Managing Chronic Back Pain

If you are someone who experiences chronic back pain, you know how debilitating it can be and how significantly it can impact daily life. Patients who are seen at our office that deal with chronic back pain tell our providers what they are not able to do because of their chronic back pain. Before digging into the causes of chronic back pain and treatments of it, we first have to define what chronic pain is and demonstrate the difference between chronic and acute pain. 

Acute pain can be defined as "short-term" back pain, which typically resolves on it own but can last a few days to a few weeks. This short-term pain typically does not cause residual loss of function (U.S. Department of Health and Human Services, 2020). 

Chronic pain is defined as pain that lasts longer than 12 weeks or greater even after treatment of an injury or acute back pain.  About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year (U.S. Department of Health and Human Services, 2020).  Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases, pain continues despite medical and surgical treatment. (U.S. Department of Health and Human Services, 2020). 

Chronic pain can take many forms, but is often placed in one of these two major categories:

1. Pain with an identifiable cause, such as an injury. Certain structural spine conditions, including degenerative disc disease, spinal stenosis, and spondylolisthesis, can cause ongoing pain until they are successfully treated. These conditions are due to a diagnosable anatomical problem. If the pain caused by these types of conditions has not subsided after a few weeks or months of non-surgical treatments, spine surgery may usually be considered as a treatment option (Deardorff, 2017). 
2. Chronic pain with no identifiable cause. When pain persists after the tissue has healed and there is no clear reason for the pain that can be identified, it is often termed “chronic benign pain" (Deardorff, 2017). 

Causes and Risk Factors of Chronic Back Pain

Chronic back pain is typically age-related but can also result from a prior injury. Common causes include:

• Arthritis of the Spine: The gradual thinning of the cartilage inside the spine
• Spinal Stenosis: Narrowing of the spinal canal that may lead to nerve pain
• Disc problems, such as a herniated or bulging disc
• Myofascial pain syndrome: Unexplained muscle pain and tenderness

Low back pain can typically be diagnosed through a few different tests, such as x-rays, MRIs, CT scans, nerve conduction studies, electromyography (EMGs,) discography, blood tests, or bone scans. However, it may be difficult to pinpoint the cause of chronic back pain. It is important not to make drastic decisions or undergo extensive medical procedures until the origin of the pain is found. Certain medical procedures may not help and could make the pain worse. If the source of the pain is not known or can’t be treated, your best option may be to work with your doctor on reducing the flare-ups and making the pain manageable with non-surgical treatments.

Treatment Considerations and Management of Chronic Back Pain

Acute back pain and chronic back pain are treated differenty, and the effectiveness of a particular treatment for chronic pain will often differ from person to person. For example, a specific medication or injection for a herniated disc may provide effective pain relief for some people but not for others. Chronic back pain is most often treated with a stepped-care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain. Pain management for chronic pain is often done by a multidisciplinary team so that all aspects of pain can be treated at the same time. In order to find the best treatment for pain management of your specific circumstance, it is recommended to find a physician that specializes in physiatry (physical medicine & rehabilitation) or anesthesiology who utilize the multidisciplinary team approach (Deardorff, 2017). 

Support for Chronic Pain

Managing your chronic pain can not only be debilitating but can also be isolating or depressing. While you are working through your treatment options to address your pain, there are support groups for individuals to encourage one another through the process, such as online forums, virtual support groups, and some in-person meetings. For some resources for support groups that fit your preference, visit https://painresource.com/chronic-pain/how-to-connect-with-chronic-pain-support-groups/ to learn more and gather advice for selecting the best group for you.

At Signe Spine & Rehab, we have many patients that come into our office with chronic back pain. If you are someone who experiences chronic back pain, give us a call at 843-730-4124 to set up your New Patient appointment to get a thorough evaluation and individualized treatment plan with a conservative, diagnostic approach to spine care. 

To learn more about chronic back pain, check out these sources below as well:

• National Institute of Neurological Disorders and Stroke Low Back Pain Fact Sheet: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
• Spine-Health - Chronic Pain as a Disease: Why Does It Still Hurt?: https://www.spine-health.com/conditions/chronic-pain/chronic-pain-a-disease-why-does-it-still-hurt 

References

Deardorff, W. (2017, February 2). Types of back pain: Acute pain, chronic pain, and neuropathic pain. Spine-Health. https://www.spine-health.com/conditions/chronic-pain/types-back-pain-acute-pain-chronic-pain-and-neuropathic-pain.

U.S. Department of Health and Human Services. (2020, March). Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.

Author

Signe Spine Team Contributor