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Spine and Mental Health

Patients with chronic pain such as chronic back pain are under significant stress. This can lead to a variety of mental health issues, such as stress, anxiety and depression. This does not mean a patient is “mentally ill”, but is often a normal response to severe stress when our coping mechanisms are overwhelmed.

Here are some options of how to deal with problems of our mental health:          

I. Stress Relief

What kind of Stress Relief techniques are there?

Stress does not usually cause pain, but chronic pain often produces severe stress. Stress releases certain hormones which can cause us to feel even more pain.

Here are some stress-relieving techniques:

a. Breathing exercises

What are Breathing Exercises?

  • Sit comfortably with your back straight
  • Place one hand on the chest and the other on the stomach
  • Take deep controlled breath
  • Inhale through your nose
  • Exhale through your mouth pushing out as much air as you can while tightening up your abdominal muscles
  • Focus on breathing only, without any other conscious thoughts
  • Do this for 2-5 minutes and repeat throughout the day as needed

b. Progressive Muscle Relaxation

What is Progressive Muscle Relaxation?

  • Get comfortable first, loosen your clothes
  • Relax for a few minutes before starting
  • Breathe slowly and deeply throughout this exercise
  • Progressively flex and relax individual muscles in the body
  • Focus on one muscle group at a time, and make it into a sequence (i.e. right calf, left calf, right thigh, left thigh, etc.)
  • Flex muscle for 5-10 seconds and then relax it for 30-60 seconds, then repeat

c. Guided Imagery

What is Guided Imagery?

  • Picture yourself in a beautiful, calm, peaceful place of your choice, someplace you have been to or have seen pictures of
  • Place yourself there
  •  Experience the beauty of it by “looking” at different details of this place, listening to the sounds, “smelling” the air
  • Breathe slowly and deeply while you take in the sights, sounds, and smells

d. Body Scan

What is Body Scanning?

  • Lie on your back with arms and legs relaxed
  • Breathe deeply and slowly
  • Focus on what you feel in one part of the body at a time (i.e. right foot, left foot, right calf, left calf, etc.)
  • Imagine each breath flowing to that part of the body
  • At the end focus on what you feel for the whole body

e. Meditation

What is meditation?

  • Meditation can give a patient a break from pain
  • Meditation can disrupt the cycle of stress and pain
  • Meditation can be combined with exercise in Yoga, Pilates, and Tai Chi

f. Aerobic Exercise

How does Aerobic Exercise help relieve stress?

  • Can reduce stress hormones
  • Can release endorphins, which are chemicals that can interfere with pain

Here are some ways to maximize these stress-reducing techniques:

  • Make a schedule of practicing these techniques both by day and time of day
  • Avoid practicing the techniques when tired
  • Consider combining them (e.g. exercise and guided imagery)
  • Learn to practice the techniques while doing other things to incorporate them into our daily life


II. Psychological Treatments for Spine Pain

Why do patients with chronic back pain benefit from Psychological Treatments?

Spine specialists sometimes refer patients to Psychologists. This is usually not meant to imply that the pain is psychological, but rather the realization that the mental and physical health are often strongly related. Since spine specialists deal with the physical health, they often feel that a specialist who can help with the mental health is an important part of the team. It is this team approach (multidisciplinary) that can make more progress than just one specialist alone.

When a patient is chronically in pain it is normal to feel angry, sad and depressed. Pain can change your personality, appetite, sleep hygiene and interfere with relationships.

When pain becomes chronic (often more than 6 months) it is no longer a useful signal given to us by our body. Instead it makes us stressed, anxious and inactive which creates an escalating cycle of pain. Patients suffering from chronic spine pain often suffer from emotional distress.

What kind of psychological problems can chronic back pain cause?

Psychological counseling plays an important role in the management of chronic pain. Psychologists can help address some of the following issues:

  • Anger
  • Self-esteem issues
  • Anxiety
  • Emotional distress
  • Behavioral Issues
  • Sleep Disturbance (insomnia)
  • Pain Perception
  • Depression
  • Social withdrawal issues


What are some of the specific Psychological Treatments which help back pain patients?

Here are some specific psychological treatments available for chronic spine pain:

  1. Cognitive Behavioral Therapy (CBT)

CBT teaches patients to divert their attention from pain to other more pleasant thoughts and sensations. The sensation of pain is often only useful for acute pain such as touching a hot stove. This sensation of pain makes the patient move the hand from the stove to avoid injury. In chronic pain, there is often no real usefulness to the perception of pain and it is therefore not necessarily a warning sign.

CBT teaches the patient to overcome the fear associated with pain and rather replace it with a different more pleasant sensation. This can have significant benefits, especially when combined with an exercise program.


  1. Biofeedback

Biofeedback makes patients aware of reactions of the body which are often subconscious. An example is a back muscle which begins to tighten from stress and eventually spasms, causing pain.

In Biofeedback, small sensors are placed over specific muscles. These sensors can detect rising muscle tension, which can cause muscle spasm and pain. Patients can learn to recognize the rise in muscle tone and tension, and learn to relax the muscle before it becomes a painful spasm. This can give the patient a greater sense of control over the pain, and potentially help avoid it altogether.

      2. Relaxation Training

Here are some examples of relaxation techniques taught by Psychologists:

a. Breathing Exercises

b. Progressive Muscle Relaxation

c. Guided Imagery

d. Body Scan


3. Psychoanalytical Therapy (Talk Therapy)

Here are some items about Talk Therapy:

a. Founded by Sigmund Freud

b. Psychologists listen to patients talk about their lives

c. Psychologists look for events or patterns in the patient’s lives to help coping with current issues


4. Group Therapy

This form of therapy can help with the following:

  1. Patients can learn from the experiences of others
  2. Patients can get input from others who have been through similar experiences
  3. Patients do not feel alone with their problems
  4. Patients can get emotional support from other patients


III. Psychiatric Treatments for Spine Pain

What are Psychiatric Treatments for Spine Pain?

When a patient’s spine pain likely requires medication management or a more intense treatment course, psychiatrists are often involved in helping the patient. This is not because the patient is mentally ill, but rather some patients may require mental health help from a medical specialist. Problems with substance abuse are also treated by Psychiatrists.

Unlike psychologists, psychiatrists can prescribe medications and admit a patient to a hospital if needed.

Here are some medications often prescribed by Psychiatrists for Spine Pain patients:

  • Anti-depressant medications
  • Anti-anxiety medications
  • Sleep aids