Back Pain Management
As a long-time sufferer of chronic, trauma-induced back pain, I know that I’m not alone in my colorful opinions about the medical community. After having been told for years to “live with it,” I’ve tried desperately to develop, discover, and direct my own treatment plans—and I know many others who’ve done the same. Most of our attempts have one thing in common—and it’s the one thing that, regretfully, too many medical professionals seem unable to help with: pain relief.
While medical professionals focus on prevention and rehabilitation, they are too often unable to help with that most urgent of concerns: relieving pain—immediately. And while everyone would agree that prevention and rehabilitation are worthy and valuable pursuits, I know that in moments of agonizing, unimaginable, near-collapsing, kick-you-while-you’re-down, hurts-to-breathe-speak-and-move paralysis, what I need is relief, not long-term therapy programs or lifestyle lectures. I need comfort.
Of course, I do need those therapies and lectures, too. Just not when my pain has taken over.
Behind this situation lies the real predicament. Often by the time I arrive in an examining room, my doctor is left with few options. And this situation is not unique. Patients commonly avoid seeing a medical professional until their pain is past its breaking point. (It might be suggested that much of the reason for this reluctance is a result of the “nothing we can do about it right now; try to relax and lie down; don’t move until it feels better” response that patients have so often heard.) Regardless of the reasons, however, trauma patients should understand that, by the time they make it to the doctor’s office, and with the rare exception of emergency surgery, the doctor’s only options are to suggest rest or to offer pain-relieving prescriptions.
It’s not necessarily the doctors who are to blame. Many medical professionals dislike the “rest or prescription remedy” approach as much as their patients do. But until all of us trauma patients begin to insist upon regular back-pain-specific checkups—during good times and bad—our doctors will be hard-pressed to identify potential problems and even harder-pressed to offer useful and practical medical assistance.
It took me many years to come to this realization, but when I did I discovered an approach that works: pain management. Before I offer pain management specifics, however, I’m compelled to urge all you other trauma patients to visit your doctors when you’re not in pain, to insist that your doctors offer solutions and advice while you are comfortable enough to listen. After all, doctors certainly realize that even their most eloquent, inspired, and practical guidance falls on deaf ears when announced during a painful episode.
Understanding Trauma and Chronic Back Pain
What are the indicators of chronic back pain? Unlike acute pain (which begins abruptly and is usually caused by trauma, spinal infection, or arthritis), chronic pain can last for several months—sometimes longer—and often can’t be relieved. Acute pain can become chronic pain; in fact, the transition is not uncommon. For example, my back injury was the result of a fall that compressed my spinal column and shattered several vertebrae. While the fall created acute trauma-induced pain, the result of that trauma is now chronic back pain.
ccording to “What to Do When Your Back is in Pain,” which appeared in the FDA Consumer Magazine, “Acute pain comes on suddenly and intensely, usually from doing something you shouldn’t be doing or from doing it in the wrong way. The pain usually lasts a short while. Chronic pain is recurring; any little movement can set it in motion and…it lingers on and on.” The Pain Management Center suggests that chronic pain lasts more than six months, and that its symptoms include “weakness, numbness, tingling, or other sensations, along with sleeping difficulties, a lack of energy, and depression.”
Trauma typically results in acute back pain, which is why many patients find themselves frustrated when their pain becomes chronic. Whether their trauma was the result of a compression or burst fracture, or whether they suffered a ligamentous or musculoskeletal injury, their results are often the same: acute, piercing pain that sometimes doesn’t go away. In fact, it sometimes never seems to go away, and patients are left to “live with it.”
Sometimes chronic back pain patients experience pain for no apparent reason. For example, I’ve been cautioned not to lift more than 20 pounds as a result of my back injury—but I often lift 100 pounds without trouble. On the other hand, sometimes all it takes is for me to sit incorrectly and my back is “out” for days.
Learning to stand, sit, lift, and bend with correct posture is critical for chronic back pain patients, who often feel that they’ve tried everything to improve their conditions. They’ve tried physical therapy and chiropractic medicine. They’ve tried muscle-relaxing drugs. They’ve tried sleep, immobility, exercise, braces, pillows, heat, ice, and plenty of other complicated contraptions. They’ve talked to specialists and generalists, surgeons and herbal remedy advocates. Nothing works, and no one has the answers. They are desperate for answers: if they cannot simply “cure” their pain, then what can they do to make it go away temporarily? What can they do to manage and alleviate it?
Pain Management for Trauma-Induced Back Pain
There are few easy answers for chronic, trauma-induced back pain relief. I was a pretty typical patient, mistakenly believing that my situation would eventually improve on its own—with or without my persistence or involvement. I believed that sooner or later things would get back to normal, that even without significant lifestyle changes and proper exercise, my formerly active life would pick up right where it had left off.
I was wrong.
