Chronic pain, especially low back pain, is a very common condition. Twenty to 40 percent of all adults report some form of chronic pain. In physician offices, low back pain is the fifth most common reason for a visit.
The source of low back pain is often due to a multitude of factors. These include weakened back and abdominal muscles, weight (especially if there is central obesity), occupation and activities. There can be orthopedic abnormalities with the spinal column which can produce pinching of the spinal nerves. A patient may also feel the effects of immeasurable factors like stress, perceptions of pain, and responses to pain. Every patient’s tolerance of pain symptoms is different.
The main goal of pain management is to restore a patient’s function. It is a common misconception that pain management will eliminate pain. Narcotics have become the backbone for chronic pain management, but there is little evidence that long-term use is effective in reducing pain and even less evidence that they help to restore a patient’s functional status. In contrast, there is clinically relevant evidence that narcotics cause unfavorable events like constipation, sedation, increased risk of accidents related to impaired thinking and risks of abuse, addiction and overdose when misused.
There is insufficient evidence to support the use of any medication for chronic low back pain other than non-steroidal anti-inflammatories (such as Advil® or Aleve®) and skeletal muscle relaxants. And yet four million adults are prescribed a long-acting narcotic each year for low back pain. As prescriptions have increased, so have the consequences: impairment, overdose, diversion and dependence.
On the other hand, there is plenty of good evidence that non-medication therapies make a significant difference in pain. Unfortunately, these treatments are not utilized as often. These therapies are not as simple as taking a pill every six hours; they require daily vigilance on the patient’s part to complete a physical routine. Therapies with good evidence of moderate effectiveness for chronic or moderate low back pain include exercise, spinal manipulation, physical rehabilitation and cognitive-behavioral therapy (CBT). CBT is a training program for the brain that utilizes education, relaxation exercises, coping skills and stress management to promote symptom reduction and improved functioning.
A study published in the Archives of Internal Medicine in January 2012 followed 442 patients over nine months. It found that CBT was associated with a 30 percent improvement in pain and functional status. An exercise routine produced 35 percent improvement and a combined program of CBT and exercise produced 37 percent improvement. The placebo group members had only eight percent improvement in their pain and functional status. Another study conducted in October 2011 involved 226 participants who completed a 12-week class in either yoga or stretching. The participants reported reduced pain and improved functioning over 26 weeks compared with a placebo group who did no activity. These are just two examples of the powerful evidence that exists in support of non-medication therapies.
If you suffer from chronic low back pain or even chronic generalized pain, I encourage you to visit with your doctor to discuss these alternatives to medication.