Part Three of a Three Part Series
In the last blog, we talked about how low back pain in managed in the US. Today, we are going to discuss evidence-based and practice based measures of effective low back treatment. The evidence shows us that there are specific criteria to indicate which treatment is best.
Why acute low back pain becomes chronic?
As mentioned before in part 1 and part 2 articles of this low back pain series, because most back pain in the US is mismanaged, the time it takes for someone to get the best treatment is prolonged. Imaging is typically unnecessary and prolongs the period of time that you are experiencing pain, which ultimately can contribute to a sense of hopelessness and chronic pain, otherwise known as chronic sensitization of the nervous system.
Once you have acute low back pain, you naturally become fearful of having it again. So, you change your movement, activities and even thoughts and emotions. Pain is simply information. It is a signal. Are you moving well? Too much? Not enough? Eating highly processed foods? Drinking too much alcohol?
Therefore, the first step is to determine if the patient is a candidate or not. Depending on the severity of symptoms, patients with acute low back pain can be treated in one to two visits and they are typically pain-free. As stated above, a manipulation is appropriate for acute low back pain. But, we are NOT moving bones, we are not putting things back into place, we are creating a neurophysiological relaxation response. That’s what the nervous system needs to decrease it’s pain signals. Thus, the antihyperalgesia (decreased sensitivity to pain) produced by joint manipulation appears to involve descending inhibitory mechanisms that utilize serotonin and noradrenaline. When it’s hyperreactive, we need to calm everything down.
If you are feeling signals all the time, it’s time to look a little deeper into your lifestyle habits and emotions. Are you constantly in a stressful environment? Are you getting enough sleep? Are you eating nutrient dense anti-inflammatory foods?
What is chronic pain?
Hyperalgesia is a condition where a person develops an increased sensitivity to pain. What may not hurt most people can cause significant pain in an individual with hyperalgesia. This is thought to be the result of changes to nerve pathways, which causes a person’s nerves to have an overactive response to pain. In essence, the volume control setting within the brain and spinal cord is unique to centralized pain patients. There is an amplification of pain/sensory input and poor inhibition or dampening of pain. There is, in fact, a change in the brain process and is now described as a neurodegenerative disease.
What causes chronic pain?
Peripheral (extremities) and central (brain and spinal cord) sensitization means that the nervous system is on high alert. Additionally, if someone has acute pain, they often have adaptive movement disorders and compensation. Chronic stress, PTSD, adrenal activation, and adverse childhood events all contribute to chronic pain. Lastly, opioids and chronic inflammation are huge contributors and chronic opioid use, in fact, actually enhances pain. Yes, you heard that right! Opioids are not the solution, especially considering there are nearly 125 deaths/day on average from overdoses.
Common clinical findings associated with chronic pain
Some common clinical findings associated with chronic pain include fatigue, , , depression, anxiety, PTSD/OCD, brain fog, headaches/migraines, TMJ/facial pain and many more conditions.
How can you look at pain?
It’s important to look at pain objectively. “My knee hurts,” for example. But, you sat for 12 hours yesterday and then tried to run last night. There’s a good chance that is why.
It’s equally important to not be attached to a diagnosis. A diagnosis can often really negatively impact your thoughts, your emotions, and your beliefs about pain. For example, a MRI that reads L4-5 degeneration….It means nothing! But, that information can be the demise of some individuals. When you believe that you have pain all of the time and that it never changes, try to realize that it is information. What is it telling you? What do you need to change in your life?
Effective therapeutic tools for chronic pain
First and foremost, self-regulating tools to modulate stress like breath awareness, heart rate variability biofeedback, meditation, prayer, and mindfulness practices are some of the most promising treatments for those suffering from chronic pain. This can help to look at pain as information, to look at it more objectively, separating emotions from the information. Also, Cognitive Behavioral Therapy, hypnotherapy and other forms of biofeedback can be very helpful.
Nutrition can be very powerful especially with those in a chronic state of inflammation. The first step is keeping a detailed food journal and tracking symptoms to see how food is affecting you. Use the 5 R Gut Protocol: Remove, Replace, Reinoculate, Repair, Rebalance. Watch a video on the 5R approach here. An elimination diet can be very helpful in removing any possible inflammatory triggers. Watch a video on adverse food reactions here. More specifically, there are specific such as a MITO (Mitochondria) food plan and a modified (healthy) ketogenic plan that can be powerful in mitochondria support, nerve membrane stabilization, and improving glycemic responses.
Lastly, purposeful movement is key! For those in chronic pain, a slow and gradual progression is critical. Too many times, I see people trying to go too fast too soon. Patience is important when it comes to this. For example, walk for 10 min every other day, not 45 minutes five days in a row. I know you may be thinking, “it’s just walking. I should be able to do that.” But, remember the volume is turned up too high. Take your time and enjoy the journey to health.
In summary, it is absolutely possible to get yourself out of chronic low back pain (or any chronic pain for that matter). It is important, however, to implement lifestyle changes. Daily self-care is foundational! Seek out a qualified rehabilitation professional that understands pain science to help you on your path to feeling great again. Please feel free to reach out with any questions!
For your reference, here is a video on chronic pain