Everyone experiences pain after an injury such as stubbing your toe or twisting your ankle. You even get pain after many types of surgery. However, this pain is useful for your body to tell your brain that something is wrong. When the injury has fully healed, the signals stop travelling to your brain and the pain goes away.
Chronic pain is when pain lasts for more than three months. Even when the injury has healed, your brain is receiving signals that you should be in pain and therefore you experience pain. This pain is often experienced as a constant, dull ache but can also be felt as ‘stinging’, ‘squeezing’ or stiffness. There are lots of different causes of chronic pain including arthritis, headaches, and damage to your nerves. However, the most common cause is chronic back pain, particularly lower back pain.
Back pain is extremely common all across the world. The World Health Organisation and Back Pain Clinic estimate that about 60-70% of the Western World experience back pain at any point in their life. Just in the last 20 years, there has been a 12% increase in how many people have a disability because of back pain. It is generally more common as you get older, although the most common age group to experience back pain is 35-55, and all age groups are at risk.
Exercise and staying in shape can help prevent back pain as movement is important that the muscles that support your back stay strong. Low-impact exercises, such as swimming and walking, are particularly useful in building up these muscles. Keeping your weight down can also help as an extra can put more strain on your muscles. Finally, smoking can make your bones weaker which can make back pain more likely, so quitting reduces the risk of back pain.
Back pain may develop due to a specific illness or after an injury. Traumatic injuries such as playing sports or falling can damage bone, muscles tendons or ligaments. The spine being compressed can also cause a disc to herniate, giving pain in the back which can travel down the legs as the nerves become compressed. These injuries may cause damage to the structures of your back, causing the pain to become chronic. However, chronic back pain may also develop even with no identifiable structural damage remaining. This is often called ‘chronic benign pain’.
Certain medical conditions can lead to chronic back pain as well. Arthritis, particularly a form called osteoarthritis, frequently targets the lower back. The cartilage of your spine becomes damaged, causing friction and inflammation. The swelling around your spine sends a signal to your brain that you are in pain. Osteoporosis can also lead to chronic back pain. As your bones become less dense, they are more susceptible to lots of little painful fractures.
In April 2020, the guidelines on how to treat chronic pain were updated. These changes show that a more holistic view of the management of chronic pain is needed. Whilst medication is still useful, there are many other lifestyle changes that can be made to help overcome the pain. In general, chronic back pain is treated in a step-wise manner, starting with less invasive and cheaper approaches before escalating to more aggressive management.
Firstly, exercise and physical activity are crucial in managing back pain. It is important to stay safe whilst exercising with chronic pain as it may become worse if the movements are not done properly and safely. Starting with low-impact movements such as stretching, yoga, walking or swimming is a safe way to start the exercise. Once you have started exercise, slowly increase how much you do each time to ensure that no further damage occurs. Building up the muscles that support your back, particularly your abdominal muscles, can help ease the pain too.
Other than directly supporting the back, exercise help with the pain by improving your overall health. It helps you to lose weight as well as keeping your arteries healthy which helps to supply oxygen and nutrients to your bones and muscles. Each person experiences back pain in a different way and therefore needs a different exercise plan to support recovery. It is important to speak to a doctor, physiotherapist or another healthcare worker to work out the safest and most effective exercises for you.
Chronic pain is not fully understood by scientists, particularly how one person’s body can respond to the same stimulus and feel more pain. They believe that it is because the nerves travelling from the site of pain to the brain send signals more often, or due to your brain interpreting the same signals as increased pain. Therefore, specific psychological therapy can really help to alter how your brain receives the signals and interprets the level of pain.
Acceptance and commitment therapy or cognitive behavioural therapy have both been recognised in helping those with chronic pain. These are both forms of talking therapies that help someone living with chronic pain deal with it in a few different ways. As well as altering the brain’s response to the signals it receives, they help change the way that people view their pain. Developing coping strategies and contextualising the pain both help
It has been found that stress, anxiety and depression all increase how much you respond to pain. Chronic pain can also make all three of these more likely, as living with a long-term condition is not just physically difficult but mentally and emotionally as well. Mindfulness and meditation both help to focus on things other than the pain, improving symptoms and mental wellbeing.
Many medications have been found to be ineffective in treating chronic pain. Paracetamol, ibuprofen, and opioids are amongst the drugs which do no help long-term pain. Antidepressant medication is often prescribed, even in the absence of a diagnosis of depression. This is because they are able to improve sleep quality, stress and quality of life. This in turn leads to less discomfort from the source of pain.
Medical cannabis is a newer medication to treat chronic back pain. Research is still being conducted into how effective medical cannabis is, but some people do report improvements in pain based on trials that have been carried out. More studies need to be run to fully determine its efficacy, but the evidence so far is promising.
The most recent guidelines also include advice on alternative treatments. These have less evidence of efficacy than more established treatments such as exercise but do have a place in the management programme. acupuncture has been found to have a positive effect on chronic pain by causing the release of endorphins, a molecule that helps to block the pain signals. Massage therapy also holds promise, although the current evidence is uncertain on how efficacious it actually is. Any alternative treatments should be carried out alongside exercise, psychotherapy and medication. A holistic approach to chronic pain management is the most effective.
Leva Clinic is the UK’s first fully registered online clinic for chronic pain management. Leva provide a personalised care package with a dedicated pain team including doctors, nurses, physiotherapists and clinical psychologists. Leva clinic is currently offering a free eligibility phone call. For more information, go to www.levaclinic.com.