What is Chronic Low Back Pain?

 

Article Summary
  • Acute pain is short term and helpful, it keeps you safe.
  • Chronic low back pain is persistent and unhelpful.
  • It is caused by a cascade of changes in your body that leads to an amplification of painful symptoms that may persist long after any initial injury may have healed.

Let's start by explaining what we mean by chronic low back pain. The official definition of chronic or persistent pain is when something hurts for more than 6-12 weeks. The term 'acute pain' is used to describe pain that has been around for less than 6-12 weeks.

What is the Definition of Chronic Pain?

  • Acute = less than 6-12 weeks
  • Chronic = more than 6-12 weeks

When medical professionals talk about the word 'chronic' they are not describing how severe or bad the symptoms are. They are talking about a type of pain, not how it feels. If you have heard someone say 'my lower back is really chronic today' meaning that they are having a bad day with their symptoms; this is not the same as the medical term.

Why 6-12 weeks?

This time frame is chosen as that is the normal healing time for most tissues – most things get better in 6-12 weeks, even broken bones. So if you still have pain after 12 weeks then something other than tissue damage has probably got something to do with it.

This is just a rule of thumb and personally I find these 6-12 weeks a bit confusing and not always very helpful as the time frame differs for everyone. You can start to have chronic pain much earlier than 6-12 weeks and sometimes acute pain lasts longer than this and does eventually go away.

The video below explains the reason for the 6-12 week timescale.

 So although this 6-12 week timeframe is a useful guideline I prefer to think about it in a much more simple way:

  • Acute pain is helpful, useful pain that you get early on
  • Chronic low back pain is unhelpful, pointless pain that can go on and on.

What is helpful and useful about acute symptoms?

Pain is a brilliant survival system. We need to know if we are injured so that we can:

  • Take care of the injured part so that it heals
  • Run away from danger (i.e. avoid greater injury or harm)
  • Make sure we don’t do the same thing twice

Take care of the injured part

You only have to look at people with diseases that affect feeling to see how easy it is for them to overlook injuries that then become infected or worse. Take a diabetic with peripheral neuropathy and loss of feeling in the feet who may not have noticed a foot ulcer developing. The consequences of this can be terrible and can result in the loss of the limb.

Run away from danger

If you are experiencing pain it is natural to try and get to safety, it lets you know you need to move or get away from the threat to you. For example I have been swimming in the sea and been stung by jellyfish, my overwhelming instinct was to get out of the water first and foremost – 'get me out of here' my brain was yelling at me, this environment is dangerous to me. And that was helpful pain; it made sure I took myself away from danger and didn’t get stung again.

Make sure we don’t do the same thing twice

Most of us try not to repeat painful mistakes. Watch a toddler putting their fingers into everything and the shock and surprise on their face when they experience pain. We learn to keep ourselves safe by evaluating these experiences and deciding if they pose a threat to us and hurt is an important teacher. Not many of us touch a hot stove more than once unless it is accidental.

Note – all these three things - taking care, running away, learning from experience - are all things that are processed by our minds. It is our brains that decide how we behave toward this painful experience. This is a very important point that I will come back to.

Why is chronic pain unhelpful and pointless?

With chronic pain there is no longer anything to protect - any soft tissues injuries will have healed, longstanding changes to joints such as degenerative changes generally don’t need protection from movement – the opposite in fact.

This is not keeping us safe from danger and it does not even teach us useful experiences about what to avoid in the future because the pain is often unrelated to an injury. For example some people feel worse just thinking about certain movements –this is not helpful.

Chronic lower back pain does not help you do well – it has the opposite effect.

  • It may make you fearful of movement and less confident with day to day activities.
  • It can interrupt your normal day to day life
  • It can leave you feeling alone and a bit isolated if you go out less often because of it
  • It can cause work problems if you have to take time off or can't do your job in the same way
  • It can mess with your sleep leaving you tired and irritable
  • It can put family relationships under strain as you can't do all your normal things
  • Families can sometimes get tired of hearing about it which can inhibit you from talking freely about how you feel
  • It can be so dominant it can feel like it is ruling your life.
  • And because there often is no clear injury and no obvious injured tissue diagnosis it can leave you feeling helpless and depressed.

This collection of ill effects is called chronic pain syndrome.

Find out more about Chronic Pain in this series of related artices:

Lower Back Pain Toolkit Home Page

29-Jul-2017

 

 

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