Master Chronic Back Pain With a Full Range of Treatment Options, Experts Say


The dose24h29How can I manage chronic back pain?

Millions of people around the world suffer from chronic back pain every day, often without knowing if they will ever recover. Pain specialist Dr. Brenda Lau offers advice on how to manage chronic back pain, as well as some of the new treatment options that may provide relief.

Ann Marie Gaudon was at the gym when she injured her back. After bending down to lift something from the ground, she felt a wrenching sensation throughout her body.

“The air was being sucked out of my lungs,” said Gaudon, an Ontario psychotherapist and social worker. “I couldn’t breathe, I couldn’t get up. I didn’t know what was happening, but I knew it was serious.”

Gaudon spent years talking to chiropractors, massage therapists and pain experts, finally finding a specialist who helped her recover.

A woman looks into the distance.
Ann Marie Gaudon is a psychotherapist who has lived with chronic back pain since 2017. (Submitted by Ann Marie Gaudon)

But she felt no pain for only a few years before her back pain returned. Gaudon says she has less pain now than when she first injured her back in 2017, but still experiences discomfort on a daily basis.

What is chronic back pain?

Gaudon is one of the near eight million Canadians who live with chronic pain and one of 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, British Columbia, pain can be acute — caused by injuries, stress or illness — or chronic. The pain is usually 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 suffering from chronic back pain between the ages of 25 and 55.

A group of four people – three men and one woman – stand together while smiling at the camera.  The men wear medical scrubs.
Dr. Brenda Lau, right, poses with team members at the CHANGEPain clinic in British Columbia. Lau is a pain specialist and co-founder and medical director of the clinic. (Submitted by Brenda Lau)

“In general, he’s someone who spends a lot of time sitting,” Lau said. The dose welcome Dr. Brian Goldman.

Smoking, poor eating habits and poor sleeping habits also contribute to chronic back pain, Lau added.

What causes chronic back pain?

When Gaudon was first injured, medical imaging revealed a herniated disc, a bulging disc and three areas with pinched nerves.

Although Gaudon physically traumatized his back, Lau says many people with chronic back pain often have no physical problems with their bodies.

“We also know about imaging, MRI, CT scans, X-rays, whatever you see there, they don’t correlate with intensity,” Lau said. The dose welcome Dr. Brian Goldman.

WATCH | Exercise the best medicine:

The science of lower back pain

Most Canadians will likely experience lower back pain at some point in their lives. There is now some scientific consensus on the most effective way to achieve relief.

Instead, Lau says, medical images done on people with back pain can look a lot like images of people who don’t.

The term nonspecific low back pain can often be applied in circumstances where there is back pain, but the reason is unclear.

“It becomes very difficult to say that the structural abnormalities that you see on an X-ray or an MRI, or that you discover during a physical exam, are actually the cause of a person’s back pain,” said the Dr. Ted Findlay. pain specialist at the Calgary Chronic Pain Centre.

“That’s what we mean by nonspecific low back pain. It doesn’t mean we need to do imaging to identify a particular tissue or structural abnormality in order to develop a treatment plan.”

How to treat chronic back pain?

Typically, when a person is injured, the body’s neurochemical processes come into play to aid recovery, according to Lau.

“There’s an incendiary soup, if you like,” Lau said. “All types of host defenses come into action when tissue injury occurs.”

In chronic pain, however, the pain persists even after the body has healed.

A man smiles outside in the desert.
Dr. Ted Findlay is a pain physician at the Calgary Chronic Pain Centre. (Submitted by Ted Findlay)

“It changes the nervous system itself, so that now (pain is) no longer the area where some sort of inflammatory response occurs,” Lau said. “It’s more like the nervous system has been heightened.”

Treating chronic back pain therefore requires a “biopsychosocial model,” according to Findlay, referring to a model of care that connects biology, psychology and social factors.

SEO World Health Organization guidelines published in late 2023Findlay said treating chronic back pain requires a combination of education and rehabilitation.

“The most recent guidelines suggest that spinal manipulation may have benefits,” 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 relieve pain or discomfort.

WATCH | Anti-inflammatory medications could make the situation worse:

Taking painkillers to treat inflammation could lead to chronic pain, research suggests

New research suggests that treating acute pain with anti-inflammatory medications, such as ibuprofen, may have an unintended effect: increasing the chances of developing chronic pain.

Lau agrees that treating chronic back pain requires a full-spectrum approach.

“What we need to do is re-educate, retrain how these muscles work,” she said.

“Dedicated physical therapists, chiropractors, exercise physiologists and (and) 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’re feeling — can also be “very effective” in helping the patient recover, Lau says.

“Pain reprocessing therapy involves using a combination of active thought patterns that will inspire you to move the body, eat well and reduce fears related to the pain itself,” Lau said.

“You’ve already been diagnosed.…Now is the time to start reinterpreting (the) pain signals to the extent that you can change them.”

Can medication help?

People with chronic back pain might be tempted to resort to medications to ease their discomfort, but Lau and Findlay recommend being careful about overuse of anti-inflammatory medications like naproxen.

“We know that their long-term side effects actually cause more harm,” Lau said. “Kidney damage and stomach problems (are) two of the main problems.”

That said, Findlay says you don’t need to avoid over-the-counter medications completely.

“If you’re a weekend warrior, you play hockey and you have back pain, then why not take an anti-inflammatory or acetaminophen,” he said.

“But in the long term, they probably have very little effect.”

Can chronic back pain ever go away?

Lau says she has seen patients recover from their discomfort over time.

However, Findlay says there are many cases where patients continue to experience pain, even if they take steps to improve their overall health and well-being.

A recent meta-analysis published by CMAJ showed that patients with pain lasting less than six to 12 weeks “had substantial improvements in pain and disability levels within the first six weeks.”

Patients with pain lasting between 12 and 52 weeks continued to experience “high levels of pain and disability with minimal improvements over time,” the analysis added.

The flow24h11How Reframing Chronic Back Pain Could Bring Relief

Many Canadians suffer from debilitating chronic back pain, affecting their work, relationships and even their mental health. Researchers tell us about a treatment called pain reprocessing therapy, which could offer slight relief by reframing that pain in our minds.

While this may not seem like good news for people with chronic, persistent back pain, the analysis suggests that diagnosing and treating back pain early could “reduce the likelihood” that it will develop into persistent lower back pain. .

“Pain is a call to action that most people cannot ignore,” Lau said.

“We hope that in this call to action, you will empower yourself to say, ‘Yes, there are things I personally need to change, but I also need to connect with providers who can help me to guide me.'”

At the same time, Lau encourages people with chronic back pain to seek new approaches if relief remains out of reach.

Gaudon echoes Lau’s sentiments.

“If you really don’t know what’s going on and you go to alternative practitioners and you’re still in pain, why do you keep doing that?” said Gaudon.

But, she added, it is important to stick with it to find a solution.

“You’re not helping yourself if you’re still in pain.”

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