RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
BACK
OR NECK PAIN
June, 2006
Scope
of the Problem
Estimates indicated that at any given time, 15%-20% of
Americans have back pain, and 70% have had back pain at
least once in their lives (Atlas & Deyo, 2001; Lipman
& Jackson, 2000).
Back
pain is the second leading cause of absenteeism from work
(AAPA). Work-related back injuries are the country’s number
one occupational hazard and costs Americans $50 billion a
year (NINDS, 2005).
According to government statistics, there were 14.3 million
office visits for conditions associated with back pain
(Hart, Deydo & Cherkin, 1995). One study estimated that
almost one-third (or 203 million) of all visits to
complementary and alternative providers in 1997 were for
back or neck pain (Wolsko, Eisenberg, et al, 2003).
Being in chronic pain can result in many psychological side
effects, including anger, anxiety, depression, low
perceived quality of life, low self-efficacy, and poor
coping skills (Materson, 1999).
Mind-Body
Approaches
Many studies demonstrate the effectiveness of
cognitive-behavioral measures, including relaxation,
meditation, and guided imagery, in reducing pain
perception, physician visits and narcotic use, and
increasing feelings of well-being and self-efficacy in pain
conditions. One study of people with neck and back pain
found that cognitive-behavioral intervention, including
relaxation and imagery, was able to stop the pain from
becoming a chronic disability in 88% of the cases (Linton
& Andersson, 2002).
German back pain patients who used cognitive-behavioral
therapy had long-term decreases in pain, less disability,
and better outlook, and improved physical functioning
(Basler, Jakle, et al., 1997). Researchers found meditation
successful in a mixed group of chronic pain patients,
including those with back pain. Location of pain did not
appear to make a difference (Kabat-Zinn, Lipworth &
Burney, 1985).
In 2003, researchers conducted an extensive review of
studies of psychosocial-mind-body interventions (including
imagery, relaxation, CBT meditation, imagery, and
hypnosis) and concluded that “there is
considerable evidence” that these approaches are effective
in the treating chronic lower back pain (Astin, Shapiro et
al, 2003).
A follow-up review by Astin confirmed that “multi-component
mind-body approaches” are suitable adjunctive treatments
for chronic lower back pain (Astin, 2004). The following
year, a Cochrane Database System Review found strong
evidence that CBT had a “medium positive effect” on pain
and behavioural outcomes,” but whether these effects were
long-term was inconclusive (Ostelo, van Tulder et al,
2005).
Another study reported that a higher percentage of patients
had used complementary therapies for their back and neck
pain than had used conventional approaches (54% vs. 37%). A
higher percentage of those using complementary methods
found those approaches “more helpful” than those who used
conventional approaches (Wolsko, Eisenberg et al,
2003).
A
three-year follow up study of back and neck pain patients
revealed that a program of behavioral medicine had cut sick
leave by almost two-thirds (Jensen, Bergstron et al, 2005).
One multidisciplinary program that incorporated relaxation
was also deemed effective in significantly reducing sick
leave (Storro, Moel & Sveback, 2004). Patients who used
a breath therapy program (body awareness, movement,
breathing, and meditation) improve significantly, both
physically and emotionally (Mehling, Hamel et al, 2005).
Meditation was able to reduce not only pain, but also anger
and psychological distress in those with chronic low back
pain (Carson, Keefe et al, 2005). Among other complementary
approaches, patients using Iyengar yoga showed significant
improvements in pain, function, and medication use;
significantly, they also had high compliance rates.
(Williams, Petronis et al, 2005).
Other studies of imagery in chronic pain include a study of
tension headache patients (Mannix, Chandurkar et al, 1999).
The imagery group were three times as likely to report
major pain reduction (p=.004.) Relaxation and imagery has
significantly reduced pain in studies involving patients
with cancer, arthritis, fibromyalgia, hemophilia, and
migraine headaches (Syrjala, Donaldson et al, 1995; Varni
& Gilbert, 1982; Walco & Ilowite, 1992).
In all studies with follow-up, improvements in pain,
function, and mental outlook were sustained through
follow-up lasting as long as 18 months (Kabat-Zinn,
Lipworth and Burney, 1985; Linton & Andersson, 2002;
Materson, 1999).
Conclusion
Guided imagery can be a cost-effective complementary
treatment for chronic pain, including back pain.
