Chronic Low Back Pain

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DR. SCHUBINER: I agree with that completely. Many times people will say, “Oh, you mean your treatment is mind over matter.” Actually, when you think about it, as I mentioned earlier, if chronic pain is a disorder of the brain and a central sensitization process, then really it’s “mind over mind,” and that’s clearly possible. People can change the way they approach things, they can change the way they conceptualize things, and they can change the way they respond.

For example, we know that pain causes fear. We also know that fear causes pain. This vicious cycle is responsible for a tremendous amount of suffering. The techniques that we’re talking about can interrupt that cycle and lead to healing.

DR. RAKEL: That’s supported by the research on neuroplasticity and how we can change the brain.27 I think the most important thing I can do is convey to the patient that I believe they can get over the pain. Sometimes, they need to hear that from their health care provider. That may not always be the case, as we have to be real and truthful. But, having someone believe in their healing potential is half the journey.

DR. KURISU: Just a comment on the hope that Dr. King was talking about. Many a times, these patients have bounced around from many different pain clinics and many different specialists. The model that was presented to them is just more medications or conventional surgeries. So, when they finally get that sense of hope or finally feel that sense of empowerment, the light bulb goes on and they feel like, “Oh well, I can control this. This pain is a part of me as much as I’m a part of it. I can take these steps to help prevent this from happening.”

DR. SCHUBINER: It’s not false hope. It’s the truth, and what I always tell my patients is that “the truth will set you free.”

DR. RAKEL: Any final words anyone?

DR. KING: We have not mentioned that word “spirit” in the body–mind–spirit dimension. I think we talked around it in the mental-emotional-psychosocial aspect. This is something that I think the doctor-patient relationship, and the uniqueness of that, addresses as a relationship of one being with another being. How we operationally define that for research, is something to be seen. For the sake of our discussion, I don’t think we can avoid matters of “the spirit” or the soul. I just wanted to mention that because I think it is embodied through the approach where you’re talking to your patient and you’re putting your hands on them as all of us in the manual medicine/manual therapy will do.

DR. SCHUBINER: There is neurological research being conducted on this topic.28

When you activate social connectivity, you’re activating a sense of awe, and you’re activating the parts of the brain such as the dorsolateral prefrontal cortex that turn off the amygdala and the anterior cingulate cortex pathways that create pain. So, you’re absolutely right.

DR. RAKEL: Isn’t this a great opportunity for us to expand our strategies and research skills to look at the outcomes and the pragmatic controlled trials that ask us to determine what influences our quality of life the most? If we look at that bigger picture, we can’t help but bring up topics like meaning, belief, emotions, and spirituality. If we are going to create expertise to better understand how complex systems heal, we have to include these important ingredients.

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