Learning to live with chronic back pain
By Janet D. Pearl, M.D.
Special to Reminder Publications
For most Americans, aches and pains come and go. However, roughly 10 percent of Americans experience chronic pain or pain that lasts longer than the normal healing time of three months. Often, they're caught in a vicious cycle of unrelenting pain and sometimes depression. Because physical activity can seem intolerable for those in pain, many avoid activity altogether. As a result, they lose strength and flexibility valuable assets that could ultimately help improve their condition.
Persistent pain can also change sleep habits and mood, causing people to withdraw from social situations and straining relationships. Physical inactivity and emotional stress can lead people to experience a higher degree of pain, perpetuating the cycle. Moreover, the combination of physical pain, exhaustion and depression can overwhelm a patient, making daily life difficult.
Low back pain is one of the most common forms of chronic pain. Despite the frustration it creates for patients and their families and friends, chronic low back pain (and other types of chronic pain) can be effectively managed by a multi-disciplinary team of health care professionals experienced in the complex interplay between the physical and emotional aspects of pain.
Many factors can cause chronic low back pain. Congenital conditions, like curvature of the spine; age-related degeneration of the spine, where discs lose fluid and flexibility and joints become arthritic; and traumatic injury are major causes. But, such pain can also come from years of poor posture, smoking (which causes discs to degenerate), improper lifting and carrying of heavy objects, or obesity. Even sleeping on a poor mattress and wearing high heels can be causes.
Coping with pain: blending body and mind
Chronic back pain usually has no cure, unlike acute back pain, which lasts a few days to a few weeks. However, the pain can be managed effectively by the right combination of health care professionals, including a pain medicine physician, physical therapist, primary care physician, psychologist or other mental health practitioner, and, depending on the underlying problem, other specialists like an orthopedist or a neurologist. Communication and collaboration are important in diagnosing, treating and monitoring the physical, social and psychological aspects of pain.
The primary treatment goal is to enable patients to engage in as healthy a level of physical and mental activity as possible. Exercise can prevent or interrupt the vicious cycle of pain by releasing the same type of brain chemicals that antidepressant medications release. The results are a happier mood, better sleep, and less pain. Physical therapists can adapt exercises to fit the condition of specific patients so they can also improve their strength, flexibility and physical functioning despite pain.
Psychologists and mental health practitioners help patients with pain overcome psychological obstacles that make living with pain especially difficult. They teach people methods to cope when the pain is particularly severe, train patients to notice negative or distorted thoughts that might color they way they experience pain, and provide psychological counseling to reduce anxiety and depression.
Pain Medicine physicians lead this multi-disciplinary approach. After a careful evaluation of the patient, the physician develops a treatment plan tailored to the patient with the goal of improving function. Treatment may include injections that provide pain relief and enable patients to live more active lifestyles. Physicians also prescribe medications to decrease chronic pain and its effects, monitoring patients closely for side effects and changes in function. They communicate with the patient's other providers, especially the primary care physician, who usually knows the patient the longest. In addition to facilitating physical therapy, Pain Medicine physicians can also recommend other types of care such as chiropractics, acupuncture, and massage therapy to decrease pain and reduce stress.
Coping with chronic pain is difficult, often taking six months to figure out the right combination of treatments to manage the pain. However, those who feel their pain is "in control" are also likely to experience a significant improvement in their emotional well-being. With the right help, most people can lead fulfilling lives even with persistent and severe pain.
For more information on chronic back pain and its treatment, visit the National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov/disorders/backpain
or the American Society of Anesthesiologists:http://www.asahq.org/patientEducation/managepain.htm
Janet D. Pearl, M.D., M.Sc., is the founder and medical director of Complete Pain Care, a pain medicine practice in Framingham, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult their personal physician for treatment. Comments are welcome at PhysicianFocus@mms.org