Despite hundreds of billions of healthcare dollars being spent on medications, diagnostic imaging, and surgical procedures, chronic pain is more prevalent than ever, affecting 1 in 5 Australians.1
Many of the most widely used medical interventions for chronic and persistent pain, such as spinal fusion surgery and opioid pain medications, have little or no evidence supporting their long‐term effectiveness.2
Low back pain is now the leading cause of disability in every developed country on earth.3
But it doesn’t have to be like this! Thanks to some remarkable scientific discoveries about how persistent pain works, we now know that there’s a much better way.
Modern best‐practice guidelines highlight the need for patient‐centred multidisciplinary care that views the individual as a whole person (not simply a damaged body in need of repair) and emphasises the importance of psychological and physical therapy.2
Barbell Psychology is an approach that combines barbell-based strength training with pain psychology to enable you to manage your pain, get strong, and live life to the fullest.
Understanding persistent pain
Pain works a bit like an alarm – generated by your brain and experienced in your body – which is designed to be unpleasant enough to motivate you to take action to protect your body from harm.
Your brain uses information from a variety of different sources to generate its output of pain, based on its perception of potential threat to your body.
The greater the perceived need to take action to avoid a threat, the greater the pain your brain tends to create.
This is a highly complex and lightning‐fast largely-automatic process which is influenced by a wide range of biological, psychological and contextual factors4.
Although acute pain is often associated with physical damage to parts of the body (like a fracture or muscle tear), this is not always the case, particularly with chronic pain – often, pain can occur without tissue damage (and vice‐versa).
When it’s working the way it’s designed to, pain warns you of threats to your body, and keeps you safe. However, this system isn’t perfect – at times your pain alarm can be activated even when your body isn’t in any danger.
Chronic or persistent pain is simply defined as pain lasting more than three months5. Once pain has continued for around this length of time, it often responds quite differently to short‐term or acute pain and can cause problems in its own right.
Persistent pain is as common as it is debilitating, affecting 1 in 5 Australians1 and causing a range of secondary psychological difficulties such as depression and anxiety disorders.
Chronic pain is sometimes associated with a prior musculoskeletal injury or chronic health condition (e.g. multiple sclerosis, fibromyalgia), but often has no clear biological origin at all6.
When pain has persisted for a long time, the pain system can become over‐protective and no longer provide helpful information about potential threats to your body. In this case, the pain system needs to be ‘retrained’ to be less protective.
While medications, surgery, steroid injections, acupuncture and other ‘passive’ treatments can often help to reduce pain in the short‐term, ‘active’ psychological and movement‐based therapies, which address the underlying problem with the pain system itself, tend to be more helpful for persistent pain in the long‐term6.
The role of psychological therapy
Sometimes people are surprised to learn that psychological therapy can be an effective treatment for chronic pain. However, it makes perfect sense when you understand that pain is a complex brain‐ based system with multiple inputs – and that the psychological and contextual inputs are particularly important in chronic pain4.
Furthermore, because chronic pain can affect your overall mental health and many other aspects of your life, the most impactful interventions for chronic pain are those that treat the whole person in context, not just the specific body parts that hurt6.
Does this mean that persistent pain is ‘all in your head’? No, absolutely not!
Although pain is generated by the brain (and yes, of course, your brain is in your head, literally speaking), it’s very real, and you certainly can’t get rid of it with so‐called positive thinking or mind‐over‐matter.
Instead, psychological therapy works by addressing the psychological and contextual factors that influence (and are influenced by) pain and helps you, on the one hand, to be less negatively impacted by pain and, on the other, to retrain your over‐protective pain system gradually over time.
One particular psychological treatment approach, which has been shown to be effective for persistent pain, is acceptance and commitment therapy (ACT).
ACT is a mindfulness‐based behaviour therapy which focuses on helping individuals engage in life‐ enhancing (and pain‐retraining) behaviours by changing the way they experience their thoughts, feelings and sensations (including pain)7.
Numerous systematic reviews and meta‐analyses of clinical trials have demonstrated that ACT can be effective for managing chronic pain8; that ACT tends to significantly increase pain acceptance9, psychological flexibility9, physical wellbeing10, functioning9 and quality of life10,11; and significantly reduce pain intensity10,11, pain interference11, anxiety9,10,11, depression9,10,11 and disability11,12.
Strength training for chronic pain
‘Strength training’ simply refers to the process of using certain types of exercises to progressively increase your ability to produce force (i.e. get stronger) over time.
This increase in strength occurs through a cycle of stress, recovery and adaptation – a ‘stress’ is applied to the muscles and other tissues of the body when the exercises are performed, then the body is allowed to recover from the stress, and a favourable adaptation occurs as a result.
As well as being vital for general physical health – World Health Organisation13 and Australian government14 guidelines recommend at least two days per week of muscle strengthening exercises – strength training is particularly beneficial for chronic pain patients.
Strength training has been shown to improve physical functioning and reduce pain in a wide variety of persistent pain conditions including fibromyalgia15,16,17, axial spondyloarthritis18, osteoarthritis19,17, rheumatoid arthritis17, low back pain17,20, spinal cord injury17, and patellofemoral pain17.
Strength training has also been demonstrated to significantly reduce symptoms of depression21 and anxiety22, both of which frequently occur alongside chronic pain.
