Blending chiropractic and psychology: Whole-person chronic pain solution

Many people were surprised when I decided to pursue my third degree in psychology. “Aren’t you already a chiropractor?” Many would ask. The truth of the matter is that it is very hard to separate the body from the mind when it comes to chronic pain.

In fact, research has estimated that up to 60% of people with chronic pain have depression symptoms, and vice versa. Psychology, while a completely separate discipline from chiropractic and physiotherapy, is indispensable in successful aches and back pain treatment.

Can physical pain be treated with psychology?

Most people view pain as an entirely physical condition. This can be largely attributed to that most people experience aches and soreness with physical activity and movement. Examples including lifting heavy weight, bending over to pick something up, running, getting in and out of a car, etc.

In acute situations, such as a recent muscle strain or joint sprain, your pain can indeed be entirely physical in nature. However when the symptoms (e.g., pain, aches, stiffness, etc) last longer than three months, it is considered chronic, and can no longer be attributed to a sole physical cause.

chronic pain singapore, back pain recovery
Behaviour change is complex and multifactorial. Similarly, long term results for bodily aches and soreness cannot come from just going for chiropractic adjustments or massages. The change needs to come from you!

Most tissues in our body will heal within three months. Think about it. If you were to graze your skin, it will heal within a couple of weeks. Even most fractures will heal within two months! This is why symptoms lasting for more than three months are almost never entirely physical in nature.

I am not saying that your pain is all made up in your mind. Pain is a complex, multi-faceted experience. What research is telling us that non-physical factors such as our thoughts, beliefs, expectations, emotional states, and culture all can modulate or influence our pain experience.

Psychological treatments can be used for back pain

In our last post, we talked World Health Organisation’s stance on chiropractic adjustments for back pain. Did you know WHO also endorse some psychological inventions to be suitable for low back pain? Out of the five psychological interventions they reviewed, cognitive behaviour therapy (CBT) and operant therapy are considered suitable for persistent back aches and soreness.

WHO is not the only organisation who supports psychological intervention. The Lancet’s low back pain guidelines published in 2018 also identified CBT as first-line intervention, alongside with exercise. Treatments such as massage, chiropractic adjustments were classified as second-line treatments.

If you are suffering from back pain and have tried all treatments to no avail, it may be time to consider a more holistic, whole-person approach to your recovery.

Pain is related to behaviour and lifestyle

Psychology is not just something for mental illness. The branch of psychology that deals with conditions such as depression, anxiety is called clinical psychology. Other branches of psychology include organisational psychology, defence psychology, health psychology, etc.

In broad strokes, psychology is the scientific study of the mind and behaviour. It is pretty much relevant to all aspects of our life!

Because pain is highly related to our behaviour and lifestyle, psychology can do a lot to help. Psychology can help you develop health habits and identify and reduce or eliminate behaviours that contribute to your pain experience. All of these can work together with long term results.

Most treatments only deliver temporary pain relief

The problem with passive treatments (i.e., treatments where a practitioner does something to you) such as chiropractic adjustments, dry needling, acupuncture, and the now popular tit tar treatments sensationalised by Chris Leong is that you have to keep going back.

chiropractor singapore, jesse cai
Chiropractor Jesse Cai used to offer chiropractic adjustments at Square One Active Recovery. Since we stopped adjusting our clients in 2018, over 80% of our clients will achieve their recovery goals without having to keep coming back for endless treatments.

Think about it. Sure, you may feel immediate relief after treatment. But what happens when your pain comes back? You probably will tahan (i.e., live with it) until you cannot anymore and go back for more treatments.

Surely this does not sound like a true recovery?

World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Being healthy is not just about living with as little pain as possible. It is about living our life to the fullest!

How does CBT work for back pain?

One of the goals of CBT is to improve negative thinking patterns and behaviours. As you can imagine, it is a fairly broad psychological approach that can be applied to many situations, including chronic pain, to achieve a positive outcome.

Specific to chronic pain, CBT can be used to reduce catastrophic thinking, rumination, and unhelpful behaviours. People with chronic pain often live with their pain for most, if not all, of their waking hours. It is difficult for their symptom experience to not have any effect on their overall well-being. CBT can help back pain sufferers stay on top of their pain.

For example, CBT can be used to identify thoughts and behaviours about their pain. In doing so, coping strategies or relaxation techniques can be used to reduce feelings of helplessness and gain control over their pain experience.

CBT can help with to increase (or decrease) physical activity

One of the things CBT can help with us motivation. Many people already know that not exercising enough, and too much exercising, is bad for them. The problem, however, is that knowing what is good for you alone is not enough to change behaviour.

This is where CBT comes in. How can you take small steps in changing certain thoughts and beliefs towards exercising? What are the small things you can start putting in place to set yourself up for success?

