism from work (AAPA). Work-related back injuries are the country’s number one occupational hazard and costs Americans $50 billion a year (NINDS, 2005).

According to government statistics, there were 14.3 million office visits for conditions associated with back pain (Hart, Deydo & Cherkin, 1995). One study estimated that almost one-third (or 203 million) of all visits to complementary and alternative providers in 1997 were for back or neck pain (Wolsko, Eisenberg, et al, 2003).

Being in chronic pain can result in many psychological side effects, including anger, anxiety, depression, low perceived quality of life, low self-efficacy, and poor coping skills (Materson, 1999).

Mind-Body Approaches
Many studies demonstrate the effectiveness of cognitive-behavioral measures, including relaxation, meditation, and guided imagery, in reducing pain perception, physician visits and narcotic use, and increasing feelings of well-being and self-efficacy in pain conditions. One study of people with neck and back pain found that cognitive-behavioral intervention, including relaxation and imagery, was able to stop the pain from becoming a chronic disability in 88% of the cases (Linton & Andersson, 2002).

German back pain patients who used cognitive-behavioral therapy had long-term decreases in pain, less disability, and better outlook, and improved physical functioning (Basler, Jakle, et al., 1997). Researchers found meditation successful in a mixed group of chronic pain patients, including those with back pain. Location of pain did not appear to make a difference (Kabat-Zinn, Lipworth & Burney, 1985).

In 2003, researchers conducted an extensive review of studies of psychosocial-mind-body interventions (including imagery, relaxation, CBT meditation, imagery, and hypnosis) and concluded that “there is considerable evidence” that these approaches are effective in the treating chronic lower back pain (Astin, Shapiro et al, 2003).

A follow-up review by Astin confirmed that “multi-component mind-body approaches” are suitable adjunctive treatments for chronic lower back pain (Astin, 2004). The following year, a Cochrane Database System Review found strong evidence that CBT had a “medium positive effect” on pain and behavioural outcomes,” but whether these effects were long-term was inconclusive (Ostelo, van Tulder et al, 2005).

Another study reported that a higher percentage of patients had used complementary therapies for their back and neck pain than had used conventional approaches (54% vs. 37%). A higher percentage of those using complementary methods found those approaches “more helpful” than those who used conventional approaches (Wolsko, Eisenberg et al, 2003).

A three-year follow up study of back and neck pain patients revealed that a program of behavioral medicine had cut sick leave by almost two-thirds (Jensen, Bergstron et al, 2005). One multidisciplinary program that incorporated relaxation was also deemed effective in significantly reducing sick leave (Storro, Moel & Sveback, 2004). Patients who used a breath therapy program (body awareness, movement, breathing, and meditation) improve significantly, both physically and emotionally (Mehling, Hamel et al, 2005).

Meditation was able to reduce not only pain, but also anger and psychological distress in those with chronic low back pain (Carson, Keefe et al, 2005). Among other complementary approaches, patients using Iyengar yoga showed significant improvements in pain, function, and medication use; significantly, they also had high compliance rates. (Williams, Petronis et al, 2005).

Other studies of imagery in chronic pain include a study of tension headache patients (Mannix, Chandurkar et al, 1999). The imagery group were three times as likely to report major pain reduction (p=.004.) Relaxation and imagery has significantly reduced pain in studies involving patients with cancer, arthritis, fibromyalgia, hemophilia, and migraine headaches (Syrjala, Donaldson et al, 1995; Varni & Gilbert, 1982; Walco & Ilowite, 1992).

In all studies with follow-up, improvements in pain, function, and mental outlook were sustained through follow-up lasting as long as 18 months (Kabat-Zinn, Lipworth and Burney, 1985; Linton & Andersson, 2002; Materson, 1999).

Guided imagery can be a cost-effective complementary treatment for chronic pain, including back pain.

Astin A. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32.

Astin JA, Shapiro SL, Eisenberg, DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003; Mar-Apr;16(2):131-47.

Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16:120–31.

American Academy of Physical Medicine and Rehabilitation.
Accessed November 2005.

Basler HD, Jakle C, Kroner-Herwig B. Incorporation of cognitive-behavioral treatment into the medical care of chronic low back patients: a controlled randomized study in German pain treatment centers. Patient Education and Counseling. 1997 Jun; 31 (2):113-24.

Carson JW, Keefe FJ, Lynch TR, Carson KM, Goli V, Fras AM, Thorp SR. Loving-kindness meditation for chronic low back pain: results from a pilot trial. J Holist Nurs. 2005; Sep;23(3):287-304; discussion 305-9.

Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine, 1995; Jan 1;20(1):11-9.

Jensen IB, Bergstrom G, Ljungquist T, Bodin L. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain. 2005 Jun;115(3):273-83. Epub 2005 Apr 19.

Kabat-Zinn J, Lipworth L., Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain.” Journal of Behavioral Medicine, 1985; June; 8(2):163-90.

Linton SJ, Andersson T. Can chronic disability be prevented? A randomized trial of cognitive-behavior intervention and two forms of information for patients with spinal pain. Spine, 2002; Nov 1; 25(21): 2825-31.

Lipman AG, Jackson KC II. (2000). “Headache and muscle and joint pain.” In: Handbook of Nonprescription Drugs. 12th ed. Washington, DC: American Pharmaceutical Association; 2000:41–76.

Mannix LK, Chandurkar RS, Rybicki LA, Tusek DL, Solomon GD. Effect of guided imagery on quality of life for patients with chronic tension-type headache. Headache, 1999 May;39(5):326-34.

Materson R. The stress-pain relationship. The Pain Practitioner. 1999 Winter 9(4).

Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized, controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med. 2005 Jul-Aug;11(4):44-52.

National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov/health_and_medical/pubs/back_pain.htm
Accessed November, 2005.

Osteki RW, van Tulder MW, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2005 25;(1):CD002014.

Storro S, Moen J. Svebak S. Effects of sick-leave of a multidisciplinary rehabilitation programme for chronic low back, neck or shoulder pain: comparison with usual treatment. J Rehabil Med. 2004 Jan;36(1):12-6.

Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain, 1995; Nov;63(2):189-98.

Varni JW, Gilbert A. Self-regulation of chronic arthritic pain and long-term analgesic dependence in a haemophiliac. Rheumatol Rehabil. 1982; Aug;21(3):171-4.

Walco GA, Ilowite NT. Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. J Rheumatol.1992; 10):1617-9.

Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R, Steinberg L. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005 May;115(1-2):107-17.

Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine. 2003;28(3):292-7.