There are not many of us who can say they haven't had back pain, in fact many of us have back pain often, but if you are unlucky enough to have constant pain that interferes with your life, just getting through the day at work or at home can be very challenging.
Chronic Back Pain is a Growing Worldwide Problem We are Not Solving
Chronic, noticeable pain affects 38% of the UK population.
And here's some information on the Google searches that some of these people make:
70,800 Google searches for "chronic pain"
8,400 Google searches for "chronic pain management"
In 2017 - 34% of all adults had chronic pain.
In 2020 - 38% of all adults had chronic pain, quite an increase when you consider the size of 4% of the UK population.
Back pain stops us moving freely
Most of us will experience back pain some time in our lives - the disability resulting from this will range from a few hours of careful movement to constant chronic back pain that causes permanent disability, interfering in all aspects your life.
"Once low back pain has been present for more than a year, few people with long-term pain return to normal activities" Royal College of GPs (UK).
Although the above quote was published in 2009, I fear things have not improved, despite an increase in the development of various injections, nerve blocks, pain killer medications and the really final option, back surgery.
Explaining Back Pain - Acute Pain vs Chronic Pain
Firstly, I need you to understand what acute pain is, before we can fully understand chronic pain and why it is so challenging. Acute pain is a physical injury; it is tissue damage from something as minor as a paper cut, to a broken arm or leg, to injury in a car accident, to necessary surgery for such things as gallbladder removal to cancer.
Acute injuries as mentioned above will heal. In fact it's the bodies own internal system that heals. In the past after major abdominal surgery I was initially on heaps of medication. This medication was to stop pain signals; they are effectively "painkillers" though not the tissue healers.
The tissue healers are your bodies own innate healing system those that you hear about from traditional naturopathic medicine practitioners. If you decide to visit a local naturopath their philosophy is based on the innate ability of the body to heal itself.
Research done in 2013 was very informative and gives support for my work with chronic pain patients and why I advocate aiming to live without pain rather than settle for chronic pain management.
Your body heals your back pain
As many of us will attest in a few days our back may not be as sore? If we used our muscles too much, the small tears within the muscle fibres will heal, pain gradually reduces or sometimes we'll just suddenly notice that the pains are not there any more and we have begun to more normally.
Unfortunately, as time passes, months go by and your back can still be sore. You may begin to stand, sit or walk differently from normal. This is one of the reasons I ask all of the people entering my clinic to do a short video, walking back and forth about 10 or 12 steps. Then we can discuss how chronic back pain is affecting your posture and body alignment, these posture photographs and video can be a valuable first step to understanding your pain.
Do your own movement videos - notice how you move?
When pain hangs around like this, and three months have passed doctors will generally give you the label of chronic back pain. Sometimes it may be labelled "non-specific lower back pain” meaning there is not a specific reason that they can give you for why you are in pain. This can be very challenging to understand.
As mentioned above with acute pain there is physical damage then three months in, are they saying there's nothing wrong? Or is this just a medical procedure that I don't fully understand. Keep reading and I hope by the end of this article you will be more knowledgeable about your chronic back pain.
Retired Nurse Suffering Years of Chronic Back Pain from Work
I remember one client, I’ll call here Dorothea, after lifelong work as a nurse she was enduring chronic pain that was preventing her going on her ‘bucket list’, travelling in a caravan around Australia with her husband, as it was too painful to sit and ride in the car for any length of time.
Dorothea had done everything to reduce her pain, for the past year she had been going to the gym at least five times a week, believing that exercise would relieve her constant pain. After seeing her posture photographs that showed her posture was dramatically altered by living with pain. She also recognised that working ‘out of balance’ muscles at the gym should be stopped.
With this knowledge she also took time to examine her life realising she was looking after everyone else, not herself. Just this change in attitude and lifestyle began to relieve her complex, whole of body pain.
After only two consultations she had put herself on a ‘living without pain’ track!
Again, unfortunately as human beings, we want to know why we are in pain, sometimes insisting doctors to do further investigations or perhaps refer us to a different specialist. This is not unique to one country, this tends to happen consistently particularly with Western Medicine.
Will more Medical Tests find the Cause of your Back Pain?
These further investigations can be misleading as putting anybody, of any age, under the microscope, a CAT scan or MRI can show the divergences from perfection as regards alignments, bone and cartilage structure and even the way that the past decades have produced our normal healthy posture. This is not the focus of this article but more information can be found here.
But I now ask you to consider your own non-perfection, crooked nose, uneven shoulders, slight different sides to face, perhaps one eyebrow is different to the other, one seems to be a little bit lower and other facial features. If you want to do an experiment, place a mirror down the centre of your face and introduce yourself to those two different looking people that you can see.
So, you've decided to have more tests? After these tests depending on your pain specialist, injections, nerve blocks or even operations may be suggested.
Pause, and fully research options, ask many questions of many people, as you do have to remember back pain has been around for many, many decades, new invasive ideas may not solve your pain problems and sometimes they can make your pain worse.
Story of Failed Back Surgery Syndrome (FBSS).
I remember a client, in her 50’s, for this article I will call her Helen. She walked into my clinic very confident of where she'd come to and I’m still not too sure to this day that she realised that she was walking into a complimentary medicine practitioner.
A brief overview of her back pain journey.
Ø Eight years of very painful sciatica.
Ø Running her own business, a sole practitioner doing an active job.
Ø Many different treatments and medications over the years
After eight years of what was becoming unbearable pain and threatening her ability to earn a living Helen finally went to one of those pain specialist that I mentioned above, saying something, something had to be done as after eight years she could no longer put up with the pain.