Some of the unhelpful thoughts towards exercising are:

  • I am too fat to be exercising.
  • I have too much pain to exercise.
  • I am too lazy to exercise.

Being able to identify unhelpful thoughts, reframe them, offer more helpful alternative narratives can be immensely helpful.

I observe that my weight is currently above the healthy weight range. It may be challenging for me to start exercising. However, I can start small by walking for 10 minutes everyday.

The good thing about CBT and reframing is that it can help you move away from self-limiting thoughts to one that allows for growth. Even if walking is 10 minutes per day is too long, by adopting a growth mindset, you can aim to get a couple of extra steps in while brushing your teeth! It’s all about being realistic with your limitations and finding solutions for it.

If safety is an issue, hire a personal trainer! You can also ask a friend who already works out for help. Being mindful of resources that are available to them and learning to utilise them can make all the difference.

I have too much pain to exercise

Did you know the first-line treatment for back pain and virtually all disorders of the muscles and joints is exercise?

Did you also know that exercise is the single most important thing you can do after surgery for a full recovery?

Exercise is suitable for everyone. Yes, exercise may not give instant results but it is 100% the best thing you can do to help yourself. If you are worried about exercising on your own, get professional help. This is what people like myself are here for!

chiropractic clinic singapore, chiropractic rehab
BJ Palmer, one of the founding fathers of chiropractic, had an entire floor dedicated to exercise. Exercise is part of chiropractic since its early days. Equipment included stationary bike, punching bag, dip bars, etc.

Chiropractors are trained to provide musculoskeletal rehabilitation. In fact, being competent in exercise therapy is one of the prerequisites for you to graduate from chiropractic school! This may sound surprising to some of you but exercise has been a core part of chiropractic since its founding days.

If you feel that you have too much pain to exercise, start with something small and easy (e.g., walking, swimming). If your pain is in the lower limb, try an upper body exercise. Bicep curls are fairly easy to do on your own and many household items can be used for weight. Some exercise is better than none!

There is always something that you can do exercise-wise. It may take a bit of brainstorming or professional help to figure it out, but there is always something.

I am too lazy to exercise

Sometimes you have to get started to get started. Aim to take the stairs instead of the lift. Walk on the spot when you are brushing your teeth. Do 10 squats everyday before you shower.

It is normal to not feel motivated to exercise. Once you start, however, no matter how small, it gets easier and you are likely to do more.

The issue is not that you are lazy. It could just be that exercise is not something you enjoy doing. Yet, exercise is something that you need to do for your own well-being. After all, both WHO and Ministry of Health agree that you need at least 150 minute of aerobic exercise and two days of muscle strengthening exercise every week. If you are above 65, the recommendation is THREE days of strength training per week!

Exercise is important.

who physical activity guideline, functional training singapore
150 minutes of aerobic exercise alone may not be good enough for you! The World Health Organisation (WHO) clearly recommends at least 2 days of “muscle strengthening activity”.

That doesn’t mean we need to enjoy it! I personally don’t enjoy exercising but I still aim to do at least a little everyday. Am I successful every day? No. But I end up getting some almost everyday, most of the time. Every bit counts for something. Exercise is not something we need to be perfect at. It’s about doing the best we can, with our current resources, at our current circumstances.

There are many things in life that we do even though we don’t necessary enjoy it. In Singapore, all of us have been through compulsory schooling and more. I dare say most of us would not enjoy studying for some parts but still showed up anyways.

We may dislike going to the dentist but still go for it anyways. Maybe a little less often than we should but most of us would still attempt to go.

There are usually at least some things you are currently already doing in your life that you do not particularly enjoy. Yet you still do it anyways because of the benefits and rewards that come with it. It is important to acknowledge that you don’t need to enjoy exercising to start exercising.

How to get long term back pain relief

small change to big change
Not entirely unique to psychological treatments but 100% important to consider when trying to make any meaningful change.

If your pain is chronic and you are not getting results from pain treatments, look at pain solutions that consider your whole-person. With what we understand about persistent pain, it is not reasonable to focus on just one area and expect long lasting results.

Exercise can help you improve the health of your muscle and joints. Psychology can help you make exercise a part of your lifestyle. If your pain is inflammatory in nature, consider dietary changes. For those who are overweight, consider signing up for an evidence-based weight loss programme.

Stress, needless to say, can also affect your symptoms. Mindfulness practice, while alone may not help with your pain, can help with stress management and help you feel better.

Persistent back pain and neck pain can indeed be challenging to treat. However, evidence-based and effective options are available for you. Sometimes what we need is a radical shift to do something absolutely differently, within an evidence-based framework, to get the results we are looking for.

Don’t give up!



Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.