Chronic Back and Neck Pain — Neuroplastic & Mind-Body Resources
By Kent Bassett
Chronic back pain and neck pain are some of the most confusing conditions to understand clearly because doctors frequently give people wrong information that makes them fearful.
It is common to tell patients that an MRI has revealed the cause of pain, when in fact, it is only a correlation. Doctors often attribute herniations, bulging discs, narrowing of the nerve canal (“stenosis”), and disc degeneration as causing pain, when it’s been demonstrated in studies that huge numbers of people have these same spinal changes with no pain.
In response to scary-sounding diagnoses combined with worsening pain, people will fear they have structural damage and start avoiding activities in order to prevent further damage. Their pain will typically grow worse, and this can lead to a fear-avoidance cycle that snowballs into worsening pain, inactivity, and disability.
Check out the webinar below with The Pain PT, Jim Prussack! Hosted by This Might Hurt director, Kent Bassett. 👇
NEW! Pain Reprocessing Therapy (PRT) for Back Pain recently featured in a 2023 TODAY show segment
“Yoni Ashar, PhD: Tell me when it starts, tell me when it stops, does it move, tell me your pain history, how many chronic pain conditions have you had over the course of your life...
NEWS ANCHOR: What you’re describing sounds like talk therapy, not physical therapy.
Yoni Ashar PhD: Yes, it’s physical therapy for the brain”
What If There’s Spinal Damage that Requires Surgery?
According to an article Howard Schubiner, MD wrote about back pain, “Back Surgery for Back Pain: Caution Is in Order,” “those with back pain who do not have loss of muscle function do not need surgery, even if they have evidence of spondylolisthesis, degenerated or herniated discs, or spinal stenosis.” If there isn’t loss of muscle function along with pain, then taking injections and going under the knife is merely “wishful thinking.” (Of course, clear structural damage problems like a tumor or an infection can require surgery as well.)
The exception to this guideline is for people who have pain and a physical examination that reveals problems with muscle control. Muscle control issues are uncommon with back pain patients, but when it happens surgical intervention can be quite successful. The vast majority of chronic back pain patients (studies say about 85%) do not meet this criteria, yet they are frequently recommended surgery anyways.
There is a massive financial incentive to operate on chronic back pain patients even when it is unnecessary and unlikely to lead to pain relief.
Below is a trailer for This Might Hurt specifically made for people with chronic back and neck pain.
Here’s renowned neuroscientist Lorimer Moseley, PhD, breaking down the old understanding of back pain versus the new neuroscience-informed understanding.
Don’t Treat Your MRI
In an excerpt from our film, This Might Hurt, Dr. Schubiner presents about a compelling study that shows how it’s unwise to assume herniated discs, bulging discs, and degenerative disc disease are the cause of chronic back pain:
And here’s an animated video and discussion of how MRIs are frequently used to justify unnecessary surgeries:
Does Surgery Work for Chronic Back Pain?
The data on surgery for chronic back pain is … not great. One significant study found that “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC (Workers Comp) setting is associated with a significant increase in disability, opiate use, prolonged work loss, and poor Return to Work Status.”
In this study, two years after fusion surgery, 26% had returned to work, whereas for a control group with back pain who did not get surgery, 67% returned to work.
Of course, all doctors, including physicians who specialize in diagnosing psychophysiologic disorders agree that many back surgeries are 100% necessary. These surgeries become necessary for instances of a tumor, or for a significant nerve compression that also creates symptoms in the legs that line up according where you would expect a specific nerve compression to create symptoms.
If you have questions about whether back surgery is necessary, you may want to consult the work of David Hanscom, MD, a spinal surgeon who has also undergone spinal surgery himself.
After looking carefully at the research, Dr. Hanscom began diverting a majority of his prospective surgery patients, and helping them become pain-free without surgical intervention. His book “Do you Really Need Spinal Surgery?” is a good place to start. His podcast interview is also good.
Tools for Healing Back Pain Without Drugs or Surgery
1. You could fill out this quiz on our site, which gets people asking themselves insight-generating questions about their symptoms. A score of more than 2-3 points indicates a high likelihood of brain-induced causes of pain, rather than structural causes.
2. You could listen to this interview with a spinal surgeon, Dr. David Hanscom, who breaks down the data on back pain and talks about why he diverts a large percentage of his patients away from surgery.
3. Here’s a great podcast with psychologist Dan Ratner about his journey with back pain. Ironically, he had a clean MRI scan, but still horrible chronic back pain.
4. Check out our five steps to overcoming chronic pain.
5. Read other people’s stories from the TMS Wiki of overcoming severe back pain using concepts featured in This Might Hurt.
A Groundbreaking Study Suggests There’s a Cure for Chronic Back Pain
Brain imaging: “When people in the PRT group (Pain Reprocessing Therapy) were exposed to pain in the scanner post-treatment, brain regions associated with pain processing – including the anterior insula and anterior midcingulate —had quieted significantly.” by Lisa Marshall at SciTechDaily.
A new brain imaging study on back pain was recently published, “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain,” written by Yoni Ashar, Tor Wager, Alan Gordan, Howard Schubiner, Christie Uipi, Tor Wager, et al, at the Wager lab in Colorado, JAMA Psychiatry, September 29, 2021.
“Of 151 total participants, 33 of 50 participants (66%) randomized to PRT were pain-free or nearly pain-free at posttreatment, compared to 20% for the placebo injections and 10% randomized to usual care. Treatment effects were largely maintained at 1-year follow-up.” Average duration of pain was 10 years.
In other words, pain reprocessing therapy was a cure for back pain for two-thirds of people randomized to the treatment.