When Back Pain Becomes Chronic
Chronic low back pain is one of the most common complaints among people over 50. Yet, in many cases, doctors can’t point to a specific cause. Even when there is a physical explanation—a deteriorating disc, for instance—the degree of pain people experience often doesn’t correlate with the amount of damage.
And after decades of research, doctors still don’t have a sure-fire way to reliably treat low back pain. Surgical approaches work in some cases, but not all, and there are risks involved.
Medications can blunt pain, but there is growing concern about regularly using pain pills, especially narcotic-based painkillers. Over time, in fact, opioids may worsen chronic pain for some sufferers.
On the plus side, hundreds of studies conducted over the past few decades have shown that a variety of different approaches can offer at least some relief for low back pain to many sufferers. The list includes everything from exercise and physical therapy to biofeedback and psychological counseling as ways to cope.
In 2016, after reviewing the latest evidence, the National Institute for Health and Care Excellence in the United Kingdom recommended exercise—including stretching, strengthening, aerobics, and yoga—as the first step in managing low back pain. Cognitive behavioral therapy, which helps people alter negative thoughts and behaviors that may worsen their symptoms, has also been shown to help some patients with low back pain.
Increasingly, back pain specialists recommend a combination of these and other approaches. The notion is that several methods that help a little may add up to significant relief for back pain sufferers. Other findings suggest that this combined approach, called multidisciplinary rehabilitation or functional restoration, can be helpful, even if it’s not a magic bullet.
In a 2015 article published in the BMJ, a team of international researchers reviewed findings from 41 studies that included 6,858 people with chronic low back pain. They found that a multidisciplinary approach—one that addressed the biological, psychological, and social dimensions of persistent pain—was more effective at easing pain and helping people return to active lives than any single approach.
Surprisingly, two of the studies suggested that, for some people, multidisciplinary rehabilitation may be just as effective as surgery on several of the measures, including pain and disability, with far less risk.
Defining exactly what multidisciplinary therapy or functional restoration includes isn’t easy.
Different pain treatment facilities combine different approaches. In general, multidisciplinary therapy seeks to address the physical aspects of low back pain, the psychological factors that contribute to chronic pain, and the social factors that may make it difficult for sufferers to deal with pain and discomfort and remain active.
A number of pain treatment centers include exercise to improve physical conditioning, relaxation training, stress management, and cognitive behavioral approaches designed to help counter negative thoughts and behaviors that may contribute to discomfort. Although some programs include carefully controlled use of pain medications, others encourage pain sufferers to reduce their dependence on them, especially on narcotic-based painkillers.
Behind the new multi-pronged approach is a growing awareness that chronic pain itself is complex. It may start out with a physical cause, such as a sprained muscle or damaged disc. But psychological and social factors also play a role, especially when acute pain becomes chronic.
Only by addressing chronic low back pain in all its dimensions, many researchers now believe, can doctors offer genuine relief.
Focusing on function
One crucial way this new approach differs from some conventional therapies is in its goal. Reducing pain is important. But the primary goal—as the term functional restoration suggests—is to help chronic pain sufferers function as normally as possible, even in the face of discomfort or occasional flare-ups.
Many people with low back pain will never be pain-free, but they can find ways to be active. That’s important because physical activity itself—even just doing daily activities such as walking or chores around the house—can improve flexibility and help ease pain. Inactivity, in contrast, often makes back pain worse.
Does the multidisciplinary approach offer real benefits? In a 2015 report published in the online journal PLOS, for example, European researchers compared 536 chronic pain sufferers. Half were assigned to conventional treatment approaches; the others were enrolled in a more intensive multidisciplinary approach that focused on helping sufferers cope with discomfort and pain and encouraging them to be as active as possible.
After 12 months, people in the multidisciplinary group were functioning better and were less likely to avoid activities because of fear of pain than those in the conventional care group. But if the new approach shows promise, it is far from a miracle cure for low back pain.
A 2010 study published in the journal Spine compared patients given intensive back muscle strengthening exercises with those given multidisciplinary biopsychosocial therapy. Both groups showed roughly the same improvement on pain and disability measures.
What’s more, there are downsides. Multidisciplinary treatment takes time and can be costly, since it involves the participation of experts from a variety of fields, all working closely with low back pain sufferers. Like almost any therapy, multidisciplinary approaches work best when patients commit themselves to getting better.
If standard approaches haven’t worked for your low back pain— and you’re willing to try a combination of ways to ease your pain and function better in your daily life—talk to your doctor about multidisciplinary treatment programs in your area.
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