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Behavioral Medicine Clinic

 
 

What is Chronic Back Pain?

low back pain

Chronic back pain is usually felt in the lower back, but can also extend into your legs or feet. If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Fortunately, serious or permanent damage is rare. Most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

Low back pain is measured by its duration. Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature – the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.

Back pain that persists for more than 3 months is considered chronic. Because chronic pain lasts beyond the time of normal healing, it can be difficult to identify an exact cause of chronic pain. Chronic low back pain can last for months or years – and, as horrible as it sounds, even for a lifetime. It can interfere with an individual’s sleep, productivity, and quality of life

Causes and Risk Factors

As people age, bone strength, muscle elasticity, and tone decrease. The discs between the bones of the spine (vertebrae) act as shock absorbers. When they begin to lose fluid and flexibility, the discs lose their ability to cushion the vertebrae.

Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results. Few people with back problems have a slipped disc that traps a nerve. Even then, it usually gets better by itself.

Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions. The word “degeneration” sounds frightening, but it’s not damage or arthritis. Degeneration is a normal change that comes with age – much like gray hair.

Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, inappropriate posture for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.

Occasionally, low back pain may indicate a more serious medical disease. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.

Treatment

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take acetaminophen, aspirin, or ibuprofen to help ease the pain. Exercise and surgery are not usually used to treat acute back pain.

The following are some types of treatments for chronic back pain.

Hot or Cold Packs (or Both)

Hot or cold packs provide temporary relief of sore, stiff backs. Heat reduces muscle spasms and pain. Cold helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this treatment does not fix the cause of chronic back pain.

Exercise

Proper exercise can help ease chronic pain but should not be used for acute back pain. Your doctor or physical therapist can tell you the best types of exercise to do.

Medications

The following are the main types of medications used for back pain:

  • Non–steroidal anti–inflammatory drugs (NSAIDs) are drugs that reduce both pain and swelling. NSAIDs include over–the–counter drugs such as ibuprofen, ketoprofen, and naproxen sodium. Your doctor may prescribe stronger NSAIDs.
  • Analgesic medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications.
  • Topical analgesics are creams, ointments, and salves rubbed onto the skin over the site of pain.
  • Muscle relaxants and some antidepressants have also been prescribed for chronic back pain, but it is not yet known if they work for back pain.
  • You may be surprised to know that simple over-the-counter pain killers are often the most effective for back problems. Unfortunately, many people don’t get maximum relief from them because they do not use them properly. So make sure you work with your doctor on getting the most out of medications.
Injections

Your doctor may suggest steroid or numbing shots to lessen your pain.

Complementary and Alternative Medical Treatments

When back pain becomes chronic or when other treatments do not relieve it, some people try complementary and alternative treatments. The most common of these treatments are:

  • Manipulation is when professionals use their hands to adjust or massage the spine or nearby tissues. Doctors now agree that manipulation can help with back pain. It is safe if done by a qualified professional.
  • Transcutaneous electrical nerve stimulation (TENS) consists of a small box over the painful area that sends mild electrical pulses to nerves. Studies have shown that TENS treatments are not always effective for reducing pain.
  • Acupuncture is a traditional Chinese practice that uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as a part of a comprehensive treatment plan for low back pain.

Surgery

Most people with chronic back pain do not need surgery. You may, however, need surgery if you have:

  • Herniated disc. When one or more of the discs that cushion the bones of the spine are damaged, the jelly–like center of the disc leaks, causing pain.
  • Spinal stenosis. This condition causes the spinal canal to become narrow.
  • Spondylolisthesis. This occurs when one or more bones of the spine slip out of place.
  • Vertebral fractures. A fracture can be caused by a blow to the spine or by crumbling of the bone due to osteoporosis.

When back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, surgery is needed right away to ease the pain and prevent more problems but these conditions are rare.

Anxiety, Stress and Muscle Tension

Anxiety and stress can aggravate the amount of pain we feel. Tension can cause muscles to tighten and become painful.

Many people get anxious about back problems, especially when they don’t get better as fast as they expect. Anxiety is also fueled by uncertainty and conflicting advice from family, friends, and doctors. There are many sound ways to get a handle on anxiety that arises from having low back pain. In the meantime, remember that serious damage is rare and the long term outlook is good. So do not let fear and worry get in the way of recovering from a back problem.

Managing Your Low Back Pain

Medical treatments may be used to relieve chronic pain, but for millions of patients with low back pain these options often are only a few of the pieces necessary to solve the pain puzzle. Behavioral self–management skills training is another piece of the puzzle that can provide significant relief of pain and physical limitations caused by low back problems. Behavioral treatments teach patients practical tools for reducing physical tension that aggravates low back pain, strategies for tackling negative mood that may accompany pain; and tips for problem solving around realistic stressors that arise from having a chronic pain problem. Research shows that behavioral treatments reduce low back pain and related behaviors. With behavioral management, activity level increases, social functioning improves, and patients report less distress and anxiety on a daily basis. For many patients, these improvements bring significant relief from the day–to–day pain and suffering of chronic low back pain problem.

If you or someone you know is suffering from pain that medications or other therapies are not effectively controlling, the Behavioral Medicine Clinic may be able to help. Contact us online or call us at 716-898-5671 to get the help you need.

Source:

Gatchel, R. J. & Mayer, T. G. (2008). Evidence-informed management of chronic low back pain with functional restoration. Spine Journal, 8(1), 65–69.

Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128–2156.


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