Living with chronic pain, especially low back pain, can feel like carrying an invisible weight everywhere you go. It affects more than just your physical movements; it seeps into every aspect of your life, from your work productivity to your mental health. Simple activities like bending over, lifting groceries, or sitting for long periods can become sources of frustration and dread. But there’s hope. With the right strategies and support, it’s possible to regain control, reduce pain, and prevent future flare-ups.
Low back pain is one of the leading causes of disability worldwide. According to the Global Burden of Disease Study, it is estimated that up to 80% of people will experience low back pain at some point in their lives. Chronic low back pain, defined as pain lasting more than 12 weeks, affects approximately 20% of those who suffer from acute episodes of low back pain. It’s a condition that can significantly impact daily activities and overall well-being, but there are effective ways to manage it.
"In 2020, low back pain (LBP) affected 619 million people globally and it is estimated that the number of cases will increase to 843 million cases by 2050, driven largely by population expansion and ageing"
Understanding Chronic Low Back Pain: What Makes It Different?
Chronic low back pain is not just an extension of acute pain but a complex condition with its own unique characteristics. While acute pain is typically short-lived and often results from a specific injury, chronic pain persists for 12 weeks or longer. According to the Global Burden of Disease Study, low back pain remains the leading cause of years lived with disability globally, affecting up to 20% of people at any one time, and is often associated with a lower quality of life, limited mobility, and emotional strain. Yes we may be living longer but more people are living longer and suffering with some disability that is preventing them from living the life they want.
Acute vs. Chronic Pain: What’s the Difference?
The primary distinction between acute and chronic low back pain lies in their duration and underlying mechanisms:
- Acute Pain: Typically a direct response to an injury, inflammation, or mechanical stress on the body, acute low back pain is the body’s immediate response to a threat. For instance, bending awkwardly or lifting a heavy object can strain muscles or ligaments in the back, resulting in acute pain.
- Chronic Pain: Chronic low back pain persists beyond the normal healing time, often lacking a clear or ongoing injury. Instead of simply being a response to physical stress, chronic pain becomes more complex, involving changes in the nervous system, emotional responses, and behaviour patterns. Chronic pain is often due a build up of macro and micro traumas over time, it isn’t just one thing that contributes to the pain experience but an accumulation of stressors (chemical, physical, emotional) that are at play. This is why it is so important to look at all avenues that can be impacting a person and their pain.
Why Does Pain Become Chronic?
The journey from acute to chronic pain is influenced by several factors, including physical, psychological, and neurological elements:
Inflammation and Structural Changes: Prolonged inflammation due to issues like disc degeneration or arthritis can lead to ongoing pain. Structural issues, such as disc herniation or spinal stenosis, can also contribute to long-lasting discomfort if untreated.
Central Sensitisation: Chronic low back pain is often linked to a process called central sensitisation, in which the nervous system becomes hypersensitive to pain signals. Essentially, the brain and spinal cord start amplifying pain signals, leading to an exaggerated response to stimuli that wouldn’t normally be painful. Studies suggest that this sensitisation process is a key driver of chronic pain, as it lowers the pain threshold and increases pain intensity (Woolf, 2011).
Psychosocial Factors: Emotional and psychological factors, such as stress, anxiety, and depression, play a crucial role in chronic pain. Research has shown that individuals with chronic low back pain often report higher levels of stress and psychological distress than those with acute pain. These factors can worsen the perception of pain and contribute to a cycle where pain and emotional distress reinforce each other, making it harder to manage.
Fear-Avoidance Behaviour: Individuals with chronic low back pain often develop a fear of movement, a phenomenon known as fear-avoidance. Due to the fear of aggravating their pain, they may restrict physical activity, which leads to muscle weakness, stiffness, and decreased mobility over time. This avoidance can create a vicious cycle, where reduced movement leads to increased pain, further reinforcing the fear.
The Cycle of Chronic Low Back Pain
Chronic low back pain is often described as a vicious cycle. Pain leads to reduced movement, which causes muscle weakness and joint stiffness, further exacerbating the pain. The cycle becomes self-perpetuating, creating a sense of helplessness and frustration. Breaking this cycle requires a multifaceted approach that addresses the physical, mental, and lifestyle factors contributing to pain.
Common Causes of Chronic Low Back Pain
- Poor Posture: Prolonged sitting, especially with poor posture, places strain on the lower back muscles and discs.
- Muscle Weakness or Imbalances: Weak core muscles, tight hip flexors, and inactive glutes can all contribute to back pain.
- Injuries and Trauma: Previous injuries, such as herniated discs or muscle strains, can lead to chronic pain if not properly rehabilitated.
- Stress: Psychological stress can manifest as physical tension, particularly in the back and neck.
- Sedentary Lifestyle: A lack of movement leads to joint stiffness and muscle weakness, making the back more susceptible to injury.
The Mental Toll of Chronic Pain
Living with chronic pain doesn’t just affect the body; it also takes a toll on mental health. Many individuals with chronic low back pain report feelings of anxiety, depression, and helplessness. The fear of aggravating pain can lead to avoidance behaviours, further limiting mobility and independence. However, with the right mindset and strategies, it’s possible to overcome these challenges.
"LBP is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation."
