Man suffering from back pain at work
Treatment for cyclist  treatment successfully relieves low back pain
Business woman with back pain

Chronic pain – A specialist perspective

When you are injured or suffering from an illness, your body reacts by sending pain signals to the brain via the spinal cord. Whether you are suffering from a paper cut, a broken bone or a torn ligament, the result is the sensation of pain. Chronic pain is different to acute pain, in that acute pain is generally a temporary experience that dissipates as the injury heals, and chronic pain is persistent over a long period of time.

There are many possible causes of chronic pain, often related to ongoing tissue damage, like that seen in osteoarthritis. In many other cases however, the pain can continue long after an injury has healed and there are even instances where no injury or physical cause for the pain have ever occurred. Dr Mark Alexander-Williams is a Pain Medicine Consultant with a wide area of expertise. Ranging from diagnosis and treatment of low back pain and sciatica, to complex regional pain syndrome and chronic pelvic and abdominal pain, Dr Alexander-Williams has an interest in challenging pain problems.

Woman with chronic back pain

Chronic pain or acute pain? How to tell the difference

Three months is usually the cut-off point for when pain really becomes chronic, but we actually talk a lot about problematic pain. If your pain is having a serious impact on your ability to carry out your lifestyle, then it’s chronic pain.

Back pain & sciatica

Back pain is different from sciatica, sciatica is a pain that originates in the back and runs down the leg. Back pain in the absence of sciatica is a condition that affects approximately 80% of the population at some stage in their life. It is a disease of sedentary humans more than anything else.

Chronic pain & mental health

If you consider what pain actually is, it’s a biopsychosocial phenomenon. Pain has layers. You have mechanical problem and then that starts to have an impact on your ability to function, it starts to have an impact on relationships, and then it starts to affect you emotionally. That’s when it becomes overwhelming. All pain is real, but all pain has different components that are biological, psychological and social.

The cause

There are usually a combination of factors involved. The main reason for chronic back pain is that you aren’t moving enough. However, there are specific issues and specific parts of the back. A lot of people have  purely muscular chronic back pain. Here the treatment is often quite straight forward.

Occasionally you’ll end up with joint pain in addition to the muscle pain and the treatment for that can be a little bit more involved. It can sometimes involve injection treatment.

There is the possibility that you have major structural change where you have things slip, and in extreme cases when it affects the legs that’s when we may involve our surgical colleagues, but that is quite rare.

Occasionally we see a situation where someone may have inflamed discs and that can cause muscle spasm or cause back pain. Sometimes it’s just a combination of muscles and ligaments or sometimes it can be straight forward muscle pain, it can even have involved joints, discs, slippage, ligaments  or a combination of the above.

Cycling to work without back pain

Chronic pain isn’t always chronic spinal pain

80% of the patients we see have spinal pain, the other 20% have chronic pain from other sources and it could be any number of things. There’s headaches, neck pain, abdominal pain, pelvic pain – lots of different conditions and the thing about it is, the management philosophy is the same regardless of where the pain is. A lot of it is about removing fear.

Doctor examining patient's back

How to manage chronic back pain

All treatment is a partnership between the patient and the treating clinician, so every patient has a major role to play in the management of their condition. Almost always you’ll find that lifestyle changes are required. Some people get obsessed about obesity but actually it isn’t particularly important in back pain. Certainly movement and activities are important. In the workplace, looking at your work station, taking regular breaks, standing and stretching, doing any form of exercise that involves stretching is beneficial. There is a strong association between smoking and back pain, so avoiding smoking can be very helpful in the management too.

So essentially, its exercise, not smoking, getting up and stretching on a regular basis and not worrying too much. Often one of the roles in just seeing a specialist and having investigations done is to relieve any worry the patient may have. Worrying can perpetuate the pain.

Young woman suffering from back pain

The dangers of leaving chronic pain untreated

The danger of leaving chronic pain untreated is the fact that you get yourself into a rut. What you tend to find is that the pain takes over. First of all it affects your sleep, and when your sleep is poor it tends to make you more anxious. It tends to affect your relationships with other people, sometimes your ability to do your job or your hobbies, it can have an impact on your friendships – all of that and your life just gets smaller and smaller as the pain tends to take over. What you need to do is address that early, to treat it before it becomes too painful and before the pain takes over your life.

Senior couple running after treatment for chronic back pain

Treating Chronic Back Pain – Is surgery essential?

Surgery is almost never required in cases of chronic back pain. The vast majority of patients don’t require surgery at all, and you’d never want to rush into unnecessary surgery. Really the only time that somebody with chronic back pain requires surgery is when they have something like cancer, or a major slippage, as neither of those will resolve on their own. Good physiotherapy, and in some instances osteopathy or chiropracty will be enough to treat the majority of patients – essentially movement based therapy where people alter their lifestyle. For the vast majority of patients with chronic back pain that’s all that’s required.

To treat more complex problems we need to diagnose exactly the biopsychosocial phenomenon. To do this we interview the patient, get a real feel for who they are, what they do and what they’re doing wrong - so we can know how to fix it. We take a history, examine the patient, carry out appropriate investigations and then make a plan. As far as what’s required in treating chronic pain, there are five modalities. Which of the five will be used to treat each patient will differ dependant on what the patient is presenting.

  • Medication
  • Physiotherapy
  • Psychotherapy
  • Neuromodulation
  • Injections