Gratitude and Low Back Pain

Gratitude is frequently stated to be useful to improving health within alternative health circles. However is there any evidence that improving our focus on gratitude can be useful to improving low back pain?

There have not been any studies examining the benefits of gratitude interventions on pain. However, gratitude interventions have improved positive affect, inflammatory markers and specifically depression and anxiety.

Emmons and McCullough (2003) were the first to examine the effects of focusing on gratitude or hassles on psychological markers. They assigned patients to focus on either gratitude, hassles or neutral events or social comparison. Patients kept either weekly or daily records of their moods. In a third arm patients with neuromuscular disease were randomly assigned to either a gratitude intervention or control. The gratitude intervention was as follows;

“For the next eight weeks you will be asked to record 3-5 things for which you are grateful on a daily basis. Think back over your day and include anything, however small or great, that was a source of gratitude that day. Make the list personal, and try to think of different things each day”.

The results showed that a focus on gratitude improved emotional and interpersonal markers.

Redwine et al (2016) found that a daily gratitude practice reduced inflammatory markers and improved heart rate variability in congestive heart failure patients. Patients were instructed as per Emmons and McCullough (2003). Interestingly sleep appears to play a mediating role in the effects of gratitude on depression and anxiety (Ng and Wong 2013). The mediating effect exists for depression but appears stronger with anxiety. Thus interventions should look to target sleep and gratitude together for best results.

To date there are no studies showing direct effects of a gratitude practice on pain. However as inflammation levels decrease the nociceptive threshold and mean we feel more pain there is a plausible mechanism for an impact on pain. Similarly positive affect is associated with better outcomes in low back pain patients and thus the suggestion is it may be beneficial low back pain patients.

A practice of writing down 3-5 things each day that you are grateful for is a free, quick and potentially useful adjunct to the management of chronic low back pain.


Emmons, R.A. and McCullough, M.E., 2003. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. Journal of personality and social psychology, 84(2), p.377.

Ng, M.Y. and Wong, W.S., 2013. The differential effects of gratitude and sleep on psychological distress in patients with chronic pain. Journal of health psychology, 18(2), pp.263-271.

Redwine, L.S., Henry, B.L., Pung, M.A., Wilson, K., Chinh, K., Knight, B., Jain, S., Rutledge, T., Greenberg, B., Maisel, A. and Mills, P.J., 2016. Pilot randomized study of a gratitude journaling intervention on heart rate variability and inflammatory biomarkers in patients with stage B heart failure. Psychosomatic medicine, 78(6), pp.667-676.

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