If you had a low back pain episode, the odds are that 2 out of 10 people like you have the chance to develop chronic low back pain with persistent symptoms at one year. If your back pain lasts for more than 12 weeks (3 months) then it is considered to be chronic low back pain. This may be due to injury, inflammation or disease to the tissues of your body. About 20 percent of people affected by acute low back pain develop chronic low back pain at one year.
Back pain is the second most frequent medical reason to visit a doctor after common cold with loss of work time and disability in people under 45 years of age?
What is the natural history of low back pain?
What are the symptoms of Chronic back pain?
Chronic back pain presents with a wide variety of symptoms that range from mild annoying constant pain to very severe pain that is crippling and unbearable. Chronic back pain also behaves in the way that initially comes and goes, starts slowly and gradually worsens over a period of time. Symptoms range from:
- Dull and achy pain over your lower back
- Low Back pain with no leg pain
- Low Back pain that radiates from your back and to your lower legs or feet with tingling and numbness (sciatica)
- Worsening pain on prolonged standing or sitting
- Difficulty in activities of daily living like walking, bending and turning
- Tightness in your low back with muscle spasms extending to the pelvis and hips
What are the causes of Chronic low back pain?
98% of low back pain is caused by these 5 common conditions:
- Back sprain
- Disc prolapse or herniation
- Disc Degeneration (wear and tear)
- Oesteoarthritis of the spine
- Spinal Stenosis
How does chronic low back pain present?
Chronic Back pain presents in 3 different ways:
There is no clear reason for the low back pain. When the pain is of such a long duration, your pain pathways from the brain get so used to the pain signals for that period of time.
So even though there is no ongoing tissue damage, your nervous system misfires and creates back pain.
Now the low back pain has become the disease rather than a symptom of an old injury!
In Neuropathic back pain, there is no signs of the injury or cause of low back pain. But the nerves from the back continue to send pain messages to your brain even though there is no tissue damage.
Neuropathic pain feels different than low back pain as it is intense, sharp, sudden, stabbing, burning, or cold. There is tingling, numbness or weakness. There is radiation of pain from the spine to the arms and legs.
Can Chronic back pain be cured?
Chronic backpain is difficult to cure completely. But it can be managed effectively with different strategies. The main reason for this difficulty in treating chronic backpain is that it affects gradually and takes control of our life. Before we actually realise the intensity and struggle with chronic backpain, we develop unhealthy ways of coping with chronic backpain. Without our knowledge, we will start to the use over-the-counter medications and in high doses and over longer periods of time.
We tend to become more dependent on alcohol or other substances to control our pain. All these with the passage of time, can lead to sleep deprivation, depression due to social isolation and can affect our relationship at home and work
Chronic backpain has close relationship with the depression anxiety and other psychological conditions. Therefore there is no single treatment that will cure chronic backpain. It requires a combination of techniques with medications, psychological counselling, physical therapy, relaxation techniques and cognitive behavioural therapy.
How exactly does chronic low back pain develop?
These are the factors in the development of Chronic pain.
Initially like any pain, the back injury is felt like back pain and our thoughts come into it to feel the back pain along with the events sorrounding the back pain. Our response to our thoughts about back pain is now influenced by our emotions like fear, anxiety and depression.
Gradually over time, our emotions with back pain become a suffering with the pain as it continues over a long period of time. The suffering from back pain blends into a back pain behaviour.
When should I be worried about Chronic back pain?
As you know that 98% of low back pain settles within 6 weeks with simple measures like:
But if your back pain continues beyond 6 weeks and if it is not improving or is actually getting worse, then you should be worried about your back pain and must seek medical attention.
What are red flag signs and symptoms of low back pain?
These are warning features that we must be alert to if we suffer from low back pain. In most instances, the back goes away within 6 weeks. If your back pain still hangs around for more than 6 weeks and you find any one of these symptoms, it is a severe warning sign to seek immediate medical attention. Any delay will lead to danger to life.
Back pain with fever
Sudden weight loss followed by Back pain
Prolonged Back pain in children and adults less than 20 years old
Back pain more than 6 weeks in adults more than 50 years old
Sudden severe back pain in people who take intervenous drugs
Back pain that is worse in patients with history of cancer
Sudden onset of back pain in those taking long term steroids
Back pain along with numbness of the buttocks and pain in both legs
Back pain with difficulty in passing urine or lack of control of your bladder or bowel function
Back pain more than 6 weeks after injury in an elderly patient
What are the ways to treat Chronic back pain without surgery?
LIFE STYLE MODIFICATIONS
Learn to work within the limit of your pain. Adapt yourself and slow down your movements. Understand and be aware of the activities that trigger or worsen the back pain. Avoid them if possible. Take frequent breaks when carrying groceries, mowing the lawn or while taking a long walk.
