Chronic Back Pain

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Back Pain Symptoms

Published: 07 August 2018

Are you looking for Chronic Back Pain relief?

Let’s first step back and look at just what we mean by “chronic back pain”.

Chronic back pain is a very extensive condition in industrialized countries and the most common reason for functional limitation in people under the age of 45 years. Chronic Pain in the back is commonly defined as pain in the back that persists for longer than three months.

Generally, it is caused by degenerative or traumatic conditions of your spine. While acute back pain (pain that arises to alert you to an underlying problem - fix the problem - pain goes away) has a biological purpose - Chronic back pain has not.

Chronic back pain is a disorder that evolves over time and results in a very complex collection of signs and symptoms. It greatly reduces an individual’s productivity and psychological performance to an extent far beyond that of acute back pain. Of the estimated 70% of people who experience lower back pain during their lifetime, an estimated 8% develop chronic back pain.

Lower back pain is second only to the common cold and flu as a cause of time off work. Productivity losses - both for you personally and within the business world - are huge on an annual basis.

As I mentioned earlier, back pain is defined as chronic if it lasts longer than twelve weeks. This is due to the fact that the normal healing process of connective tissue occurs within six to twelve weeks unless a structural anatomic instability continues. Furthermore, the less vascular nature of the intervertebral disc may contribute to the slowness in resolution of chronic low back pain.

Do you understand your chronic back pain?

Traumatic or degenerative conditions of the spine are the most common chronic causes of back pain. Frequently, patients with chronic back pain find that their objective findings on MRI scans and other investigations do not consistently match the degree and duration of pain they have. An example would be in disc herniations and protrusions, commonly reported to be the cause of lower back pain. The extent of disc protrusion found on MRI scanning and the severity of clinical symptoms experienced by the patient are commonly unequal - that is a small disc protrusion on an MRI scan can result in a presentation of chronic pain whereas a major protrusion may produce less symptoms. This makes the ultimate diagnosis and explanation of chronic back pain more difficult for the practitioner involved in the diagnosis.

Quite often, if diagnostic studies are not conclusive on the structural cause of chronic back pain - the patients and therapists alike start to question whether the pain has a psychological rather than a physical cause. This point is, in my opinion, of paramount importance. Although pain is physical in nature - and the intensity of pain we feel is a physical feeling - the underlying emotional contributions to chronic pain presentations seem to be extensive. CranioSacral therapy is the tool I use on a daily basis to work with the emotional side of chronic back pain.

What are examples of chronic back pain?

The most common causes of chronic back pain I see are:

• Discogenic pain - where the disc itself is the cause of the pain.
• Reticular pain - where the nerve root is impinged, inflamed or traumatized, resulting in the referral of pain into the leg commonly diagnosed as sciatica.
• Facet joint pain - where chronic inflammation of these joints results in pain, stiffness and dysfunction with secondary muscle spasm leading to eventual degeneration. This process happens over time, such is the nature of chronic back pain. Sacro Iliac pain is a commonly mis-diagnosed cause of lower back pain where the pelvis is the primary dysfunction and the lumbar spine is secondary to the development of pain.
• Muscle pain - a common chronic back pain condition I see on a daily basis which is characterized by muscles that are shortened, or contracted in nature, resulting in increased tone and stiffness. Fibromyalgia is an example of this. This has a movement effect on the underlying joints and discs - which eventually causes degeneration to the discs and joints - further increasing pain.

Is early intervention important for Chronic Pack Pain Relief?

Early intervention is of paramount importance with all back pain in order to prevent the probability/possibility of a chronic condition resulting. The evolution of chronic back pain is complex and, as described, has physical, psychological and psycho-social influences. The longer your pain is there, the more difficult it is to treat each of these influences. But ultimately. all three influences need to be worked through. Understanding and acknowledging the complexity of your back pain is what will support your recovery over time.