The countless medications she was on no longer "cut the mustard", the painkillers didn't kill the pain any more and chronic pain management over the years had not helped.
Next step surgery - to stop the back pain.
Helen walked into my pain clinic three months after her spinal surgery that was going to finally fix the pain. Notice that "three months", again. She had just recently returned to her GP as her pain was worse, much worse than before her surgery. She was really struggling to fully comprehend what had happened. Her GP introduced another, stronger painkiller, an opioid called Targin.
Obviously one of the reasons that she went online to find me, a local pain therapist was that her pain had gotten worse, much worse than before her back operation.
Life was collapsing around her. Also the side-effects of her newest medication had made the situation worse. She felt dizzy and was really worried that she seemed to be walking very haphazardly almost swaying side to side, appearing as if she was drunk, causing more anxiety about what people would think.
This final symptoms pushed her to look for something else.
She found me.
“The development of more sophisticated surgeries and interventional treatments has not made a measurable impact on outcomes relative to return to work or medication use.” (Shapiro, 2014)
What I didn't realise then was that this failed back surgery was not a rare occurrence and it has a name, Failed Back Surgery Syndrome. The surgeons or pain specialists are saying that the surgery didn't fail, the surgery was done correctly and healed correctly, it's just the reason that it didn't help her original pain was due to the complexity of her original chronic pain.
She was in a group of people that could be a candidate for pain to actually get worse after surgery. These can be people who are already anxious either about their chronic pain or are generally a more sensitive person.
Remember – Surgery is a one-way door!
This does sound very sad but I do believe it's not a unique situation. Luckily Helen found me and we worked on a variety of issues, using a lot of the techniques that I had developed during my clinical musculoskeletal research done in 2004. And of course add another eighteen years of experience working with all the lovely chronic pain clients each one teaching me so much.
After four months Helen had little or no pain, mostly totally pain-free. However, her story continued because when she tried to reduce her latest new opiate medication, prescribed by her GP, she could hardly get out of bed and I had to encourage her husband to bring her to the clinic to continue to work with me.
But we got there!
Five years later I got in touch to see how she was - "I'm off medication and just a few aches to be expected with being nearly 65 years old."
Acute pain vs Chronic pain
Remember, at the beginning of this article before describing the difference between acute and chronic pain, I talked about some very interesting research. The full copy of the research done by Canadian neuroscientist, Dr. Javeria Hashmi (2013) can be found via the references at the end of this article. Here I'll try and give a brief summary of why I found it so interesting and truly exciting.
With the use of functional MRI’s researchers can see changes in the brain as people move or change from acute pain to chronic pain. And it seems to involve brain neuroplasticity and emotional areas of the brain.
Chronic Pain and Neuroplasticity (Brain Changes)
The research done by Dr Hashmi followed people with acute back pain over a period of one year, that entailed four separate visits to have functional MRI’s, brain scans. Some of the research participants developed chronic back pain, as opposed to naturally recovering as I’ve described above. The premise tested was that over time there is a reorganization of brain activity (neural reorganization) compared to normal state.
Enough of technology – here’s another client’s chronic back pain story
Several years ago Barry, a client I’d not seen for several years when he had problems with asthma, arrived at my pain clinic, very grumpy, very sore and walking with a pronounced limp as his back was so painful he had begun to ‘favour’ his hip movement.
His usual forms of treatment, I think mainly chiropractic and ‘across the counter’ painkiller medication had not helped. The video below shows the changes within four weeks with one treatment session each week.
Successful back pain treatment
The successful treatment that left Barry pain-free was based around re-assessing past stressful times in his life. There is not space here to detail all of either the hour-long sessions or the treatments used but, addressing two stressful times in his life illustrate a different approach to chronic pain management.
First appointment – marriage breakdown that wasn’t his choice, 25 years previously, and the concomitant emotions caused due to the trauma and personal changes. These were released, without talk therapy, so details were not shared with me.
Final appointment – at five years of age, Barry, a bubbly outgoing child, his hips and legs were put into a cast and braces, leaving little ability to move and he missed most of his first year of school. A sociable little boy missed out on socialising and mixing with other children.
This time caused not only physical developmental issues that may be implicated in over 30 years of regular back pain and compensatory regular treatments to manage his pain, without identifying the cause of his back pain. But this experience of such a small child would also have been a stressful for the developing brain of a child.
Chronic Back Pain Complicated by Past Emotional Experiences
As this article has shown, chronic back pain, whether in your upper back, middle or lower back and possible spine changes that we all experience, makes this issue complex. As you can see from my philosophy the only approach is to not separate out the spine as a ‘thing’ on it’s own and look to engineer it as if it’s the drive shaft of your car, but to look at the whole person.
Treatment MUST be designed around the person, you, who has back pain and has moved into that confusing and problematic time of greater than three months and maybe many, many years. My holistic approach is to not just treat you physically, but to consider your emotional reactions to living with pain and what is happening now, and what happened previously in your life.
‘Not mind or body treatment, but rather mind and body begin involved in treatment simultaneously.’
There are not many of us who can say they haven't had back pain, in fact many of us have back pain often, but if you are unlucky enough to have constant pain that interferes with your life, just getting through the day at work or at home can be very challenging.
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This article is the personal opinion of the author, Jean Jordan who is a natural therapist who works online with people who have chronic pain and related stress and anxiety.
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References
Hashmi JA, Baliki MN, Huang L, Baria AT, Torbey S, Hermann KM, Schnitzer TJ, Apkarian AV. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013 Sep;136(Pt 9):2751-68.