Chronic low back pain – what is it? Generally the term “Chronic” means that a condition has been hanging around longer than three months. (Arbitrary yes, but diagnostically useful most of the time).
Chronic pain is a bit weird. We know a lot more about the changes that occur to our body when we have long lasting pain now than we did 5 years ago, and tonnes more than we did 10 years ago.
In order to understand these changes, we need to understand how pain works.
Usually pain is there for a reason. Something sharp grazes your leg, and that part of your skin sends a message to your brain saying “Hey, what does this mean? I think it’s sharp, what should we do about it?”
Your brain then compares that sensation to previous experience. If you’ve injured yourself before after grazing against a sharp fence, your brain recognises the similar sensation and sends a message back down to your leg saying: “Danger! Move the leg away to prevent injury!”. How does it do this? By making something hurt.
So technically, pain doesn’t exist until your brain interprets the messages coming into it as dangerous or not dangerous, and decides whether to make it painful or not.
Chronic pain can exist where there is no injury. How? Why?
Take low back pain – you might have had a minor disc injury that after 3 months has pretty much healed. But it’s still agonising every time you bend over. Why?
Our nervous system adapts to the input it’s gathering. After being in pain for some time, our nervous system can become sensitive and accidentally misinterpret benign messages as danger messages. That might mean that it hurts every time you bend forward, because your brain mistakes that movement/pressure/temperature messages for danger messages and pain is the result. This is called central sensitisation.
There is also a lot of research coming out at the moment about our thoughts and emotions regarding our pain and how it affects it.
For instance, we now know that those people who are scared that their injury will be permanent are less likely to recover quickly. Common fears are “I’ll never work again”, “I can’t play with my kids”, “This will be here forever”.
This negative thinking can further sensitise the nervous system.
So how can we address it?
=Q=
I see patients with similar conditions regularly, often they’ve seen multiple practitioners and haven’t gotten anywhere.
If pain has been hanging around for a really long time but there is no injury present, pain psychologists are absolute angels to work with. Their job is to help the patient to understand their pain and how to reduce the fear and worry associated with it, as well as providing management and coping strategies.
GP’s can prescribe helpful medications in some cases, that help to dull the danger messages getting up to our brains. Often these will be Endep or Lyrica.
What can I do as an osteopath?
Often the patient has never had this series of events explained to them, and have no idea what the injury was in the first place. Knowledge is power! Sometimes just by explaining what is happening in their body, the patient immediately feels more empowered and relieved.
Also, we’re great at picking up on what patients are GOOD at. So, they might not be able to bend over and pick up a little one, but they can certainly squat down and play with little Harry, and pick them up with the help of a step or porch.
We can help find ways of completing every day tasks in a slightly different way so as to reduce pain.
We can also give exercises and management tips to help get you moving again, as exercise is imperative to recovery both from a physical and neurological point of view.
I really love this video from Dr Lorimer Moseley explaining these concepts in easy to understand language. (And he’s super funny!) Please have a watch if you or someone you know lives with chronic pain.
Until next time,
Claire
