Overview of Chronic Back Pain
If back pain persists for over 3 months, it is considered chronic back pain. That doesn't mean wait 3 months to see a doctor - an aching back can be a symptom of something that requires immediate attention such as a kidney infection.
Back pain that lasts several days should should be diagnosed and treated by a physician. This may simply be acute pain. There are several diagnostic differences between chronic back pain and acute back pain that are discussed in this site. It the back pain is severe or is accompanied by numbness or pain down the leg, a doctor should be seen immediately.
People who suffer from severe, chronic back pain know how it can utterly disrupt and damage one’s life. Chronic back pain can be cruel—making it hard to enjoy even the simplest daily activities, and certainly making it a challenge to carry out an exercise routine and other healthy activities.
Moreover, chronic pain was not previously all that well understood. The medical profession used to believe that pain is always a manifestation of an underlying injury or disease. As such, doctors focused on treating the underlying cause of the pain, with the belief that once the injury or disease was cured the chronic pain would then disappear.
If no underlying cause could be found for the pain, then the patient was told that very few treatments are available, or worse, “the pain must be in your head”. Unfortunately, some doctors still practice in this manner, having no appreciation for the unique problem of chronic pain, newer theories about chronic pain, and the many factors that influence a chronic pain problem.
The medical community is starting to understand that if pain is no longer a function of a healthy nervous system (signaling that there is a disease or underlying injury), then the chronic pain itself becomes the problem and needs to be treated as the primary pathology.
There are at least two different types of chronic pain problems - chronic pain due to an identifiable pain generator (e.g. an injury), and chronic pain with no identifiable pain generator (e.g. the injury has healed).
Chronic pain due to an identifiable pain generator
This type of chronic pain is due to a clearly identifiable cause. Certain structural spine conditions (for example, degenerative disc disease, spinal stenosis and spondylolisthesis) can cause ongoing pain until successfully treated. These conditions are due to a diagnosable anatomical problem.
If the pain caused by these types of conditions has not subsided after a few weeks or months of conservative treatments, then spine surgery may usually be considered as a treatment option.
Chronic pain with no identifiable pain generator
This type of pain continues beyond the point of tissue healing and there is no clearly identifiable pain generator that explains the pain. It is often termed “chronic benign pain”.
It appears that pain can set up a pathway in the nervous system and, in some cases, this becomes the problem in and of itself. In chronic pain the nervous system may be sending a pain signal even though there is no ongoing tissue damage. The nervous system itself misfires and creates the pain. In such cases, the pain is the disease rather than a symptom of an injury.
The term “chronic pain” is generally used to describe pain that lasts more than three to six months, or beyond the point of tissue healing. Chronic pain is usually less directly related to identifiable tissue damage and structural problems. Examples of chronic pain are: chronic back pain without a clearly determined cause, failed back surgery syndrome (continued pain after the surgery has completed healed), and fibromyalgia.
Chronic pain is influenced by many factors, such as ongoing pain signal input to the nervous system even without tissue damage, physical deconditioning due to lack of exercise, a person’s thoughts about the pain, as well as emotional states such as depression and anxiety. Chronic pain is much less well understood than acute pain.
The experience of chronic pain
Contrary to popular belief, all pain is real. This may seem like an obvious statement, but people with chronic pain are sometimes treated as if their chronic pain is either imaginary or exaggerated. In some cases, they feel like they have to prove their chronic pain to their friends, family and doctors. Some patients are told by their doctor that there is no reason for the chronic pain and therefore “it cannot be that bad”.
Chronic pain is a personal experience and cannot be measured like other problems in medicine, such as a broken leg or an infection. For instance, a broken leg can be confirmed by an X-ray and an infection by a blood test measuring white blood cell count. Unfortunately, there is no medical test to measure chronic pain levels.
To make matters more challenging for the patient, for many chronic pain problems there is no objective evidence or physical findings to explain the pain. Thus, many chronic pain sufferers go from one doctor to the next searching for explanations. This process can lead to unnecessary evaluations and treatments, in addition to putting the patient at risk for actually being harmed or made worse by the healthcare profession.
Everyone experiences and expresses pain differently. Two people with the exact same injury will feel and show their pain in unique ways depending on a number of things such as:
The situation in which the pain occurs
Thoughts about the chronic pain, such as “this is nothing serious” versus “this pain could kill me”
Emotions associated with the chronic pain, such as depression and anxiety versus hopefulness and optimism
Cultural influences determining whether a person is to be more stoic or more dramatic in showing pain to others
The newest theories of chronic pain can now explain, on a physiological level, how and why people experience pain differently.