Treatment for Chronic Back Pain

What is the best treatment for chronic back pain? Chronic back pain is a modern day epidemic. Despite the number of people who suffer with it, it is still very difficult to know what is the best treatment for chronic back pain. What can you do to get back in control of the problem? This is especially difficult if you have been living with back pain for a while and if you have had conflicting advice about how you should manage it.

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The standard text book definition of chronic back pain is pain that you have had for greater than 6 weeks. Although some people have flare ups of pain and are pain free in between this is still a type of chronic back pain.

There are lots of positive things you can do to which may help if you have this problem.

Pain Relief

  • Use suitable pain relief - exercise has been shown to be one of the most helpful types of treatment for chronic back pain. If you need to increase your activity levels but pain is stopping you from doing that then using pain relief may be good idea. The NHS Direct Web site shown below has some helpful advice about pain relief.
  • Don't fear that you will mask a serious problem with pain killers and end up hurting yourself. If you have simple lower back pain this is very unlikely to happen. There are other ways to manage pain other than using drugs. Other methods of controlling pain include using a TNS machine or having some acupuncture as a treatment for chronic back pain .

  • Heat therapy may be effective to relieve muscle spasm. Cold therapies may also be useful for pain control - try both and see which you prefer.They both improve the blood supply to the area. (Make sure you take precautions to avoid an ice or heat burn by wrapping the hot/cold pack in a towel before applying it)

  • Take a look at this section on back pain relief - I have tried to talk about all the different types of treatment that are out there. Many of these will be offered as treatment for chronic back pain and I have tried to pull the evidence together so you can see what we know works and what doesn't.

Education

  • Learn as much as you can about back pain so that you can be reassured that your problem is not serious (most people with back pain, 95% in fact, have simple low back pain which is not serious). Education helps, recent research supports my personal view that the more you know about the problem the less disabling it is.

Fear and worry

  • Recent research (1 ) has found that avoiding activities because you are scared of causing damage or more pain (fear avoidance) and also having unhelpful beliefs about back pain make it more likely you will have longer term problems with your back pain. This is something I have to deal with all the time in my own practice. These unhelpful beliefs and attitudes are called yellow flags.
  • Red Flags warn us about possible serious spinal problems, yellow flags warn us about unhelpful beliefs that may lead to a poor outcome with treatment for chronic back pain

If you are fearful of movement or worried that you have a serious spinal problem go and talk to someone about it to put your mind at rest.

(More detail about these beliefs can be found in the New Zealand Guide to assessing Psychosocial Yellow Flags (1) which is the guideline I use in my own practice)

General advice

Discuss the following points with your doctor or physiotherapist:

  • Try your best to get back to work, discuss any ongoing problems with your doctor, physiotherapist or occupational health team who may help you solve any work problems.
    ways to reduce the postural stress and strains you put your spine under. There may be a few changes you can make that would help.

  • Think about starting a programme to improve your low back fitness. Perhaps you could try some back stretching exercises to get your spine moving again or practice some back strengthening exercises to help strengthen the core muscles that support your back.


  • Try and improve your general fitness levels, go walking or swimming, cycling may help too.


  • Learn to pace your activities. Many people get caught up in activity cycling where they overdo it on the 'good' days and then feel rotten afterwards so do very little on a 'bad' day. Simple pacing activities will help you get much better at planning any activities before you start and will hopefully help you achieve much more.

Discuss how to pace your return to activities with your physiotherapist or doctor. Before starting any exercise programme check with your doctor or physiotherapist to ensure it is suitable for your individual needs.

References and Resources

This is a great list of medicines for Back Pain:

http://www.nhs.uk/Conditions/Back-pain/Pages/MedicineGuidePage.aspx

I have found a nice article that contains 11 chronic pain control techniques - I will definitely be sharing this with some of my patients. You can find it here on Spine Health

(1)

Read more in the full New Zealand Acute Low Back Pain Guidelines document here.

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13-Oct-2013

 

 

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