Right now, about twenty percent of us are suffering from chronic back pain.

In some cases, it’s squirming on the floor in excruciating pain. In others, it’s enough of a pain to interfere with our work and our life.

At some stage of life, most of us will suffer back pain. Treatment and pain education has focused on the biomechanics of pain. On what’s happening physically that might be causing it and the physical therapies and movement patterns that can help.

But pain experts understand that chronic pain is not just physical. Pain signals can keep firing long after the body has healed itself. Fear of moving in certain ways, work pressure, family tension and financial stresses can prolong and intensify pain and poor function.

Psychological distress is very common among those suffering from chronic pain. Over fifty percent of patients who suffer chronic back pain are also diagnosed with depression. This reduces their chance of recovery and increases the likelihood they’ll use heavy medication and opioids to manage their pain. A lose-lose situation.

The most effective treatments for back pain include physiotherapy and adjunctive therapies like counseling, mindfulness, pain education and cognitive behavior therapy.

Two months after treatment, cognitive behavior therapy or pain education alongside physiotherapy and structured exercise programs were all effective for pain intensity. But in the long-term, physiotherapy and behavioral therapy with muscle relaxation techniques and graded exposure to an activity where movement is broken down into parts was the most effective for reducing pain.

These approaches, when compared with physiotherapy alone were as much as twenty percent more effective twelve months after treatment.

We need to reconceptualize what back pain is. It’s something that happens in our brain. It’s not necessarily structural. It’s not a quick fix.

Clinicians prescribe anti-inflammatories or paracetamol. We need to realize there are more effective ways of managing pain.

Reference

“Psychological interventions for chronic, non-specific low back pain” British Medical Journal (2022)