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The Dose24:29How can I manage chronic back pain?

Millions of people around the world suffer from chronic back pain every day, often not knowing if they will ever recover. Pain specialist Dr. Brenda Lau offers advice on how you can manage chronic back pain, as well as some of the newer treatment options that can provide relief.

Ann Marie Gaudon was at the gym when she injured her back. After bending down to pick up something from the ground, he experienced a feeling that ripped through his body.

“The air was sucked out of my lungs,” said Gaudon, an Ontario psychotherapist and social worker. “I can’t breathe, I can’t stand. I didn’t know what was going on, but I knew it was serious.

Gaudon spent years talking to chiropractors, massage therapists and pain specialists, finally finding a specialist who helped him recover.

Ann Marie Gaudon is a psychotherapist living with chronic back pain since 2017. (Submitted by Ann Marie Gaudon)

But he was pain-free for only a few years before his back pain returned. Gaudon says he’s in less pain now than when he first hurt him in 2017, but still deals with the discomfort every day.

What is chronic back pain?

Gaudon is one of the approx eight million Canadians who lives with chronic pain, and is one of hundreds of millions of people all over the world with chronic back pain.

According to pain specialist Dr. Brenda Lau, co-founder and medical director of CHANGEPain clinic in Burnaby, BC, pain can be acute – caused by injuries, stress or illness – or chronic. Pain is usually classified as chronic after three to six months.

The persistent discomfort associated with chronic back pain affects men and women alike, with most people experiencing chronic back pain between the ages of 25 and 55.

A group of four people - three men and one woman - stand while smiling at the camera.  The men wore medical scrubs.
Dr. Brenda Lau, right, poses with team members at the CHANGEPAin clinic in British Columbia. Lau is a disease specialist and co-founder and medical director of the clinic. (Submitted by Brenda Lau)

“Usually, it’s someone who sits down a lot,” Lau said The Dose host Dr. Brian Goldman.

Smoking, poor eating habits and poor sleeping habits also contribute to chronic back pain, Lau added.

What causes chronic back pain?

When Gaudon first injured himself, medical imaging revealed a herniated disc, a disc bulge and three areas of pinched nerves.

While Gaudon had physical trauma to his back, Lau says that many people who live with chronic back pain often have nothing physically wrong with their bodies.

“We also know imaging, MRI, CT scan, X-ray, whatever you see there, they don’t correlate with intensity,” Lau said. The Dose host Dr. Brian Goldman.

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Instead, Lau said, medical images made of people with back pain can look the same as images of people who don’t.

The term non-specific low back pain is often applied to situations where there is discomfort in the back, but the cause is unclear.

“It becomes very difficult to say that the structural abnormality that you see on an X-ray or on an MRI, or that you see on a physical examination is, in fact, the cause of someone’s back pain,” said Dr. Ted Findlay, a pain physician at the Calgary Chronic Pain Center.

“That’s what we mean by non-specific low back pain. It goes away from saying that we need to do imaging to identify a particular tissue or structural abnormality in order to create a treatment plan.

How do we treat chronic back pain?

Normally when a person is injured, the body’s neurochemical processes kick in to aid in healing, according to Lau.

“There’s an inflammatory soup, if you will,” Lau said. “All kinds of host defenses are activated when there is damage to any tissue.”

In the case of chronic pain, however, the pain continues even after the body has finished healing.

A man smiling outside in the wilderness.A man smiling outside in the wilderness.
Dr. Ted Findlay is a pain physician at the Calgary Chronic Pain Center. (Submitted by Ted Findlay)

“It changes the nervous system itself to be present [the pain is] it’s no longer the place where there’s some kind of inflammatory response,” Lau said. “It’s like the nervous system is heightened.”

The treatment of chronic back pain therefore requires a “biopsychosocial model,” according to Findlay, which refers to a model of care that links biology, psychology and social factors.

Mention World Health Organization guidelines published in late 2023Findlay said treating chronic back pain requires a combination of education and rehabilitation.

“Newer guidelines suggest that there are benefits from spinal manipulation,” he said.

Spinal manipulation is a process where specialists use their hands or small instruments to apply pressure to a patient’s spine, to help relieve pain or discomfort.

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Lau agrees that treating chronic back pain requires a full-spectrum approach.

“What we need to do is rehabilitate, retrain, how the muscles work,” he said.

“Physiotherapists, chiropractors, exercise physiologists, [and] Dedicated trainers can get people back on their feet.

Tools like pain reprocessing therapy — which uses common psychological techniques to encourage patients to refocus their thinking on the pain they’re experiencing — can also be “very effective” in aiding patient recovery, Lau said.

“Pain reprocessing therapy is all about using a combination of active ways of thinking that encourage you to move the body, to eat well, to reduce fears around the pain itself,” Lau said.

“You’ve received the diagnosis.… Now it’s time to start interpreting again [the] pain signals until you can change them. “

Will medication help?

People living with chronic back pain may be tempted to rely on medication to ease their discomfort, but Lau and Findlay recommend caution about overusing anti-inflammatory drugs like naproxen.

“We know that the long-term effects of those, in fact, cause more harm,” Lau said. “Kidney damage, gastric issues [are] two of the main things.”

That said, Findlay says you don’t need to avoid all over-the-counter medications.

“If you’re a weekend warrior and you’re playing hockey and you have a sore back, then why not take an anti-inflammatory or acetaminophen,” he said.

“But for the long term, they probably have very little impact.”

Will chronic back pain go away?

Lau said he has witnessed patients recover from their discomfort over time.

However, Findlay says there are many instances where patients continue to experience pain, even while taking steps to improve their overall health and well-being.

A new one meta-analysis published in CMAJ showed that patients with pain that persisted between less than six weeks and 12 weeks, “had significant improvement in pain levels and disability within the first six weeks.”

Patients with pain that lasted between 12 and 52 weeks continued to experience “high levels of pain and disability with little improvement over time,” the analysis added.

The Current24:11How to reverse chronic back pain relief

Many Canadians suffer from debilitating chronic back pain, affecting their work, relationships and even mental health. We’ve heard from researchers about a treatment called pain reprocessing therapy, which can provide some sweet relief by reprogramming that pain in our minds.

While this may not sound like good news for people living with chronic back pain, the analysis suggests that diagnosing and treating back pain early can “reduce the likelihood” that it will develop. persistent back pain.

“Pain is a call to action that most people ignore,” says Lau.

“We hope that with that call to action, that you will empower yourself to say, ‘Yes, there are things that I need to change personally, but I also need to link to providers that help guide my way.'”

At the same time, Lau encourages people who suffer from chronic back pain to seek new methods when relief is out of reach.

Gaudon echoed Lau’s sentiments.

“If you don’t really know what’s going on and you go to alternative practitioners and you’re still sick, why do you keep doing that?” Gaudon said.

But, he added, it is important to stay in order to find a solution.

“You can’t help yourself if you’re still in pain.”

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