Is chronic back pain for life?
Chronic back pain is just that, chronic, but is this pain for life?
Chronic back pain is just that, chronic. It means that it persists for more than 3 months. It can be progressive and often the cause is difficult to determine. Whether or not it will last for a lifetime depends on several factors including cause, treatments options, adherence to individual treatment plans as well as the attitude and determination of the individual.
Nearly everyone has back pain at some point in their lives. In fact, nearly nine out of ten adults will experience back pain. For Americans, it is the most common cause of disability with at least $50 billion being spent each year. Fortunately, most occurrences of back pain are acute and go away within a few days. For the rest, it takes much longer to resolve. This leads to the question…Is chronic back pain forever?
Before it can be treated, chronic pain needs to be evaluated for a cause. Here are a few of the more commons causes of chronic back pain, however the causes are as varied as the population that it effects.
Herniated (bulging) discs
The cartilage between the vertebrae may weaken and become displaced, pushing into the space containing the spinal cord causing pain. This can sometimes lead to cauda equina syndrome, which is a serious complication. This occurs when the disc is pushed into the spinal canal and then compresses nerve roots. Permanent damage may result if this is left untreated.
This is a condition in which a herniated disc presses on the sciatic nerve which carries nerve fibers down from the pelvis to the leg. This causes electrical or burning low back pain that can also manifest as pain through the buttocks, down the leg and sometimes down to the knee and even foot.
This is caused by the narrowing of the internal canal of the vertebra. It can be congenital or by the degeneration from disc wear and tear over time.
This disorder is progressive and is identified by the decrease in bone density and strength. It can then cause fractures of bones within the hips, pelvis and spine with painful outcomes.
This is an inflammatory process that causes chronic back pain and stiffness. The symptoms are often made worse with immobility. It is definitively diagnosed through the identification of gene markers.
Don’t take your pain laying down…literally! It used to be the belief that rest allowed for healing. That is not always the case. Exercise may be the most effective way to speed recovery from low back pain. It will help to strengthen muscles that are important in supporting the spine. Generally swimming, walking and yoga are good for stretching, posture and balance. Your doctor or physical therapist can provide you with a regime of exercise that can best assist you.
This is a "hands-on" approach in which a doctor of chiropractic care uses leverage and a series of precise movements to adjust spinal structures and help restore back mobility. This is often called “an adjustment”.
This method involves placing very thin needles into energy meridians, which are precise points throughout the body responsible for the transmission of life force energy. This process can allow for the release of naturally occurring painkilling elements and keeps the body’s normal flow of energy open and unblocked.
Transcutaneous electrical nerve stimulation is a series of mild electrical pulses that are administered via an external device. It is thought to block pain signals to the brain and help stimulate the brain’s endorphin production.
This type of therapy can help ease pain by blocking the nerve conduction through the injection of anesthetics and anti inflammatory medications.
However, a report published July 3 in the New England Journal of Medicine, indicate that these blocks may not be as effective in spinal stenosis patients as previously thought.
"Steroid injections are a common treatment for spinal stenosis, and we were surprised by the finding," said lead author Dr. Janna Friedly, an assistant professor of rehabilitation medicine at the University of Washington in Seattle.
"These steroid injections aren't helpful," she said. "There is no added benefit to the steroid itself, so if people are considering these injections, I would recommend that they consider an alternative."
Pain relief may involve a combination of both prescription drugs as well as over-the-counter remedies. It is important to reveal to your doctor what medications you are taking so that a proper regime can be established. Some medication combinations can be either non-effective or even dangerous.
These types of medications reduce inflammation as well as pain. They include aspirin, ibuprofen and naproxen.
This prescription category includes codeine, morphine, oxycodone and hydrocodone. They are normally only prescribed by pain specialists and have the potential for addiction.
These drugs are sometimes helpful for nerve pain and are often prescribed in combination with analgesics.
This class of drugs is often prescribed for chronic pain as they not only assist in mood and sleep but can alter the perception of pain in some people.
Because surgical intervention is not always successful, it is wise to consider it only as a last resort. Procedures include discectomy, foraminotomy, nucleoplasty, laminectomy and spinal fusion.
According to the National Institutes of Health (NIH), scientists are always studying ways to reduce pain. There is renewed interest in chiropractic, acupuncture and massage as well as new lines of pain medications. Other areas of research are focusing on low-dose radiation, artificial disc replacements, and stem cell tissue growth.
In the meantime remember that pain is a complex, perception that varies. The experience can range from minor and annoying to excruciating and incapacitating. Remember that it is the perception of pain that creates the reality. An example of this is the perception of pain in a limb that has been amputated.
The perception of pain is influenced by variables such as genetics, emotional stress, developmental level and even general cultural background.
Perhaps nowhere within medicine is there an area that is so misunderstood and poorly recognized as pain management. This is due to personal experience and significance of the factors that contribute to pain.
Understanding your own expectations and recognizing the body’s inane healing capabilities can go a long way towards wellness. As in most things, perception is everything.
So is chronic pain for life? In part, the answer may be within the individual, their belief system and faith in their ability to feel better.
N Engl J Med. 2014;371:11-21
Debono, DJ; Hoeksema, LJ; Hobbs, RD (August 2013). "Caring for Patients with Chronic Pain: Pearls and Pitfalls". Journal of the American Osteopathic Association 113 (8): 620–627. doi:10.7556/jaoa.2013.023. PMID 23918913.