Want Less Back Pain? Stop Being Afraid of It

If you've ever had a sudden and unexpected bout of low back pain, you realize how debilitating it can be. The intensity of the spasms, the startling onset that came seemingly out of nowhere and the incredible pain are sometimes more than a person can bear. At its worst, an acute attack of lower back pain leaves the victim completely and totally incapacitated.

As a chiropractor, I see these cases virtually every day, and I do many a house call, for often the patient is simply unable to move. The spasms of acute back pain can literally take the legs out from beneath you. Even a simple task such as turning over in bed becomes near impossible, and the mere thought of getting out of bed causes a cold sweat.

These experiences can be frightening, and people do not soon forget just how much pain they suffered during this time or just how paralyzed and afraid they were. Unfortunately, this fear frequently leads to a delay in recovery. Not only does the fear delay recovery but quite often poor advice from a well-meaning but ill-informed physician can cause a protracted and unsatisfying recovery as well. Patients often spend too many days in bed and take too much time off work. They develop an attitude that their back is somehow made of glass and that the slightest wrong move will cause a setback. Physicians tell these people to avoid lifting and sports, and even encourage sometimes unrealistic things like changing occupations and stopping activities that have nothing to do with low back rehabilitation.

The experience with pain combined with some frightening expert advice often instills groundless fears that hamper proper recovery. The big problem with bouts of back pain is the all-too-common progression into states of chronic or recurrent pain. Recurrency occurs when a person experiences numerous acute episodes, whereas the term chronic implies long term, low grade pain and disability.

In order to discover just how important activity is to getting over back pain, researchers in Seattle set out find a large group of people who had been in pain for eight to ten weeks and who had significantly reduced their activities as a result. They randomly assigned the 240 patients they found who fit these criteria into two groups, one for increased activity and one who would just keep doing what their doctors told them, so-called “usual care.”

The activity group had a 90 minute psychology session in which they discussed back pain related fears, the benefits of getting their former lives back in terms of sport, recreation and activity, and how to set treatment goals. This group then had a couple of sessions with physiotherapists who taught stretching, work hardening and other appropriate exercises. Finally this group had another short psychotherapy session to deal with recurrences and the pains of healing and getting moving again.

These people were quite typical of lower back pain sufferers; 60% were female and all were middle-aged. As a group, they all had reported moderate to severe reductions in normal activity because of back pain.

The results compiled at the end of one year and two years were significant. Please remember that these people had no real treatment--just increased levels of appropriate activity. The activity group experienced a 33% improvement in disability scores, but only a modest advantage in their pain levels.

The basic lesson here is that fear of activity often causes prolonged recovery and increases the chance of simple back pain becoming chronic and long term. This notion of less rest and more activity has been around awhile, but sadly most treating medical practitioners are not getting the message. Research has shown that bed rest beyond three days usually makes the problem worse. Not so long ago, it was common to find a person with acute back pain taking to their bed for six weeks, and sometimes on a striker board to boot. These unfortunate souls, while receiving what was considered to be the convention treatment of the day, were never the same again. It is false notions such as these that so frustrates not only active therapists like chiropractors, but also insurance companies and workers' compensation boards. The cost of chronic care and its resultant disability skyrockets when compared to active and appropriate acute care.

So if you have back pain, don't be afraid of it. Get up and get moving!

References for this article are as follows: Von Korff M et al., A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain, 2005; 113:323-330. Richard A. Deyo discussing how medical providers inadvertently instill fear in low back patients with off-the-cuff comments and ill-advised advice in his keynote address at the Alberta International Forum VII as reported in the March 2005 issue of The Back Letter

Author Contact Info: David Phillips D.C.
http://miltonchiropractic.chiroweb.com/