Chronic Back Pain Treatment Options

On a daily basis I see clients that have or have had Non-Specific Lower Back Pain, or back pain that is caused through trauma. Individuals that come in for treatment are usually;

  • Afraid to move – based on preconceived notions which we will discuss later.
  • Have a belief that they have “put their back out” and that this is something that they will need to live with for the rest of their lives.
  • There is a heavy belief that surgery may be a good solution to reducing back pain.

As the science around back pain has developed dramatically over the last several years, the dogma around it has been slow to catch up. Unfortunately, these long held beliefs will persist with individuals due to factors that are uncontrollable by allied health professionals. Factors such as anecdotal evidence given to patients from a relative or friend that is held to a high degree, self-confirming biases – “I moved a certain way and the pain increased”, or poor self-efficacy around exercise.

The truth is that most of the science points to the fact that surgical intervention has a very poor history of reducing pain, and even worse at returning mobility to a patient. Surgeries such as spinal fusions have around 5-10% confidence rate in pain reduction. Degeneration, ruptured discs, bulging discs, arthritis, and narrowed discs have been clearly shown to not be the source of chronic back pain, in fact ruptured and bulging disks have shown the ability to repair themselves with conservative treatment. Even with all of this evidence these are the most common reasons for surgical intervention. Another factor that can impact an individual for long after surgery is that chronic pain can develop from the surgical site, this is unfortunately the case in up to 60% of post-surgical cases. Factors such as nerve impingement, that can cause pain radiating to the lower limbs, as well as other factors can see the re-operation rate be has high as 20% in the first year. A large factor that can make surgical intervention a reoccurring issue is that the fact that by decompressing the joint space, the bony surfaces then lack the mechanical loading that is needed for bone health. This can lead to further degeneration that can lead to complications at the surgical site or surrounding tissue.

Unfortunately, back and cervical pain can be one of the hardest pains to live with. Our brain has an innate drive to protect the central nervous system for survival purposes. Pain signals from the tissue surrounding the spine can and often do drive several protective mechanisms. One being protective muscular guarding, this is an increase of tension of the muscles to reduce movement and decrease the impact of injury on the spinal cord. This to can impact the intrinsic supportive musculature around the spine, impacting spinal roots and causing pain in areas wide spread inferiorly. This can lead to individuals becoming restricted through movements which cause pain and fearful of movement. In most cases this pain is not related to tissue damage but can cause an individual to avoid movements which further contributes to a ramp up of pain and muscular guarding.

Conservative treatments that are targeted at mobility and strength have been shown to be the most effective with short and long-term outcomes. Decreasing the pain loop that can quickly be imbedded in the brain and increasing strength to support stability around the pelvis, and vertebra have been clinically proven to increases positive patient results. Unfortunately, long term neurological pain tends to require long term treatment, as the pain signals become imbedded like a memory. This does not mean that the brain can’t forget this, but it takes an intrinsic motivation from the individual to self-manage. Neurological change needs to be practiced daily (the more the better) to actually benefit the individual, just like learning a new skill. If you want to learn the piano, or ride a bike, practicing once a week or fortnight will unlikely cause a neurological change. Consequently, if you want your brain to unlearn pain, you will need to practice, practice, practice!

If you or someone you know is afflicted by back pain you have many options before you think of surgery. If the pain has been present from a short amount of time between one day to less than twelve weeks (acute stage) a physiotherapist would be one of your first ports of call. During the first stages of injury manual therapies conducted by a physiotherapist are likely to have their best outcomes. By going the extra step and receiving concurrent treatment from an Exercise Physiologist, outcomes are likely to be increased and time afflicted are likely to be greatly reduced. If the pain has been present for more than three months (chronic), an accredited exercise physiologist would be best suited to help. Unfortunately, after the first acute stage is over and pain has become chronic, this is where the neural loop that we discussed becomes more impactful, and hands on treatment provide little if any benefit. At Absolute Balance we can help to guide you on the best treatment options, no matter what stage of injury you are at.

 

Jordan M Woods

(B.Sc. Exercise, Sport Science, and Rehabilitation, GradDipSc.

Exercise Physiology Rehabilitation)

 

References

Bredow, J., Bloess, K., Oppermann, J., Boese, C., Löhrer, L., & Eysel, P. (2016). Konservative Therapie beim unspezifischen, chronischen Kreuzschmerz. Der Orthopäde45(7), 573-578. doi: 10.1007/s00132-016-3248-7

Longo, U., Loppini, M., Berton, A., Laverde, L., Maffulli, N., & Denaro, V. (2014). Degenerative changes of the sacroiliac joint after spinal fusion: an evidence-based systematic review. British Medical Bulletin112(1), 47-56. doi: 10.1093/bmb/ldu030

Martin, B., Mirza, S., Comstock, B., Gray, D., Kreuter, W., & Deyo, R. (2007). Reoperation Rates Following Lumbar Spine Surgery and the Influence of Spinal Fusion Procedures. Spine32(3), 382-387. doi: 10.1097/01.brs.0000254104.55716.46