Chronic back pain (CBP) is pain that continues more than 12 weeks or longer, even after an initial injury or underlying cause of acute back pain has been treated.
There are many causes of chronic back pain, usually related to the way bones, discs, tendons, muscles and ligaments interact. CBP can usually be associated with a fall, injury or other medical condition.
Symptoms:
- Ongoing and persistent pain, which can be felt in the middle or either side of the back
- Pain described as sharp, stabbing, dull or throbbing
- Spasms
- Stiffness
- Tinging / Pins and needles
- Numbness in the legs/feet.
- Other associated symptoms experienced may include anxiety, depression, fear and distress.
For some patients, back pain including LBP will settle down, but for other patients, it will continue and become a chronic issue. Current statistics indicate that 1 in 10 people will have pain that will continue.
Back pain, particularly Lower Back Pain (LBP) is the leading cause of disability worldwide and considered one of the most common reasons for people of working age to drop out of the workforce. Furthermore, 4 out of 5 people experience it at some time in their lives.
Diagnosis:
Diagnosing the cause of CBP will involve a complete assessment and thorough examination.
The examination will include the back itself, your ability to sit, stand, walk and lift your legs. Assessment will include a numerical rating of pain along with recognised pain assessment tools/questionnaires that are used to give an overall picture of your pain and how it impacts your life as a whole.
In some cases, imaging tests are not needed but in other may be recommended to rule out specific causes of pain including spinal stenosis, disc issues, and inflamed joints, identify nerve pressure areas etc. Occasionally, the cause of CBP is difficult to determine.
Treatment:
CBP is most often treated with a stepped care approach. This involves moving from simple, less invasive treatments, to more aggressive treatments. As always, treatment will depend on your presenting symptoms and will be based on the assessment and physical examination.
Treatment should be multi-modal to ensure a personalised pain management plans is implemented and may include the following management options:
- Pharmacology: Common pain medications such as paracetamol and anti-inflammatories may prove to have some impact on reducing symptoms/pain associated with CBP. Other medications may also be used to manage the symptoms. These medications include Pregabalin (Lyrica), Gabapentin (Neurontin) or Amitriptyline. Stronger pain medications such as Opioids are not recommended for long term use in controlling the persistent CBP. A short course of stronger pain medications may be deemed suitable if there is a pain flare. If an opioid medication is being used, it is important to use the lowest dose possible to manage symptoms and ensure the least side effects as these medications can be associated with issues of tolerance, dependence and withdrawal if ceased too soon/suddenly. Your pain specialist will work with you to find the best medications for your pain and come up with a medication plan. Medicinal cannabis is other medication which for patients who meet a strict criteria, may find benefit from. The medication plan will involve working with your GP to achieve the desired dose to help with symptom control. As with most medications used to treat pain, making adjustments to doses may be necessary.
- Exercise Physiotherapy: Ensuring patients with CBP keep active and moving is vital. Contrary to popular belief, research has shown that patients who participate in regular exercise will have overall better outcomes. A trained exercise physiotherapist who specialises in chronic pain management is a great place to start and your pain specialist can recommend one for you. This will involve active participation on the patient’s behalf. It is also recommended to see an exercise physiotherapist to ensure the appropriate exercise is selected for the patient’s level of fitness. Low impact or water based exercises are good starting points.
- Lifestyle Factors: Getting enough sleep, reducing caffeine intake and having a routine for sleep and waking up is also important. Eating a balanced diet that includes plenty of Omega-3 fats (such as oily fish, fish oil supplements, linseed or linseed oil, canola oil and walnuts) has also been shown in research to help ease the symptoms of chronic pain by helping to naturally reduce inflammation. In addition, drinking green tea regularly has also been shown in some research to help naturally reduce inflammation. Maintaining a healthy weight may also improve the symptoms of your CBP. It is also highly recommended that if a patient suffers with CBP and is smoking, they work with their GP on quitting as this will have an impact on the pain a person experiences (Studies have shown that patients who smoke will report higher levels of pain compared to those who are non-smokers). Together with other treatment options, lifestyle factors can help manage pain.
- Psychological Support: The overall impact from CBP can be significant. Involvement of a trained pain psychologist is recommended to help patients gain better control of their pain, reduce stress, symptoms of anxiety and/or depression, and help patients be able to cope with their condition in everyday life. A referral to a trained pain psychologist may be recommended by your pain specialist.
- Interventional Procedures: Your pain specialist may recommend you for an interventional procedure. Based on your underlying pathology, procedures such as nerve blocks, radiofrequency neurotomy or even more advanced procedures such as spinal cord stimulation. These procedures aim to give maximum pain reduction but will not provide a cure. If you are recommended for a procedure, further information will be provided to you.
It is important to note that chronic back pain affects people in different ways and one person’s response to treatment will be different from another person’s. Your pain specialist will work out a plan on how best to treat you and your symptoms.
**This information sheet has been written for patients affected by chronic back pain and provides general information only**
References:
Pain Australia; Arthritis Australia
National Institute of Neurological Disorders and Stroke