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My Back Recovery: Recovering from Chronic Low Back Pain

In every episode we share valuable insights from systematic research and clinical guidelines, as well as advice from experts dedicated to helping people recover from chronic low back pain. My Back Recovery promotes evidence based treatment options, safe training and expert strategies to help you make smart decisions about your rehabilitation process.
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Sep 4, 2017

Through relaxation you can break the vicious circle of pain and stress. This podcast takes you through some easy to learn methods of relaxation, helping it to become part of your daily life and improving your wellbeing. It also lists the benefits of meditation and looks at the supporting scientific evidence, examining why relaxation should be an integral component in your recovery.

 

Relaxation

Relaxation is an integral component of cognitive behavioral treatment programs for chronic pain.1 Taking care of stress and anxiety as a chronic pain patient is crucial for your recovery.

 

Meditation

 

Meditation is also a great way to built relaxation into your daily life. There are many different ways of practicing meditation and you have to find what works best for you.  

Many people enrich their lives through practicing meditation.

When you read interviews with successful CEO´s, entrepreneurs or celebrities who have incorporated meditation routines in their lives it is astonishing to see the huge benefits they experience.

 

Personal benefits of people who meditate regularly:

more happiness

having more energy

having more creativity

living more efficiently

a better understanding of ones own emotions

more sensitivity to the feelings and emotions of others

more control over ones own emotions

less pressured by your experiences

less stressed

feeling more relaxed

more calming thoughts

control over your sensory filtering

improved memory and executive function

increased ability to concentrate

increased emotional intelligence

 

Thinking about relaxation, mindfulness and awareness during our recovery can’t be done without looking at some important evidence and thoughts about meditational practices:

Mindfulness meditation programs improve anxiety, depression and pain over the course of 2–6 months. The effects are comparable with those you can expect after taking antidepressants for the same period of time, but without the associated toxicities.2

47 placebo-controlled trials all found small to moderate improvements in pain, anxiety and depression. What is really great about this review (Meditation programs for psychological stress and well-being from 2013) is that it demonstrates that the meditation group attained better results compared to the control group undertaking an equally intense treatment regarding focus and time, such as lectures, talks and art therapy sessions.

If we consider this evidence, then it seems a good reason to check out mindfulness for yourself and see if meditation could be something for you to try.

 

 

A definition of mindfulness

Mindfulness has been described as a “non-elaborative, non-judgmental awareness” of present moment experience.3

Maybe you have heard of Zen, it´s very closely related to the mindfulness approach.

In general mindfulness techniques can be divided into two styles:

focused attention

"Focused attention is associated with maintaining focus on a specific object, often the changing sensation or flow of the breath or an external object. When attention drifts from the object of focus to a distracting sensory, cognitive or emotional event, the practitioner is taught to acknowledge the event and to disengage from it by gently returning the attention back to the object of meditation".3

open monitoring

"By contrast, open monitoring is associated with a non-directed acknowledgement of any sensory, emotional or cognitive event that arises in the mind. Zen meditation is considered to be one form of open monitoring practice. While practicing open monitoring, the practitioner experiences the current sensory or cognitive ‘event’ without evaluation, interpretation, or preference".3

 

Many guided meditation programs consist of a mix of those two styles. Often changing from one to the other within a meditation session.

I also think that it’s really important to know that clinical research into mindfulness has been going on since the early 1980s. For me this means that there is a good scientific evidence for using meditation techniques detached from religious beliefs or dogma for health purposes.

 

How to start

There is plenty of good content on the Internet available for free, simply search for mindful meditation. Check out some talks about meditation on TED.com and be inspired, or check out www.mindful.org

Here are some great resources:

Free guided meditations from UCLA:

Each week has a different theme, and usually includes some introductory comments, a guided meditation, some silent practice time, and closing comments. Presented by the UCLA Mindful Awareness Research Center.

http://marc.ucla.edu/body.cfm?id=107

http://marc.ucla.edu/body.cfm?id=22

 

UCSD Center for Mindfulness:

Guided audio files for practicing Mindfulness-Based Stress Reduction (MBSR) from the UC San Diego Center for Mindfulness.

