Eighty percent of the American population experience back pain. Out of that, an estimated 15-20 % develops protracted pain while approximately two to eight percent have chronic back pain.
Back pain is one of the most common causes of doctor’s visit and one of the leading reasons why people miss work. Usually, an episode of back pains lasts anywhere from a few days to a few weeks. The condition becomes chronic when it lasts longer than 12 weeks.
What causes chronic back pain?
Chronic back pain is often attributed to degenerative changes or traumatic conditions of the spine. Additionally, it is also associated with various conditions, including fibrositis, inflammatory spondyloarthropathy, and metabolic bone conditions.
There is no definitive cause of chronic back pain but epidemiologic data suggests the following risk factors:
- Cigarette smoking
- Morbid obesity
- Occupations that require repetitive lifting
- Forward bending
- Twisting positions
- Exceeding physical capacity
- Exposure to vibration caused by motor vehicles or industrial machinery
How do you treat chronic back pain?
Chronic back pain may be treated without resorting to surgery. An uncontrolled study conducted by Saal et al showed that 90% of patients with herniated lumbar disk and radiculopathy (symptoms of chronic pain) were successfully treated with aggressive rehabilitation and medical therapy. This only goes to show that surgery is not an absolute necessity when it comes to treating chronic back pain.
Most healthcare professionals suggest a three-phase treatment plan for chronic back pain, consisting of the following:
- Bed rest
- Physical therapy
Bed rest for chronic back pain is only advisable for two days. Several studies have shown that two-day bed rest is more effective than 7-day rest period in increasing a person’s recovery rate. In addition, it has been found that prolonged bed rest can make chronic back pain worse instead of better as the long bout of inactivity may cause secondary complications to arise. An inactive patient with chronic back pain may experience deleterious physiologic effects, which could lead to shortened muscles and other soft tissues, decreasing flexibility and range of motion and reduce muscle strength.
Medications for chronic back pain includes tricyclic antidepressants that can alleviate insomnia, enhance endogenous pain suppression, reduce painful dysesthesia, and eliminate other painful disorders such as headaches. Additionally, anticonvulsant medications (useful for reducing paroxysmal or neuropathic pain) and calcium channel blockers and alpha-adrenergic antagonists (for treating complex regional pain syndrome) may also be used for treating chronic back pain.
Physical therapy for chronic back pain may be divided into passive and active categories. For passive therapies, the patients are subjected to the ministrations of a physiotherapist, often with the aid of modalities (like ultrasound, electric muscle stimulation, etc.) and manual therapy. Active therapy, on the other hand, involves exercises which a person with chronic back pain may perform to help build up and maintain muscle strength and increase recovery rate.