One may ask: So what should one do when an episode of back pain occurs? Take simple medications over the counter, use local heat and keep active. The old advice “go to bed until the pain goes away” is a bad one because inactivity creates deconditioning and muscle weakness. At times help from a professional (chiropractor, massage therapist or physiotherapist) is valuable as well. However, simple uncomplicated non specific back pain can and should be prevented by each one of us assuming personal responsibility. Let’s think how many afflictions in our life are the result of lifestyle choices such as diabetes, heart disease, lung and other cancers, just to mention a few (because of what we eat, drink or smoke and because of lack of activity). The bottom line relates to nutrition and diet, exercise, habits and excesses for most of human kind’s diseases. Back pain for most can be prevented or minimized if we keep a healthy weight, be physically active, maintain strong abdominal and back muscles and learn proper ways to push or lift while we maintain proper posture and proper seating.
Persistent or recurrent low back pain that becomes chronic and debilitating (in the absence of some serious spinal problem) has been shown to be more the result of environmental and psychological factors. Research has shown that risk factors for developing chronic low back pain have very much to do with liking one’s job, the presence of anxiety, depression or psychological stressors, history of previous pain problems and even the availability of compensation that may serve as a financial disincentive. In those situations things become much more complex. People become conditioned to fear or anticipate pain, adopt protective and guarding behaviours such as immobility or limping, and become inactive and deconditioned. The treatment is more complex and the patient requires assistance from more than one professional, including help from psychologists or psychiatrists.
On the other hand what happens when someone has some serious wear and tear in the spine while the clinical examination points to specific problems with certain joints in the back, the discs or nerves? This usually is the case in older individuals (unlike the 25 or 30 year old people who’s back pain is usually much simpler). In older folks, the problem is not any more “simple uncomplicated back pain” and the treatment may have to expand beyond the use of exercises, physiotherapy or chiropractic. Medications (anti-inflammatories or stronger pain killers with doctor’s prescription), and injections into muscles, nerves and joints are of value, in addition to local “pain relieving modalities” used at home such as heating or cold packs or TENS (standing for Transcutaneous Nerve Stimulator, a small machine that delivers little impulses in the skin which may block pain). In the next and last column we will discuss the need/role for surgery.
Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)
Director, Comprehensive Pain Program,
Senior Investigator, Krembil Neuroscience Centre
Toronto Western Hospital,
Chair ACTION Ontario www.actionontario.ca
Keywords: pain, treatment