Chronic Pain’s Impact on the Nervous System
When pain becomes chronic, it changes how the nervous system processes pain signals. This phenomenon, known as neuroplasticity, means that the nervous system starts adapting to the constant presence of pain, effectively “rewiring” itself. These adaptations are part of the reason why chronic pain can persist even when the original cause of pain is no longer present.
Pain Pathways and Sensitisation: In chronic pain, the brain’s pain-processing pathways become more efficient at sending and receiving pain signals. Over time, this leads to a hypersensitive pain system, where even minor stimuli can trigger significant pain responses. Central sensitization explains why people with chronic low back pain may feel pain during movements or activities that wouldn’t normally be painful.
Pain Memory: The brain can develop a “memory” of pain due to repeated pain experiences. This memory can influence how future pain is experienced, making individuals more prone to heightened pain sensitivity.
Emotional and Cognitive Effects: Chronic low back pain affects areas of the brain associated with emotion and cognition. Pain becomes intertwined with negative emotions like frustration, anxiety, and depression, creating a loop in which emotional distress amplifies the perception of pain. This link between pain and mental health is why managing chronic pain often requires a holistic approach that includes psychological support.
Common Myths About Chronic Low Back Pain
There are several misconceptions about chronic low back pain that can hinder effective treatment and recovery:
- Myth: “Rest is best”: While rest is important during the acute phase of an injury, prolonged inactivity can worsen chronic pain by weakening muscles and reducing mobility. Movement and exercise are key components of pain management.
- Myth: “Pain means damage”: In chronic pain, the intensity of pain does not always correlate with the degree of tissue damage. Chronic pain is more about how the nervous system processes pain signals.
- Myth: “There is no hope for recovery”: With the right approach, including exercise, lifestyle changes, and professional care, many people with chronic low back pain can experience significant improvements in pain and function.
- Myth: “Chronic pain is all in your head”: Chronic pain is a complex condition that involves both physical and psychological components. While the brain and nervous system play a role in how pain is perceived, this does not mean that chronic pain is imaginary or “just in the mind.” It is a genuine condition that can result from physical changes in the body, nerve dysfunction, inflammation, or past trauma.
- Myth: “If the pain is gone, you are healed!”: Chronic pain management often involves reducing symptoms to a manageable level, but the absence of pain does not necessarily mean the underlying cause has been fully resolved. Long-term pain management often focuses on maintaining movement, preventing flare-ups, and building strength and resilience, even if the pain subsides.
Actionable Steps to Manage Chronic Low Back Pain
Managing chronic low back pain can feel overwhelming, but there are actionable steps you can take to regain control and reduce pain. A comprehensive approach that incorporates movement, lifestyle changes, and professional care can significantly improve your quality of life.
1. Seek Chiropractic Care
- Chiropractic care offers a holistic approach to managing chronic low back pain. Chiropractors use gentle spinal adjustments to improve alignment, enhance joint mobility, and reduce inflammation. This can provide both immediate pain relief and long-term benefits by addressing the root causes of your pain.
- What to Expect: Your chiropractor will conduct a thorough assessment to understand the underlying factors contributing to your pain and develop a personalised care plan that may include adjustments, soft tissue therapy, and home exercises.
2. Stay Active and Engage in Regular Exercise
- Regular exercise whether that be walking, swimming, pilates, weight training, pilates yoga and stretching are all going to be beneficial. It is important to listen to your body and get a guage of what you can tolerate especially if you are just starting out. This may look like 10-15 minutues to start but with consistency and time you should find yourself being able to do 30-45 minutes of activity a day.
3. Manage Stress and Prioritise Mental Health
- Chronic pain often worsens with stress and anxiety. Consider stress-reduction techniques such as deep breathing, mindfulness, journalling and meditation
- Mind-body practices like yoga and tai chi can improve mental well-being while also reducing pain and improving flexibility.
4. Prioritise Quality Sleep
- Good sleep is essential for healing and reducing chronic pain. Create a sleep-friendly environment with a dark, quiet, and cool room.
- Maintain a consistent sleep schedule and avoid screens before bedtime. If you experience discomfort while sleeping, consider using a supportive mattress and pillows that promote spinal alignment.
Key Takeaways
- Chronic low back pain is the leading cause of disability worldwide
- Chronic low back pain requires a multifaceted approach. Addressing physical, mental, and lifestyle factors is crucial for effective management.
- Movement and exercise are essential for pain relief. Strengthening, stretching, and regular movement reduce muscle imbalances and improve spinal health.
- Chiropractic care provides holistic support. Spinal adjustments, soft tissue therapy, and personalized care plans address the root causes of pain and promote long-term wellness.
- Managing stress and prioritising mental health is key. Mindfulness, stress reduction, and self-care play a critical role in reducing chronic pain.
Final Thoughts
Chronic low back pain can be challenging, but it does not have to define your life. By taking a proactive approach and combining professional care with self-management strategies, you can reduce pain, improve mobility, and enhance your overall quality of life. Remember that healing is a journey—it takes time, patience, and a commitment to taking small, consistent steps.
With the right support and determination, a pain-free and active life is within reach. Start today by reaching out to a trusted professional and implementing these actionable strategies to take control and start to refine your health!
