Mechanisms of persistent back pain


Some people can experience persistent back pain, sometimes termed chronic pain if it persists for 3 months or longer.  There can be many causes of chronic back pain and a combination of these factors can be responsible for the effects they cause and the maintenance of your pain.

Maladaptive pain behaviours

Many people with persistent back pain adapt their activity levels and lifestyle to cope with their pain.  In the early acute phase these adaptive strategies can benefit the healing process of injured tissues.  However these strategies become unhelpful after a very short time initiating a stronger and more complicated mechanism for your pain, known as maladaptive pain behaviours.

Altered movement & control

Furthermore people with persistent back pain can form incorrect beliefs that certain postures and movement patterns are bad for their spines leading to unhelpful changes in the way we move.  In this situation assessment to identify and restore painful impaired movements; and learning to control pain provocative postures and movements patterns can be helpful. 

Hyper-vigilance, despair, suffering, & not coping

Avoiding activities in the belief that they cause us harm, such as time off work and activities we love doing that give us a sense of purpose, identity, and meaning, can have negative social and emotional effects.  As a result we can suffer a sense of helplessness, despair, an inability to cope, and a depressed mood state.  Additionally in the presence of ongoing pain we can constantly attend to every normal innocuous sensation, increasing our awareness to anticipate potential threats that may cause the onset of another painful event.

Avoiding an active lifestyle

Avoiding an active lifestyle has obvious negative effects on our health, and causes a decrease in body strength, leading to our daily activities being more strenuous, causing further aches and pains.  

Anticipating pain

A further unhelpful strategy in the management of our pain is to use guarding movements.  Whilst in the acute phase guarding can help to offload an injured tissue to help your body repair this is unhelpful in the presence of persistent pain.  When we anticipate pain we move more rigidly bracing ourselves in the belief this will help reduce our next foreseeable painful event.  When muscles are constantly active, this reduces essential muscle relaxation periods, causing further aches and pains.

Increased stress, poor sleep quality

Persistent back pain can also affect the quality of our sleep and increase physical and mental stress, all of which increase cortisol levels within the body, which is linked with suppressing the immune system, and amplifying the perception of pain.

To scan or not to scan

As you are beginning to see persistent back pain can be generated by many factors unassociated from injured joints, ligaments, and muscles.  So this raises the next issue of the relevance of having a back scan when we have persistent back pain.  A back scan is essential if there is a high suspicion of serious spinal pathology or trauma requiring immediate medical treatment.  However the majority of back pain is classified as non-specific with no clearly identifiable structural cause.  Back scan reports which identify changes with the spinal discs,  for example a bulge, herniation, or degeneration, reinforce a belief that the cause of your back pain is due to something injured in the spine generating your pain, further amplifying your pain experience.  Additionally this belief can be amplified further when we are advised to change our activity levels and rest, or have surgery as a result of these disc changes, falling in to the trap of treating the scan and not the person.

People with no back pain can have disc changes

But heres the thing, the relationship between back pain and disc changes is very weak!  Many studies have shown spinal disc bulges, herniation, and degeneration in people who don't have pain, and that disc changes are normal age related occurrences. In fact studies have shown that there is no difference between the long term outcomes such as health and wellbeing, ability to cope, leading an active lifestyle, and pain, when people with back pain are managed conservatively and surgically, further showing the complexity of persistent back pain and the multiple factors generating a persons pain experience.

Reform can help you...

Reform can help to break the cycle of your persistent back pain and empower you to take control.  Reform will actively listen to your unique story, to identify key factors, which are responsible for your painful experience.  This allows Reform to make treatment decisions based on your unique story, pain experience, and goals, to get you back doing the activities you love doing.