There is a difference between acute back pain and chronic back pain, and there are unique challenges represented by chronic pain. This video explains why chronic back pain may be best treated using a multidisciplinary approach, including physical therapy, chiropractic, pain medications, injections and, if warranted, surgery. To be successful, treatment for chronic back pain should address the whole person, including mental health issues such as depression.
Video presented by Peter F. Ullrich, Jr., MD
In This Article:
There’s a big difference between acute pain and chronic pain. Acute pain is something you get usually because something happens to you, if you have some minor injury. It has a protective function, that’s why we take our hand off a stove – we put it on there and it hurt. Chronic pain doesn’t have that function, in fact most times chronic pain is not due to ongoing tissue damage. A lot of times, the source of chronic pain can’t be found. There are some things that result in a degenerative cascade, which will cause chronic pain, such as degenerative disc disease, congenital spondylolisthesis, isthmic spondylolisthesis. Most times, nine times out of ten, there is no anatomic defect that can account for the pain. If the source can be identified as amenable with surgical correction, surgery may be able to help with the chronic pain. If it’s not, treating that pain is basically a trial and error method – find some way that will help you manage the pain better. The thing to focus on chronic pain, it can’t be cured so learn how to manage the pain and how to function.
Sometimes different injections will help patients. Sometimes an epidural might not be all that helpful but a sacroiliac injection may be more the source of the pain and may be more helpful. There are a whole bunch of different medications from antidepressants that help mitigate pain to the newer anti-seizure type drugs that also alleviate pain. Some other drugs developed to help patients more are non-steroidal anti-inflammatory drugs or in severe cases maybe narcotics. There’s physical therapy too in terms of keeping the muscles stretched, the muscles strong, keeping well conditioned, which can help manage pain by keeping it as healthy as possible.
Pain may be there, but you don’t always have to listen to it. It’s sort of like oftentimes sitting in a room; the air conditioning might be running, but we don’t have to listen to it. If we can learn to shut off the parts of pain that we don’t need to know about, then we can continue to function, continue to live a productive life. But when you let the pain be your life and take on more meaning for you, that’s when you become less functional and more disabled. Sort of the old way of treating chronic pain was to completely ignore it, which is sort of the old timely way of treating pain because everybody has low back pain, so they didn’t think there was any treatment necessary for it. Nowadays it’s treated more at multi-disciplinary spine clinics where multiple professionals treat it as a disease entity, so it’s more like how cardiology treats heart disease. Multi-disciplinary treatment also allows us to treat all the different facets of pain, treat the whole person. Almost everybody with pain, to some degree has depression. That needs to be treated. If you treat just the pain and not the depression, you won’t make very much progress. If you treat just the depression and not the pain, you also won’t make very much progress. Both need to be treated.
There isn’t any one specialty that has a complete handle on back pain. By having everybody working together you can use each other’s strengths. If you are working by yourself and do not communicate with other professionals, it is sort of “I’ve got a hammer and everyone looks like a nail” sort of syndrome. So if you see a surgeon he’ll talk to you about surgery. If you talk to a chiropractor, you will get offered manipulations. If everybody works together, they can get a more appropriate treatment for the patient. There isn’t a cookbook algorithmic treatment for pain, so even for something as simple as a disc herniation, there isn’t an algorithm everybody has to go through stepwise. Some patients may do perfectly fine with one injection or a couple of pills and some physical therapy. Others might not respond to anything else or even need more immediate surgery because of the pain they’re in. Again, all the treatments need to be directed not at what’s on the MRI scan; it’s to be directed at what the person experiences. The key is that the patient gets offered different types of treatments and then also proper information so they can make the proper choice about which treatment choice is right for them.