There is a huge variety of exercise equipment that can be utilized in strength training, including resistance bands, weight machines, kettlebells, dumbbells and barbells – however, barbells are particularly useful for strength training for several important reasons.
Barbells enable you to lift much heavier weights than any other equipment allows; they can be incrementally loaded to allow you to systematically progress your training; they are ideal for whole‐ body movements that engage lots of joints and muscles all at once; and they require (and therefore help to develop) balance and coordination as well as strength.
For these reasons, barbells are the most widely used strength training equipment in strength sports such as powerlifting, weightlifting, strongman, bodybuilding and CrossFit. Put simply, if you want to get genuinely strong, you can’t beat training with barbells.
Barbell training is also extremely safe. A review of 20 studies examining injury risk concluded that barbell sports have an injury rate of approximately two to four injuries per 1000 hours of participation, the majority of which are of minor severity23. For someone training for three hours a week, this equates to a minor injury like a muscle strain every couple of years on average. For comparison, sports like soccer, rugby and cricket, have injury rates of 15 to 81 injuries per 1000 hours23.
The Barbell Psychology difference
While it’s clear that both psychological therapy and strength training can each be extremely beneficial on their own, Barbell Psychology combines these two different modalities into a single therapeutic approach, creating a genuine whole‐person treatment for individuals with persistent pain.
Given that pain is not simply a biological phenomenon (nor a solely psychological one), but a complex biopsychosocial experience, it makes sense that treatments that combine exercise with psychological therapy are recommended in clinical guidelines for the management of chronic pain24.
A recent study examining the effectiveness of an eight‐week treatment program for chronic pain combining ACT with exercise found significant decreases in pain intensity and pain interference, anxiety and depression, and improved overall psychological wellbeing25.
Barbell Psychology is a treatment approach that puts you – the person with pain – at the centre of treatment and gives you the tools to effectively and confidently manage your pain, get strong, and live life to the fullest.
- Deloitte Access Economics. (2019). The cost of pain in Australia. Painaustralia.
- Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., O’Sullivan, P. P. B. (2019). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine, 54(2), 79–86.
- Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(6), 968–974.
- Main, C. J. (2013). The importance of psychosocial influences on chronic pain. Pain Management, 3(6), 455–466.
- Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavandʼhomme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003–1007.
- Mardian, A. S., Hanson, E. R., Villarroel, L., Karnik, A. D., Sollenberger, J. G., Okvat, H. A., Rehman, S. (2020). Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care. Pain Medicine.
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: the process and practice of mindful change. New York: Guilford Press.
- Simpson, P. A., Mars, T., & Esteves, J. E. (2017). A systematic review of randomised controlled trials using Acceptance and commitment therapy as an intervention in the management of non- malignant, chronic pain in adults. International Journal of Osteopathic Medicine, 24, 18–31.
- Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & Mcmillan, D. (2017). Acceptance and Commitment Therapy (ACT) for Chronic Pain. The Clinical Journal of Pain, 33(6), 552–568.
- Veehof, M. M., Oskam, M.-J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533–542.
- Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31.
- Vowles, K., Fink, B., & Cohen, L. (2014). (543) Acceptance and Commitment Therapy for chronic pain: a diary study of treatment process in relation to reliable change in disability. The Journal of Pain, 15(4).
- World Health Organization. Global Recommendations on Physical Activity for Health (2010).
- Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines. (n.d.). Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys- act-guidelines#npa1864.
- Busch, A. J., Webber, S.C., Richards, R.S., Bidonde, J., Schachter, C.L., Schafer, L.A., Danyliw, A., Sawant, A., Dal Bello-Haas, V., Rader, T., & Overend, T.J. (2013). Resistance exercise training for fibromyalgia. Cochrane Database of Systematic Reviews, 12. Art. No.: CD010884.
- Hooten, M. W., Qu, W., Townsend, C. O., & Judd, J. W. (2012). Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial. Pain, 153(4), 915–923.
- Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews.
- Sveaas, S. H., Bilberg, A., Berg, I. J., Provan, S. A., Rollefstad, S., Semb, A. G., Dagfinrud, H. (2019). High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. British Journal of Sports Medicine.
- Oral, A., & Ilieva, E. (2011). Physiatric approaches to pain management in osteoarthritis: a review of the evidence of effectiveness. Pain Management, 1(5), 451–471.
- Owen, P. J., Miller, C. T., Mundell, N. L., Verswijveren, S. J., Tagliaferri, S. D., Brisby, H., Belavy, D. L. (2019). Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine.
- Chekroud, S. R., & Chekroud, A. M. (2018). Efficacy of Resistance Exercise Training With Depressive Symptoms. JAMA Psychiatry, 75(10), 1091.
- Gordon, B. R., Mcdowell, C. P., Lyons, M., & Herring, M. P. (2017). The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Medicine, 47(12), 2521–2532.
- Keogh, J. W. L., & Winwood, P. W. (2016). The Epidemiology of Injuries Across the Weight- Training Sports. Sports Medicine, 47(3), 479–501.
- SIGN (2013). Management of chronic pain. Scottish Intercollegiate Guidelines Network Publication No., 136. Retrieved from https://www.sign.mac.uk/sign-136-management-of-chronic- pain.html.
- Casey, M. B., Cotter, N., Kelly, C., Elchar, L. M., Dunne, C., Neary, R., Doody, C. (2020). Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One-Year Follow-Up. Musculoskeletal Care.