http://health.ucsd.edu/specialties/mindfulness/programs/mbsr/Pages/audio.aspx

 

Basic meditation with Tara Brach
Free meditations that you can stream or download.

https://www.tarabrach.com/guided-meditations/

 

Contemplative Mind in Society
Guided practices from Mirabai Bush, the center’s director, Diana Winston from UCLA’s Mindfulness Awareness Research Center, and Arthur Zajonc, president of the Mind & Life Institute.

http://www.contemplativemind.org/practices/recordings

 

Insight Meditation Society 
Selected talks, podcasts, and audio streams, including various lengths of guided meditation.

http://www.dharma.org/resources/audio#guided

 

John Kabat Zinn on youtube:

Professor of Medicine Emeritus and creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

https://www.youtube.com/watch?v=8HYLyuJZKno

 

Literature: 

  1. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175.
  2. Goyal M, Singh S, Sibinga E, et al. Meditation programs for psychological stress and well-being : a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357-368. doi:10.1001/jamainternmed.2013.13018.Meditation.
  3. Zeidan F, Grant J., Brown CA, et al. Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain. Neurosci Lett. 2012;520(2):165-173. doi:10.1016/j.neulet.2012.03.082.
May 12, 2017

Goal-setting can support your recovery from back pain and lead you to a better quality of life. Part 2 of this episode shows you proven techniques that help you in achieving what you aim for. + download your personal goal-setting sheet for free!!!

Get your free Personal-Goal-Setting-Sheet here

 

Part 1 was about what you should aim for in your recovery: 

  1. Increasing physical activity1,2,3,4
  2. improving sleep quality4,5
  3. managing stress4,6

 Now let´s dig in how goal-setting can help us in achieving that.

 In their Article from 2002 Edwin Locke from University of Maryland and Gary Latham from Univerity of Toronto sum up the evidence about what science knows about the mechanisms of goal-setting.7

Goals affect performance through four mechanisms:

  • direct attention and effort
  • energizing function
  • goals affect persistence, hard goals prolong effort (important for us, recovery process is a long term comittment)
  • goals affect action indirectly by leading to the arousal, discovery, and/or use of task-relevant knowledge and strategies

 

To sum it up: "Effects of Goal-Setting are very reliable. Goal-setting theory is among the most valid and practical theories in organizational psychology."7

Those with high specific goals reach higher performance than those who tried to do their best. It´s not always that easy and we will talk about what research tells us, what is important in defining goals that help reaching higher performance. And thats exactly what we are looking for.

 

They further conclude:7

a goal should be specific,

proximal goals should be added,

proper use of learning goals should be made.

What does this mean?

 

A general goal would be: Increasing physical activity.

A specific goal would be: Increase walking distance up to 20 min a day. Translated into a proximal goal: Walk 20 min every day for one week starting today.

And you could also add a strategy: Walk 20 min every day, before a get into the car driving to work starting today, or getting out of the bus-stop one station before my destinantion and walk there. Be creative!

 

So thinking about activity:

Set specific Goals.

Add a proximal goal and add a strategy

 

Be clear about why you are doing this!

You are not doing this right now to become instantly pain free, you want to increase physical activity, increase quality of sleep and manage stress because in the long run that is what you will benefit from and as aresult will increase your quality of life.

 

Start with something that you are confident to achieve.8

No doubt there should be some challenge within your set goals. Sucess in reaching your goals will feed your confidence and step by step you can start set higher goals for your self. Goal setting is also about self efficacy, which means confidence in that you can achieve your goals. So thats a reward on it´s own, and we need that in roder to go on with our recovery.

 

Goals lead to higher performance when people are committed to their goals and receive summary feedback.

And there are several ways you can enhance commitment.

Through factors that make goal attainment important for you

First of all write your goal down. Put your Goals somewhere where you can see them, so that you stay focused and you reflect upon them.

Having an accountability buddy helps in multiple ways. The announcement to another person will raise the importance of xour goals for you and if you hold a weekly conversation where you report about your progress or difficulties you will have a fixed time to reflect upon your situation and this feedback will enable you to find better strategies to overcome difficulties. 

