"85% of Back Pain is non specific, not attributed to any specific pathology"- Alf Nachemson
What is Chronic Back Pain?
Chronic back pain is pain that persists for more than 3 months with reoccurring episodes. It is important to note that 85% of back pain is non specific, meaning it is difficult to pinpoint exactly what is causing pain. Back pain is not as simple as black and white. The master mind behind chronic back pain is the central nervous system. In this post I will discuss how the central nervous system maintains back pain and how to adjust your lifestyle to deal with chronic back pain.
The Sympathetic And Parasympathetic Nervous System
Our autonomic (involuntary) nervous system is divided into the sympathetic and parasympathetic states. The sympathetic state is when the body is in a "flight or flight" mode whereas the parasympathetic state is when the body is more relaxed and in a "rest and digest" mode. When placed on a spectrum, homeostasis is considered the equilibrium between those two states. However unfortunately, people are rarely at perfect homeostasis because of the many stressors of everyday life such as driving, paying bills, work obligations etc.
Cognitive stress caused by "predictors" leads to the body being in a sympathetic state. A classic example of a mental prediction would be; you are late to work, you start worry that your boss will judge your for being incompetent, because of that your boss will fire you, if you get fired you won't have any money, if you don't have money you won't have food to eat, if you don't have food to eat you will starve and die. This sounds familiar doesn't it? The mind likes to jump to the worst case scenario when facing stressful situations. What does this have to do with back pain?
Think of chronic back pain like an overprotective parent. Any type of sympathetic stress that you face, your body will send out a pain signal to protect you. The brain is in constant high alert causing stress to manifest into back pain. Therefore, learning to manage cognitive stress is paramount with individuals with chronic back pain.
Central Sensitization
According to the ICP (Institute of Chronic Pain), central sensitization is a condition of the nervous system in which the central nervous system remains in a constant state of high reactivity and pain signals are overly activated. Central sensitization is often associated with the maintenance of back pain in individuals even after their injury has completely heeled.
There are two main conditions that are related to central sensitization called; Allodynia and Hyperalgesia. Allodynia occurs when a person experiences pain via a stimulus that doesn't normally provoke pain. For example, a simple touch or a brush will provoke pain. On the other hand, Hyperalgesia is when a stimulus is amplified and is more painful than it should be. For example, a simple paper cut will be extremely painful to individuals with hyperalgesia due to their amplified pain receptors.
Again, the overprotective parent the central nervous system, sends a protective response to prevent further injury, limit activity and teach us what not to do.
How To Alleviate and Manage Chronic Back Pain
1) Manage Cognitive Stress
As we discussed above, stress can lead to the manifestation of back pain. It is important to learn how to manage your stress. The best way to do this is via utilizing a free tool everyone has access to; breathing. Breathing sends a good amount of oxygen into the bloodstream which assists the brain to think clearly. As we know by now, the brain is responsible for sending pain signals. Clear brain = less inaccurate pain signals. I suggest incorporating meditation as part of your daily routine as it really helps in calming the nervous system.
2) Movement
Movement and exercise is amazing for alleviating back pain. Exercise produces endorphins which muffles pain signals. Moreover, exercise gives the area of the brain that is responsible for pain a crisp map of what is happening and thus the feeling of uncertainty diminishes. Lastly, movement receptors are a lot faster in speed than pain receptors and thus movement helps to disintegrate the feeling of pain.
3) Pain Doesn't Always Mean Damage
This is an important point to note. Pain doesn't always mean damage. As you would have learnt by now, the overly sensitive central nervous system sends out amplified signals to protect you. Pain is perception, if you understand it you can learn to manage it.
4) Acknowledge And Become Friends With Your Pain
Most people with chronic back pain are always worried about the pain that is debilitating them. Do not be hesitant of movement and anticipate your next pain episode with fear. Instead, do your best to learn to live with this issue. View this as an opportunity to change your lifestyle for the better by incorporating exercise, mobility training and meditation as part of your daily routine.
References
Central Sensitization. (2017). Retrieved from https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization
Active IQ. (2015). Physical activity and lifestyle strategies for managing low back pain. (1st ed). UK