UB researchers discuss the challenges, benefits of lifestyle interventions for chronic pain

BUFFALO, N.Y. – Pain researchers at the University at Buffalo’s Behavioral Medicine Clinic have co-authored an editorial about a recent meta-analytic study on how some patients with pain may benefit from exposure to nature.

Andrew H. Rogers, PhD, assistant professor of medicine, and Jeffrey M. Lackner, PsyD, SUNY Distinguished Professor and chief of the Division of Behavioral Medicine, both in the Jacobs School of Medicine and Biomedical Sciences at UB, conduct research with an emphasis on non-pharmacological treatments for chronic pain. Patients they see in their Behavioral Medicine Clinic, which is part of UBMD Internal Medicine, present with a range of conditions, from low back pain and irritable bowel syndrome to pelvic pain and fibromyalgia, migraine and other often refractory conditions.

Earlier this month, they published an editorial in Nature Mental Health.

They were invited to write the editorial because of their expertise in developing personalized, science-based behavioral self-management treatments for people suffering from chronic pain for whom medical therapies have not worked.

Meta-analysis of how nature exposure impacts pain

The editorial focused on a meta-analysis (a study that pools results from multiple studies to reach a stronger overall conclusion) that, Rogers and Lackner wrote, reported that exposure to nature resulted in “small to moderate reductions in pain and associated symptoms, including anxiety.”

Patients in the studies received nature exposure in different ways, from simple stimuli, such as pictures of nature, to complex stimuli-like videos and virtual reality, to real-life exposures, like sitting in an outdoor green space.

“Nature exposure, like other lifestyle interventions for chronic pain, has the advantage of being a low-intensity intervention, meaning it requires minimal effort from the patient and still potentially provides some benefit,” says Rogers. “For those that see a benefit from lifestyle interventions, whether that’s exercise, diet or exposure to nature, that’s a significant reduction in impact on the health care system.”

However, he says, the question remains as to why these treatments work. “We don’t really know the mechanisms as to why some of these interventions work and who benefits most,” he says. “There are guesses about why, but a comprehensive theoretical model is still lacking that allows clinical researchers to develop more potent treatments.”

Huge psychological component

Chronic pain, of course, doesn’t happen in isolation. “There’s a huge psychological component to chronic pain,” Rogers says. “It’s not just a physical experience; it’s also a cognitive and emotional experience.” 

He says, for example, that physical movement is really helpful simply because when people stop moving, muscles atrophy. That’s why, in the Behavioral Medicine Clinic at UB, finding out how active patients are is an important part of the assessment. People who are sedentary, Rogers adds, will have worse pain, regardless of the cause behind it.

“In our clinic, we tend to get patients for whom other treatments have failed,” says Rogers. “The majority of our patients get referred to us when nothing else has worked.”

The first step in working with these patients is conducting a comprehensive assessment and a detailed history. They discuss the patient’s approach to problem-solving and whether they engage in catastrophizing — imagining the worst possible outcomes.

“Why pain persists is different for each person,” says Rogers. He and Lackner frame their approach as behavioral self-management, where patients learn to manage the day-to-day burden of dealing with chronic pain. “We do see that when people can better manage the worry and stress of it, pain tends to decrease,” he says.

“While I was reading this study about nature exposure, I was thinking, ‘yes, I also benefit from being in nature,’” says Rogers, “but the question is, why? We really don’t know the mechanisms. How do we get to the point where we know that XYZ treatment is going to work for you?”