Medications do help to control chronic back pain. Medications along with activity modification can manage your back pain comfortably. These medications range from simple painkillers like paracetamol, ibuprofen and naproxen to muscle relexants and opioid medications (codiene, tramadol and morphine).
HOME EXERCISE PROGRAM:
A home exercise program (HEP) is usually in place before the patient is discharged from physiotherapy. These exercises and strengthening are designed to increase stability and strength. These techniques also work to avoid deconditioning that results from decreased activity and are specifically designed to suit you and your back pain. The ultimate aim is to prevent progressive loss of activity due to fear of movement.
Your coping skills are very important in the management of chronic back pain. Mindfulness and Meditation techniques by a trained psychologist will help deal with the emotional aspect of chronic back pain. Chronic low back pain can directly affect all aspects of your life including your mood, and ability to cope with pain.
Chronic back pain also affects how you interact with your friends and family. Therefore giving you the right coping skills to deal with for with anxiety, depression, irritability and frustration is very useful in the management of chronic low back pain. We will involve a trained pain specialist, psychologist or psychiatrist in the management of chronic back pain. The psychologist will also recommend, yoga, tai chi or acupunture to keep our mind distracted from the pain.
Physiotherapy includes patient education and training in a variety of stretching and strengthen exercises and manual therapies. Other additional methods like application of ice, heat, transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound are also found to be useful.
Active therapies that you can take full control (such as exercise and strengthening) usually have the most permanent and long-lasting effects. A combination of stretching and flexibility exercises, aerobic training, posture corrections, proper manual handling techniques and core stability exercises are used in this therapy. Regular physiotherapy at home will provide excellent control in chronic back pain.
Caudal Epidural steroid injections, Nerve root injections or blocks, Facet joint injections, Sacroiliac joint injections and Nerve root ablations are the procedures available under sedation for chronic low back pain. They are used to confirm the cause of low back pain or control severe pain over a short period. These are not used as long term solutions as they lose their effect very quickly and cause increased risk of spine infection.
What are the surgical options to treat Chronic back pain?
Surgical options are considered in chronic backpain that has an identifiable cause. The causes are lumbar disc prolapse or herniation, spinal stenosis, osteoarthritis and fractures of the spine. The success rate for surgical procedures are excellent with today’s modern technology and knowledge.
However in chronic backpain with no identifiable, chronic backpain with neuropathic pain, pain after previous surgery and failed back surgery syndrome, the surgical options are limited and more challenging. Surgery considered in these cases are insertion of a spinal-cord stimulator.
Should you work with Chronic back pain?
Yes you can work with Chronic back pain.
Chronic back pain must be managed in the same way as you would manage acute back pain. In acute backpain situations, you should try to remain physically active as much as possible and it helps in managing the pain. In the same way, physical activity for chronic backpain will also help reduce the severity of your symptoms.
Therefore, the current recommendation is that you can continue to work with the management strategies highlighted above as well as return to work as soon as possible.
What should you not do with Chronic low back pain?
Do not lose your posture in chronic low back pain. Sitting on a soft couch, low seat, poor back support and sitting for a long period of time will round your back. Do not lower your hips more than your knees and the normal curve in your back. Do not keep your legs straight and lean forward as it triggers and worsens your chronic low back pain.
How should you sit with Chronic back pain at work?
Sit for short periods of time (15 – 20 minutes)
Take frequent rest as much as possible
Lift up yourself and increase the curve of your back
Relax that postion a little. This is the best sitting posture
Do not twist your waist while sitting, turn your whole body
When standing up, move to the front of your chair and get up. Do not bend your back.
Does Chronic back pain qualify for disability in the UK?
Yes they do qualify for disability payments in the UK. To be eligible for disability benefits, you must have a medically determined back pain condition that will be independently assessed by a specialist spine surgeon at your local hospital. It must be determined that your back pain is chronic and not treatable. This includes herniated disc, nerve root compression, spinal stenosis or archnoiditis.
The findings of the large study in 2010 on the global burden of disease showed that Back pain is the leading cause of disability affecting one in 10 people. The study was conducted at the Royal Cornwall hospital in the UK, University of Washington in the US and from Australia. It was funded by the Bill and Melinda Gates foundation.
How do you live with Chronic back pain?
There are a lot of simple things that we can do to live with chronic back pain. Eat a healthy diet. We must learn to reduce stress in our life, as stress intensifies the feeling and emotions around chronic backpain. Exercise is a very good way of offerring pain relief as it releases a natural endorphins from our system. Deep breathing exercises and meditation can also help us relax and manage chronic backpain
Cutting back on alcohol and smoking has excellent benefit in the control of chronic back pain. Joining a support group and meeting other people who live with the same problem, helps us in getting valuable tips in managing day-to-day problems. We must actively find ways to distract ourselves from the pain so that we can enjoy life more.
There is more to life than chronic backpain.