Successful chronic back pain management is a multidimensional approach that includes medication and physical and psychological treatments. Patients with chronic back pain typically see doctors who specialize in chronic pain management.
Pain management specialists include experts from a variety of disciplines who come at pain from different directions.
They include:
- Specially trained psychiatrists
- Neurologists
- Anesthesiologists
- Physiatrists (medical rehab specialists)
Pain and Your Brain
Sudden and intense acute back pain can cause the nervous system to become overly sensitive, turning the slightest discomfort into extreme pain. New discoveries in how the brain processes memory and learning, called neuroplasticity, are shedding light on how the nervous system and brain work together.
As researchers understand more about neuroplasticity and how it may relate to chronic back pain, they can develop better ways of stopping chronic back pain before it starts. Until then, there are treatments and techniques that can help you deal with ongoing back pain.
Neuroplasticity is a relatively new concept explaining how our nervous system participates in memory. When we learn new concepts or experience events, nerves send signals to one another, creating connections.
Through repetition and intensity, lasting connections among neural pathways are made. For example, such pathways were created when you learned to walk, which makes walking second nature. The nervous system remembers all kinds of things, including pain.
When the back pain is especially intense and/or long-lasting, the central nervous system (brain and spinal cord) can be reprogrammed. It’s possible that the neurons that prevent pain signals actually die.
There are no longer the natural checks and balances for pain signals, allowing pain-producing signals to flow freely. This results in chronic pain.
Medications
Unfortunately for many chronic pain sufferers, over-the-counter medications for back pain generally don’t do enough. Such patients typically need prescription medication.
Doctors will start with lower doses of prescriptions, an especially important step because chronic back pain patients will need to take these drugs continuously.
Keep in mind that pain meds don’t cure; they temper pain and help people lead more normal lives. The medications for chronic pain are similar to those taken for acute or postsurgical circumstances.
Because different meds do different things, they may be prescribed in combination. Chronic pain meds include antidepressants, neuropathic agents, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opiates:
- Antidepressants can block pain signals from reaching the brain. These drugs may also help your body release endorphins, your own natural pain-fighting chemicals. Of course, chronic pain may also lead to depression, which is another reason your doctor might prescribe this type of medication.
- Neuropathic agents address chronic pain problems that stem from nerve damage or hypersensitive nerves. These drugs change the way pain signals travel and how they are interpreted in the brain.
- Muscle relaxants are prescribed when the pain is from muscle sprains and strains.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), as the name implies, reduce inflammation. When tissue swelling and pain-signaling molecules diminish, back pain is reduced as well.
- Steroids also reduce inflammation, but they are much more powerful drugs with greater side effects. Doctors typically prescribe these only after NSAIDs have failed.
- Opiateswork by blocking pain signals from reaching the brain. The problem with opiates is not so much addiction as it is habituation or tolerance. This means the body metabolizes or uses up the medication quicker and you need an increasingly higher dose the longer you are on it.
Spinal-Cord Stimulation
This therapy involves using low-voltage electricity to block the transmission of pain through the spinal cord before it reaches the brain. A small pulse generator connects to spaghetti-like electrodes implanted under the skin along the surface of the spinal cord.
Here the electricity overrides the normal pain transmission and replaces it with a gentle, prickly sensation. On the physiological level, it is much like the effect of rubbing your foot after you stub your toe. By rubbing, you are mechanically stimulating nerves that block back pain. The spinal cord stimulator does so electronically.
Still, spinal cord stimulation devices are not for everyone. Doctors recommend them only after other therapies have failed. You cannot get magnetic resonance imaging (MRI) scans with them in and sometimes scar tissue blocks their effectiveness. They are also quite costly, priced at about $20,000.
If it is the chosen route, patients are thoroughly screened to ensure that the device is appropriate for their lifestyle. A trial device is first implanted to confirm the therapy will work. If it does, the surgeon implants a permanent device.
Intrathecal Pumps
Unlike oral pain medication that has to go through the digestive system, the pump (an implanted device) delivers medication directly to the spinal canal. Site-specific delivery results in fewer side effects than are common from powerful pain meds such as morphine.
The amount and frequency of the medication are determined by a computer chip. As with spinal cord stimulators, neurosurgeons first test this approach with a temporary device.
The downfall of this approach is that all the medication is stored within the implanted device. Typically, medication is refilled every few months. It’s rare, but a malfunction could cause the pump to stop or overdeliver medication.
If complications do occur, the surgeon can completely reverse the treatment by removing the pump. The problem of tolerance to the medication and some of the sedating side effects can still occur. On the positive side, the majority of patients report immediate relief.
Emotional and Spiritual Therapy
Chronic back pain interrupts life as you know it. It affects body, mind, and spirit. A study reported in a 2008 edition of the Journal of Neuroscience said that chronic pain impacts overall brain function. That includes your emotions.
The researchers compared people with chronic back pain to those without pain. Through the use of MRIs, researchers could see that those with chronic pain had continuous activity in the part of the brain that’s associated with emotions.
This overactivity leads chronic pain sufferers to experience more stress, depression, anxiety, and sleeplessness. If your brain is so busy processing chronic back pain, your mind is not freed up to get adequate rest.
That’s why getting the emotional and spiritual help you need is as important as any pain medication. Depression and anxiety often accompany chronic back pain, so talking to a psychologist trained in pain management is a good choice.
Alternately or additionally, seeking the counsel of a trusted religious or spiritual leader is also wise. There is no one correct method to deal with the emotional distress that chronic back pain can create. The best method is the one that most resonates with you.
A psychologist trained in pain management will listen and understand your back pain in a way that family and friends perhaps may not. His or her office is a place where you can freely express what you’re feeling, knowing that you won’t be negatively judged.
Sometimes it’s a huge relief simply to be heard. And by listening to your challenges and your feelings, a psychologist can devise a plan for your specific needs.
Stress, of course, is a huge part of chronic back pain. Through psychologists and others, you can learn to reduce stress. Spiritual counselors can help you find peace through prayer.
Another mind/body experts such as those specializing in Eastern disciplines (such as yoga or tai chi) can help you find release through meditative techniques.
Emotions cannot be disregarded. As much as we might like to simply pop a pill to numb symptoms, it’s a short-term solution that ultimately will not be enough to manage long-term back pain. Fortunately, the subject of emotions is no longer taboo in our society.
Emotions shape and govern our experiences, our health, and our quality of life. That’s why learning to work with emotions is an especially crucial piece in the chronic back pain management puzzle.
Summary
- Reasons for chronic back pain are unclear, but there are many treatments to help people lead a better quality of life.
- Our nervous system has a pain memory. When overstimulated, it can lead to chronic pain.
- Successfully treating chronic back pain requires a multifaceted approach that includes the body, mind, and spirit.
Sources:
- & Spine, M. B. (n.d.). Pain Pump, Intrathecal Drug Pump Cincinnati, Ohio Mayfield Brain & Spine. Pain pump, Intrathecal drug pump Cincinnati, Ohio Mayfield Brain & Spine. https://mayfieldclinic.com/pe-pump.htm.
- Spinal Cord Stimulator | Johns Hopkins Medicine. (2022, January 1). Spinal Cord Stimulator | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain-with-spinal-cord-stimulators.
- Voss, P., Thomas, M. E., Cisneros-Franco, J. M., & Villers-Sidani, É. D. (2001, January 1). Dynamic Brains And the Changing Rules Of Neuroplasticity: Implications for Learning And Recovery. Frontiers. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01657/.