When I finally accepted that pain would be a part of my life—that it was something I would, indeed, have to learn to live with—I realized that I had two basic choices: to feel sorry for myself, or to do something about it. And while the choice seems obvious now, it wasn’t made overnight. I spent years doing little more than showing up for medical appointments and lamenting my fate. I can’t pinpoint when or how I changed my mind, but when I did I realized that unless I took action my problems would only get worse. I decided to manage my pain—but more importantly, to stop letting my pain manage me.
Adopting a lifestyle of pain management meant that I dedicated myself to understanding, investigating, and practicing proper pain management, which includes the “prevention, evaluation, diagnosis, and treatment” of back pain (Understanding Pain Management). According to WebMD’s Chronic Pain Center, pain management is a systematic, directed, and multidisciplinary approach to pain relief which requires patients to dedicate significant time and effort to their rehabilitation. Since the uses, techniques, and approaches for pain management are many and varied, trauma patients need to determine which approaches are best for them.
Pain Management Techniques
The pain that accompanies a chronic back problem often compounds a patient’s ability to improve his or her condition. While many doctors have come to disapprove of the “rest and relaxation” approach that has long been the standard, they also understand that strenuous physical activity isn’t the answer either. Many doctors now recognize that regular, moderate, targeted exercise usually improves their patients’ pain. Unfortunately, the experiences of many patients have taught them that their pain interferes with their ability to exercise as their doctors now suggest.
“If it hurts when you move your back, and is less uncomfortable when you don't, then you have the perfect incentive to become less active with time. Although this may seem like a logical reaction to pain, it is almost certain that avoiding physical activity will make the pain become even worse over time.” According to Dr. David Lehrman, chief of orthopedic surgery at St. Francis Hospital and founder of the Lehrman Back Center in Miami, “Most people think that a week of bed rest will take away the pain, but that’s not so. For every week of bed rest, it takes two weeks to rehabilitate” (FDA Consumer).
All pain management techniques are, in effect, either invasive or noninvasive. Noninvasive pain management includes physical therapy, massage, measured rest, chiropractic treatment, exercise, pharmocologic treatment, and heating pads or cold packs. Invasive pain management includes intrusive measures such as injections, prolotherapy, infusion pumps, and other electrotherapy devices. Surgery is not a pain management technique since it results in a more permanent modification of the spine.
I believe that it’s important for patients to first focus on noninvasive measures. Several noninvasive techniques have worked well to ease my pain, and the invasive measures I’ve tried have proven no more helpful—and much more painful—than noninvasive measures. With that in mind, I’ve focused my own pain management on noninvasive alternatives, and I’ve chosen to focus this writing on noninvasive pain management as well. I believe that noninvasive pain management is a better, less dangerous, more effective, and more patient-controlled alternative.
Noninvasive Pain Management
Plenty of noninvasive pain relief options are available; it’s up to patients to decide which approaches might suit them best. The following table (Noninvasive Pain Management Options) offers several pain relief alternatives—most of which involve long-term patient commitment. Use the table to compare the strengths and weaknesses of each and to decide which option might be best for you.
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I’ve tried all of the above methods except acupuncture and behavior modification, and I’ve heard mostly success stories from other chronic back pain patients about those two alternatives. In my experience, though, exercise is the single most important element of back pain rehabilitation. While it might cause some discomfort at first, the long-term benefits of exercise multiply over time, eventually reducing the levels and frequency of back pain altogether. My exercise regimen includes water therapy and flexion exercises, and both have led to a dramatic reduction in the amount of chronic back pain I experience.
Chiropractic medicine and physical therapy have also served me well, though they can become very costly. And electrotherapy/TENS has provided me with many wonderful and relaxing pain relief experiences, but that relief is temporary (very temporary!). While the nerve stimulation and massage-like feel of TENS is great for pain relief, its effects usually wear off within hours (sometimes minutes) after treatment.
NSAIDs have not been a practical solution for my back pain, since my pain is primarily skeletal (not muscular), but NSAIDs work quite well for temporary pain relief of muscular back pain sufferers. They do not, however, offer the long-term benefits associated with the lifestyle changes that exercise or physical therapy bring.
Finally, a note of caution: I’ve been given and have used various muscle relaxing drugs over the years, and they’ve never been a good idea. I strongly discourage chronic back pain patients from using these kinds of drugs: they have an incredible risk for habituation, and they limit and impair daily functions. I’ve typically been given muscle relaxing drugs as a last resort for extreme pain, but I will no longer accept them from my doctors. Why? Because even though they are effective pain relievers, they are not effective pain managers—and using them only teaches me to rely on them.
Managing chronic back pain is a difficult and long-term process, and it can be very frustrating at times when progress seems too slow in coming. But if you commit yourself to discovering and practicing an approach that works for you, you’ll find that your condition is likely to improve. Talk to your doctor about other pain management and long-term improvement options—and keep working to get back on track!