 

Resource Section: Goal-Setting-Sheet

Get your free Personal-Goal-Setting-Sheet here

Set your goals for each day and at the end of the day reflect on them. Did you made it? Great! If not reflect about the reasons for it. Can you think of any strategy how to achieve your goal the next time you will be in the same situation? Could you ask someone for help if it is a time problem? Any strategy is better than no strategy. And by trying out new things you probably will come along with better and better strategies that will work for you.

 

If you are short on time, make it a 5 min goal. Maybe some stretching, or mobilisation-technique that you already know that you can do before you go to sleep.

Find more information at www.mybackrecovery.com

 

 Literature:

  1. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3-5. http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012.
  2. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461-473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012.
  3. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012.
  4. Hooten W, Timming R, Belgrade M, et al. Assessment and Management of Chronic Pain.; 2013.
  5. Pakpour AH, Yaghoubidoust M, Campbell P. Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain. Pain Pract. 2017:1-2. doi:10.1111/papr.12584.
  6. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175.
  7. Locke E a, Latham GP. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. Am Psychol. 2002;57(9):705-717. doi:10.1037/0003-066X.57.9.705.
  8. Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: An exploration and status report. Patient Educ Couns. 2009;76(2):174-180. doi:10.1016/j.pec.2009.06.001.

 

Apr 16, 2017

8.1 Setting Goals to Boost Your Recovery from Back Pain - Part 1

What we should aim for in our recovery process and how setting the right goals can help us with that.

 

What to aim for

The most effective treatments for low back pain include exercise or multidisciplinary rehabilitation (also see Episode 06).

Passive treatments, on the other hand, have not been demonstrated to induce long-term improvements.1

 

  1. Physical Activity and Therapeutic Exercise 2,3,4,5

This is what we know what will help in the long term. Increasing activity. Developing a set of active coping strategies.

 

  1. Improve Sleep5

Improving sleep also makes total sense, since over 50% of people living with chronic pain suffer from depression and there is a strong correlation between quality of sleep and depression. And depression has an impact on your recovery process.5

"Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP"6

 According to the "2015 sleep in america poll", making sleep a priority is linked to better sleep, even among those with pain. Setting the right goals has a direct impact on your life.

 

Check out the videos of the national sleep foundation about sleep and chronic pain:

Sleep and Pain: Beat the Cycle and Improve Your Sleep Today

https://sleep.org/articles/sleep-pain-beat-cycle-improve-sleep/

 

Chronic Pain and Sleep

https://sleepfoundation.org/sleep-disorders-problems/pain-and-sleep

 

What is Sleep Hygiene

https://sleep.org/articles/sleep-hygiene/

 

  1. Manage Stress5

Relaxation is an integral component of cognitive behavioral treatment programs for chronic pain.8

-formal interventions are for example: therapy, counceling classes, support group,

relaxation techniques, meditation, yoga, breathing exercices, autogenic trainingcreative activity....-

There is a lot of research how people living with chronic pain can benefit from meditation and relaxation techniques. Watch out for the next episode!

 

Part 1 of this episode examined what you should be aiming for in your recovery and why this is important.

Part-2 will show you proven techniques that help you in achieving what you aim for.

find out more on www.mybackrecovery.com 

Literature: 

  1. Scheermesser M, Bachmann S, Schämann A, et al. A qualitative study on the role of cultural background in patients’ perspectives on rehabilitation. BMC Musculoskelet Disord. 2012;13(5):5. doi:10.1186/1471-2474-13-5.
  2. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3-5. http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012.
  3. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461-473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012.
  4. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012.
  5. Hooten W, Timming R, Belgrade M, et al. Assessment and Management of Chronic Pain.; 2013.
  6. Pakpour AH, Yaghoubidoust M, Campbell P. Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain. Pain Pract. 2017:1-2. doi:10.1111/papr.12584.
  7. 2015 Sleep in America Poll. Sleep Heal. 2015;1(2):e14-e375. doi:10.1016/j.sleh.2015.02.005.
  8. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175.

 

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