Get control of chronic back pain with a full spectrum of therapy options, experts say
Measures include everything from spinal manipulation to pain processing therapy
Ann Marie Gaudon was at the gym when she injured her back. After bending down to lift something off the ground, she experienced a ripping feeling rush through her body.
"The air was sucked out of my lungs," said Gaudon, an Ontario psychotherapist and social worker. "I couldn't breathe, I couldn't stand up. I didn't know what was going on, but I knew it was serious."
Gaudon spent years speaking with chiropractors, massage therapists and pain experts before finally finding a specialist who taught her spine-sparing exercises that helped her slowly overcome her pain.
But that lasted only a few years, because Gaudon says she hadn't kept up with the exercises. Since resuming them, she says she's in less pain now than when she first hurt her back in 2017, but still deals with some discomfort some days.
What is chronic back pain?
Gaudon is one of the nearly eight million Canadians who live with chronic pain, and one of the hundreds of millions of people around the world with chronic back pain.
According to pain specialist Dr. Brenda Lau, co-founder and medical director of the CHANGEPain clinic in Burnaby, B.C., pain can be acute — caused by injuries, stress or disease — or chronic. Pain is typically classified as chronic after three to six months.
The persistent discomfort associated with chronic back pain affects men and women relatively equally, with most people experiencing chronic back pain between the ages of 25 and 55.
"Typically, it's someone who's actually been doing a lot of sitting around," Lau told The Dose host Dr. Brian Goldman.
Smoking, poor eating habits and poor sleep habits also contribute to chronic back pain, Lau added.
What causes chronic back pain?
When Gaudon first hurt herself, medical imaging revealed a herniated disc, a disc bulge and three areas with pinched nerves.
While Gaudon had physically traumatized her back, Lau says many people living with chronic back pain often have nothing physically wrong with their bodies.
"We also know the imaging, MRI, CT scans, X-rays, whatever you see there, they don't correlate to the intensity," Lau told The Dose host Dr. Brian Goldman.
Instead, Lau says, medical images done on people with back pain can look a lot like images of people without.
The term non-specific low back pain can often be applied in circumstances where there is back discomfort, but the reason isn't clear.
"It becomes very hard to say that the structural abnormalities that you see on an X-ray or an MRI, or that you find in a physical examination are, in fact, the cause of somebody's back pain," said Dr. Ted Findlay, a pain physician with the Calgary Chronic Pain Centre.
"That's what we mean by non-specific low back pain. It's getting away from saying we have to do imaging to identify a particular tissue or structural abnormality in order to develop a treatment plan."
How can we treat chronic back pain?
Typically when a person is injured, the body's neurochemical processes kick in to help with recovery, according to Lau.
"There's an inflammatory soup, if you will," Lau said. "All types of host defences call into action when injury of any tissue occurs."
In the event of chronic pain, however, the pain persists even after the body is done healing.
"It changes the nerve system itself so that now [the pain is] no longer the area where there's some sort of inflammatory response," Lau said. "It's more like the nerve system's been ramped up."
Treating chronic back pain therefore requires a "biopsychosocial model," according to Findlay, referring to a model of care that links biology, psychology and social factors.
Referencing World Health Organization guidelines published in late 2023, Findlay said treating chronic back pain requires a combination of education and rehabilitation.
"The more recent guidelines suggest there can be benefits from spinal manipulation," he said.
Spinal manipulation is a process by which specialists use their hands or small instruments to apply pressure to a patient's spine, to help relieve pain or discomfort.
Lau agrees that treating chronic back pain requires a full-spectrum approach.
"What we need to do is rehabilitate, retrain, the way those muscles are working," she said.
"Physiotherapists, chiropractors, exercise physiologists, [and] dedicated trainers can get people back on their feet."
Tools like pain reprocessing therapy — which use common psychological techniques to encourage patients to reframe their thinking around the pain they experience — can also be "very effective" in aiding patient recovery, Lau says.
"Pain reprocessing therapy is all about utilizing a combination of active ways of thinking that is going to inspire you to move the body, to eat well, to reduce the fears around the pain itself," Lau said.
"You've already received the diagnosis.… Now is the time to start reinterpreting [the] pain signals to the extent that you can alter them."
Can medication help?
People living with chronic back pain might be tempted to rely on medication to alleviate their discomfort, but Lau and Findlay recommend being careful about overusing anti-inflammatory drugs like naproxen.
"We know that the long-term side effects of those do, in fact, cause more harm," Lau said. "Kidney damage, gastric issues [are] two of the main things."
That said, Findlay says you don't need to avoid over-the-counter medications entirely.
"If you're a weekend warrior and you've been playing hockey and you've got back pain, then why not take an anti-inflammatory or acetaminophen," he said.
"But for the long-term, they probably have very little effect."
Can chronic back pain ever go away?
Lau says she's witnessed patients recover from their discomfort over time.
However, Findlay says there are numerous instances where patients continue to experience pain, even while taking steps to improve their overall health and well-being.
A recent meta-analysis published by the CMAJ showed that patients with pain that persisted between less than six weeks and 12 weeks "had substantial improvements in levels of pain and disability within the first six weeks."
Patients with pain that lasted between 12 and 52 weeks continued to experience "high levels of pain and disability with minimal improvements over time," the analysis added.
While this might not seem like great news for people living with persistent chronic back pain, the analysis suggests that diagnosing and treating back pain early could "reduce the likelihood" of it becoming persistent low back pain.
"Pain is a call to action that most people can't ignore," said Lau.
"We hope that at that call to action, that you will empower yourself to say, 'Yes, there are things that I've got to personally change, but I also have to link to providers who can help guide my way.'"
At the same time, Lau encourages people living with chronic back pain to seek out new approaches if relief remains out of reach.
Gaudon echoes Lau's sentiments.
"If you truly don't know what's going on and you go to alternative practitioners and you're still in pain, why would you keep doing that?" Gaudon said.
"You're not helping yourself if you're still in pain."
Corrections
- A previous version included an inaccurate paraphrase attributed to Gaudon about living pain-free. That line has been removed.Jan 31, 2024 1:14 PM ET