REFERENCES
Astin
A. Mind-body therapies for the management of pain.
Clin J
Pain.
2004 Jan-Feb;20(1):27-32.
Astin JA, Shapiro SL, Eisenberg, DM, Forys KL. Mind-body
medicine: state of the science, implications for
practice. J Am Board Fam
Pract.
2003; Mar-Apr;16(2):131-47.
Atlas SJ, Deyo RA. Evaluating and managing acute low back
pain in the primary care setting. J Gen Intern Med.
2001;16:120–31.
American Academy of Physical Medicine and Rehabilitation.
http://www.aapmr.org/condtreat/pain/lowback.htm
Accessed November 2005.
Basler HD, Jakle C,
Kroner-Herwig B. Incorporation of cognitive-behavioral
treatment into the medical care of chronic low back
patients: a controlled randomized study in German pain
treatment centers. Patient Education and
Counseling. 1997 Jun; 31 (2):113-24.
Carson JW, Keefe FJ, Lynch TR, Carson KM, Goli V, Fras AM,
Thorp SR. Loving-kindness meditation for chronic low back
pain: results from a pilot trial. J Holist
Nurs.
2005; Sep;23(3):287-304; discussion 305-9.
Hart LG, Deyo RA, Cherkin DC. Physician office visits for
low back pain. Frequency, clinical evaluation, and
treatment patterns from a U.S. national survey.
Spine,
1995; Jan 1;20(1):11-9.
Jensen IB, Bergstrom G, Ljungquist T, Bodin L. A 3-year
follow-up of a multidisciplinary rehabilitation programme
for back and neck pain. Pain.
2005 Jun;115(3):273-83. Epub 2005 Apr 19.
Kabat-Zinn J, Lipworth L., Burney R. The clinical use of
mindfulness meditation for the self-regulation of chronic
pain.” Journal of Behavioral
Medicine, 1985; June; 8(2):163-90.
Linton SJ, Andersson T. Can chronic disability be
prevented? A randomized trial of cognitive-behavior
intervention and two forms of information for patients with
spinal pain. Spine,
2002; Nov 1;
25(21): 2825-31.
Lipman AG, Jackson KC II. (2000). “Headache and muscle and
joint pain.” In: Handbook of Nonprescription
Drugs. 12th ed. Washington, DC: American
Pharmaceutical Association; 2000:41–76.
Mannix LK, Chandurkar RS, Rybicki LA, Tusek DL, Solomon GD.
Effect of guided imagery on quality of life for patients
with chronic tension-type headache. Headache,
1999
May;39(5):326-34.
Materson R. The stress-pain relationship.
The Pain
Practitioner. 1999 Winter 9(4).
Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized,
controlled trial of breath therapy for patients with
chronic low-back pain. Altern Ther Health
Med.
2005 Jul-Aug;11(4):44-52.
National Institute of Neurological Disorders and Stroke.
www.ninds.nih.gov/health_and_medical/pubs/back_pain.htm
Accessed November, 2005.
Osteki RW, van Tulder MW, Vlaeyen JW, Linton SJ, Morley SJ,
Assendelft WJ. Behavioural treatment for chronic low-back
pain. Cochrane Database
Syst Rev. 2005 25;(1):CD002014.
Storro S, Moen J. Svebak S. Effects of sick-leave of a
multidisciplinary rehabilitation programme for chronic low
back, neck or shoulder pain: comparison with usual
treatment. J Rehabil
Med.
2004 Jan;36(1):12-6.
Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE.
Relaxation and imagery and cognitive-behavioral training
reduce pain during cancer treatment: a controlled clinical
trial. Pain,
1995;
Nov;63(2):189-98.
Varni JW, Gilbert A. Self-regulation of chronic arthritic
pain and long-term analgesic dependence in a
haemophiliac. Rheumatol Rehabil.
1982; Aug;21(3):171-4.
Walco GA, Ilowite NT. Cognitive-behavioral intervention for
juvenile primary fibromyalgia syndrome. J
Rheumatol.1992; 10):1617-9.
Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N,
Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R,
Steinberg L. Effect of Iyengar yoga therapy for chronic low
back pain. Pain.
2005
May;115(1-2):107-17.
Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS.
Patterns and perceptions of care for treatment of back and
neck pain: results of a national survey.
Spine.
2003;28(3):292-7.