One challenge with treating back pain is that there are not that many absolute rules. For example, a spinal condition that appears relatively minor can lead to severe back pain, but a very serious condition can be barely painful at all. Similarly, some patients with a spinal condition will develop chronic pain, while others with the same condition will not.
To better deal with these issues, the spine medicine community is increasingly starting to appreciate that pain is a uniquely personal experience, and many treatments and types of back care don't work the same for all patients even when they have the same diagnosis.
Chronic Pain has its Own Unique Nature
Acute pain (e.g. lasting less than three to six months) and chronic pain (e.g. lasting more than six months) have very different characteristics.
- With acute pain, the severity of pain directly correlates to the amount of damage. This type of pain is a symptom of injured or diseased tissue, and after the underlying injury is healed then your pain goes away. For example, with a herniated disc, once the pressure on the nerve is alleviated the acute pain stops.
- As pain moves from the acute phase to the chronic stage, factors other than tissue damage and injury come more into play. These may include such things as ongoing "pain" signals in the nervous system even though there is no tissue damage, as well as thoughts and emotions.
Everyone experiences and expresses pain differently. Two people with the exact same injury will feel and show their pain in unique ways. The new theories of pain can now explain, on a physiological level, how and why people experience pain differently. See also Chronic Pain as a Disease: Why Does it Still Hurt?
The Nature of Your Back Pain Will Guide Treatment Decisions
With chronic pain, the treatment will be different depending on the underlying cause of the pain. Chronic pain may be caused by:
- A painful spine condition, such as degenerative disc disease, spinal stenosis or spondylolisthesis, which has not healed well. These conditions are due to a diagnosable anatomical problem. If the pain has not subsided after a few weeks or months of conservative (nonoperative) treatments, then surgery may usually be considered.
- Neuropathic pain, in which all signs of injury are usually gone and the pain that you feel is unrelated to an observable injury or condition. With this type of pain, the nerves continue to send pain messages to the brain even though there is no ongoing tissue damage.
See also Understanding Low Back Pain (Lumbago).
Finding Effective Treatments is Often a Process of Trial and Error
Figuring out the best approach to manage your condition can be very frustrating, as many treatments work well for some people but not for others. For example, epidural steroid injections are successful in alleviating pain for about half of patients who have them. Which half? Why? This is not known. But it is known that if one works for you for a painful flare-up, then it is more likely to work again if you need it in the future (and vice-versa). It is also known that you shouldn't have more than 3 injections in one year and that using fluoroscopy with the injection measurably helps the success rate.
So even though it is not always known if a treatment will work well for you, it is still a good idea to become as educated as you can on what to expect in terms of success rates and about what can positively influence the outcome (e.g. skills the spine specialist should have, technology available, etc.).
Be Careful with Decisions about Spine Surgery
There are many highly effective surgical options to treat a variety of spinal conditions. Unfortunately, however, many people are disappointed to find that most or all of their pain is still around after surgery. While there are a number of reasons a particular surgery may fail to alleviate a patient's pain, probably the most prevalent reason is that the diagnosis was incorrect in the first place. Almost all spine surgery is elective - meaning that it is the patient's choice to have the surgery or not - so in this area it is very important to make an educated decision. See also Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery.