People suffering with back pain often hear that, to relieve pain and get your back better, you first must have a positive mental attitude. "You have to imagine it to achieve it," the popular mantra goes.

But, whether in the gym or the clinic, we have seen evidence that thinking happy thoughts not only doesn't improve one's condition, it can worsen the likelihood one will take the necessary steps to get better. The alternative mantra becomes, "If I imagine it, I don't have to actually do it." Among people with back pain, the positive thinking approach is often, "I just refuse to live in pain any longer." What too rarely follows is, "...so I'm going to do _____."

From a science and medicine aspect, proving whether a good attitude helps (or precedes getting better) is especially tricky. We want hard data or at least something measurable to detect whether Group A (positive thinkers) get better faster than Group B (neutral or negative thinkers). We also want to know what came first: thinking positive or getting better. We're far from having a specific test like measuring brain chemicals but there are some pretty reliable measures of positivity.

One researcher in particular, Dr Gabriele Oettingen, has authored more than 100 articles and book chapters and has synthesized the essence of these findings. In her book, Rethinking Positive Thinking: Inside the New Science of Motivation, she wrote,
Approached by someone who wants to achieve a specific dream, many of us offer simple advice: think positive! Don’t dwell on the obstacles, since that will only bring you down; be optimistic, focus on what you want to achieve; imagine a happy future in which you’re active and engaged; visualize how much snazzier you’ll look when you’ve lost that twenty pounds, how much happier you’ll feel when you’ve snagged that promotion, how much more attractive your partner will find you when you’ve quit drinking, how much more successful you’ll be when you’ve started that new business. Channel positive energy and before you know it, all your wishes and goals will come true.

Yet dreamers are not often doers. My research has confirmed that merely dreaming about the future makes people less likely to realize their dreams and wishes (as does dwelling on the obstacles in their path). There are multiple reasons why dreaming detached from an awareness of reality doesn’t cut it. The pleasurable act of dreaming seems to let us fulfill our wishes in our minds, sapping our energy to perform the hard work of meeting the challenges in real life.
Those are pretty harsh words to those who strongly believe positive thinking is required to achieve positive results. But those harsh words are based on good, solid evidence. I think it's pretty cool that people make it their life-long ambition to study and conduct high quality research on this topic.

As someone who treats chronic back pain, I often hear sufferers bring up positive thinking in describing family and loved ones' reaction to their pain. Those close to someone suffering want to offer encouragement while understandably often wanting the focus on pain to just go away. Pain takes a toll on everyone close to the sufferer.

So they'll say something encouraging like, "If you think positive, the pain will go away."

If not positive thinking, what are the alternatives? Should people suffering with back pain adopt a doom and gloom harsh realistic attitude of, "I'll never get better?"

Definitely not.

I think we can learn from the self-cured former sufferers. Among them, I most often hear an attitude of, "I have to work hard at getting better and I could be doing more." Yes, of course that sentiment includes first having the thought, "I can work hard" but it's uniquely different than,