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Managing Chronic Low Back Pain

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IMAGE If you have never suffered from low back pain, consider yourself one of the fortunate few. Back pain is a common reason for Americans under the age of 45 to limit their activity. It is also a common reason for visits to the doctor and for surgery. There is some good news, though. Most people recover from an acute episode in a few days or weeks without much disruption to daily activities or medical treatment. For others however, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.

Why So Common?

Many factors contribute to low back pain, such as inadequate fitness, heavy lifting, and poor posture. But our evolutionary history is to blame for our susceptibility to this pain. At some point in the distant past, some of our ancestors decided to stand on two feet, presumably so their hands would be free to fashion tools and use them efficiently. While their reasons were good, going vertical was not without its drawbacks.

Walking around on all fours distributes the force of gravity evenly over the length of the spine. Standing up, however, concentrates this force in one location—the lumbosacral region, just north of the buttocks. Our vulnerability to low back pain is the price we pay for bipedal locomotion.

Several factors can contribute to persistent back pain:

  • Having a work-related injury, particularly if the work environment requires or allows use of improper body mechanics, such as bending or twisting when lifting.
  • Having poor ergonomics for sedentary workers
  • Having a degenerative disease, such as arthritis, of the spine
  • Being overweight or obese

No Obvious Cause

Most cases of chronic back pain are idiopathic, meaning they have no clear explanation. Without a known cause, treatment is very difficult and often unsuccessful. This leads many people to alternative therapies. Below are among the most commonly used alternative therapies to treat chronic low back pain:

There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of these therapies is superior to the others or to physical therapy, the standard conventional treatment. Furthermore, it is unclear that any of these approaches provides more than short-term benefit.

More Is Better

So, what then is the best treatment for chronic low back pain? According to evidence, what seems to matter is not which one, but how many treatments you use. In other words, interventions that address not only the physical aspects of the pain, but also its psychological, social, and occupational influences seem to be the most effective. An effective rehabilitation program may encompass:

  • Physical therapy
  • Exercise and strength training
  • Cognitive-behavioral therapy—helps you adjust your behaviors to better cope with back pain
  • Massage
  • Relaxation
  • Balneotherapy—the use of hot and cold baths
  • Heat and cold application

Complex Solutions for Complex Problems

This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy, therefore, should be part of a multi-dimensional treatment strategy.

Chronic back pain can affect your ability to keep up with your normal activities. These treatments will help you slowly increase your activity level until over time.

Where Do We Go From Here?

If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:

  • Recognize that your condition is a complicated problem that cannot be treated in isolation. This is the first step to gaining control over your pain and your life.
  • Determine which facets of your pain have not been adequately addressed—psychological, social, occupational, and/or physical. Tackling this problem from only one perspective is unlikely to work.
  • Continue working with your doctor, and consider getting a referral to a doctor who specializes in physical medicine and rehabilitation, or chronic low back pain. These doctors may be in the best position to coordinate a comprehensive, multi-disciplinary treatment plan, whether or not it includes alternative therapies.
  • Strive to restore your ability to function. Your goal should be to resume your normal activities, not only to reduce your pain. Although the two are closely linked, the evidence suggests that focusing on function is the key to recovery.
  • Look both ways. Look ahead to visualize what it will be like to have no pain or disability. But also look back to measure your progress. It is easier to succeed when you see how far you have come.
  • American Academy of Physical Medicine and Rehabilitation

    http://www.aapmr.org

  • American Society of Exercise Physiologists

    http://www.asep.org

  • Canadian Society of Exercise Physiology

    http://www.csep.ca

  • Health Canada

    http://www.hc-sc.gc.ca

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  • Low back pain. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/low-back-pain.html. Updated November 2010. Accessed November 11, 2013.

  • NINDS back pain information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/backpain/backpain.htm. Updated May 1, 2013. Accessed November 11, 2013.

  • Roelofs PD, Deyo RA. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;(1):CD000396

  • 1/15/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54.