Medical commentary: It’s in your head

“Can you please prescribe Percocet for my chronic back pain? It’s killing me.” 

“Why don’t we try a different approach?” I say. “Maybe even meditation or stress relief.”

“Are you crazy? The problem is in my back, not my head. Are you going to help me?” 

“Of course, but let’s keep an open mind.” 

He ends the conversation with, “Here’s an open mind. I’m looking for somebody else.”

At a time when opioid addiction is at epidemic levels, this exchange with my patient shows how the problem begins. Well-meaning folks want an easy fix and doctors have few options. A recent study in the Journal of the American Medical Association suggests hope from a different approach.

Researchers at the University of Washington enrolled patients with chronic low back pain into a trial comparing typical physical therapy and pain relievers versus typical medical care plus meditation and yoga, or typical care combined with cognitive behavior therapy — an established mind-body training session helping people change pain-related thoughts and behaviors.

Weeks later, both mindfulness techniques and cognitive behavior therapy showed improvements that were greater than usual medical care. A year later, patients who used these techniques maintained their improvement in low back pain.

There’s reluctance for patients and some doctors to embrace such new methods of pain therapy with the belief that meditation and/or stress relief are new age hocus-pocus. But it seems to work and insurers need to cover such options. So if you find yourself with chronic low back pain, the answer might be in your head — no prescription needed.