Long-lasting back pain does not stay confined to one part of the body. On painful days, it can change plans and make people weigh what they can and cannot do. Researchers at UC San Diego School of Medicine have offered a clue to how this experience appears in the brain. When chronic low back pain patients move and their pain surges, a brain network involved in thinking about the self lights up. The findings were published October 5 in the British Journal of Anaesthesia.
Just lifting a leg was enough to activate the self-related network in the brains of 114 people
The research team recruited 114 adults who had experienced back pain for more than 12 weeks. Participants took a test in which they lifted a leg, a standard way to deliberately trigger back pain. During the test, researchers measured brain blood flow using arterial spin labeling, a form of functional magnetic resonance imaging (fMRI).
When movement triggered pain, the brain’s default mode network (DMN) became active. This network is a circuit connecting several areas of the frontal, parietal and temporal lobes, and it is active when we think about ourselves. That is why the research team calls it the self network. Patients with more severe pain had stronger connections between this network and the primary somatosensory cortex. The more intense the pain became during leg lifts, the greater the activity in sensory and motor areas. Changes in heart rate during the test also helped indicate how sharply the pain was surging.
It quieted with a hot stimulus but lit up with back pain
The researchers also conducted a comparison experiment. When they applied a painful but harmless heat stimulus to participants’ calves, the default mode network quieted. This is the familiar response the brain shows when sudden pain occurs.
Senior author Professor Fadel Zeidan said this was the first study to show that, while the network had quieted whenever people felt pain in all previous pain studies, it instead became active when chronic low back pain patients experienced a surge in pain. The research team interpreted the findings to mean that, in chronic low back pain, the brain incorrectly links physical pain with a deep sense of self. Zeidan said pain medicine today focuses only on eliminating symptoms, even though they are not the root of chronic pain.
Mindfulness was not tested in this study
This study observed brain responses. It did not test whether mindfulness meditation changes those responses. A university press release cited separate preliminary studies by the research team, saying mindfulness meditation and psilocybin may help reduce pain intensity by separating the experience of pain from a person’s sense of identity. Zeidan described mindfulness as a meditation technique that cultivates the ability to notice the present moment without judgment. The press release also made clear that these findings are preliminary and require further study. Zeidan’s lab is conducting several clinical trials based on brain imaging. Psilocybin is a substance regulated as a narcotic in South Korea.
What a 342-person clinical trial from 10 years ago found
This is not the first research to examine mindfulness and back pain together. A prominent example is a 2016 study published in JAMA by Group Health Research Institute and the University of Washington. Researchers randomly assigned 342 adults ages 20 to 70 with chronic low back pain to mindfulness-based stress reduction (MBSR), cognitive behavioral therapy or usual care. Both programs met for two hours once a week over eight weeks.
After 26 weeks, the proportion of participants whose daily functioning improved meaningfully was 61% in the MBSR group, 58% in the cognitive behavioral therapy group and 44% in the usual-care group. The effects had not diminished substantially a year later. The researchers rated the effect size as moderate. This means mindfulness is not a treatment that eliminates pain, but one option that may be considered alongside standard care.
Rather than eliminating pain, create distance between yourself and the pain
For people who meditate, this study offers a clue in the language of the brain to explain why it can matter to practice not treating pain and the self as one and the same. For people living with long-term pain, pain can become more than a sensation; it can turn into a story about being a person who is in pain. Practicing stepping back from that story is central to mindfulness.
For people with back pain, sitting meditation for long periods can be a burden. For modern people whose lives have become increasingly sedentary, practices that follow bodily sensations—such as a body scan while lying down, slow walking meditation or gentle movements coordinated with the breath—can offer an easier way in. What works varies from person to person, and if pain is severe or persistent, consulting a health care professional should come first. Meditation is not a substitute for treatment. It can, however, be a way to make time for self-care in a day spent living with pain.
For inquiries: fare3041@naver.com