Back Pain

Overview

Most cases of back pain resolve in a matter of weeks to months, but for some people the pain becomes a constant problem that interferes with many important aspects of daily life. If ignored, chronic back pain--generally defined as unremitting pain that lasts at least six months and is not relieved by standard treatments--can lead to depression, disturbed sleep, impaired balance, declining participation in physical and social activities, and decreased quality of life.

The first step in relieving chronic back pain is a careful medical evaluation by a doctor to assess the nature and degree of the pain and, if possible, to pinpoint the cause. If no specific cause of the pain can be identified (such as nerve entrapment that can be relieved by surgery), a variety of medications may be tried, ranging from over-the-counter acetaminophen or NSAIDs to prescription antidepressants, muscle relaxants, or opiates.

Regular stretching, flexibility exercises, muscle strengthening, and, if necessary, weight reduction are of particular value in treating chronic pain. Other strategies include self-application of heat and cold and cognitive and/or behavioral therapy. Spinal manipulation or alternative therapies such as acupuncture, acupressure, massage, relaxation therapy, or biofeedback may also help.

If these measures fail to relieve the pain, your doctor may advise you to enroll in a pain treatment facility.

This section has more on:

• Pain treatment facilities
• Multidisciplinary pain centers and clinics

Pain treatment facilities

People generally turn to pain treatment facilities when they have run out of other options. In addition, certain specific problems related to chronic pain may best be addressed at such programs. These include "pain behavior" (actions that worsen the quality of life such as limping, moaning, moving slowly, or using a cane); a decreased level of functioning that interferes with daily activities or work; perceiving oneself as impaired or having a disability; a discrepancy between how much pain the patient feels and how much their condition typically produces; and mental health problems, including depression, anxiety, drug or alcohol dependence, and impaired memory or concentration.

These programs do not aim to cure the cause of pain. Rather, they use a variety of approaches to reduce or eliminate both pain and its effects on daily life, such as excessive use of medication, physical impairment, and decreased daily functioning.

There are several types of pain facilities. Some focus on a single treatment method, but others target pain in a particular region of the body. Although these options may provide relief in some cases, doctors most often recommend multidisciplinary pain centers or clinics because they offer more comprehensive assessment and treatment and, to date, have shown superior results in medical studies. These facilities, headed by a trained and licensed director, may offer either inpatient or outpatient programs.

Multidisciplinary pain centers and clinics

Multidisciplinary pain centers and clinics treat pain as a complex syndrome. To adequately address the numerous problems encompassed by chronic pain, the pain facilities offer an integrated treatment team--including a primary-care doctor, surgeon, psychologist or psychiatrist, nurse, physical therapist, occupational therapist, vocational counselor, and social worker--that works together to manage each patient.

For example, in addition to traditional medical management, patients may receive physical therapy to achieve strength, flexibility, aerobic conditioning, a renewed feeling of fitness, and a more active life. Behavioral management--including group counseling and strategies such as relaxation training, biofeedback, and stress management--can help people develop coping skills and reduce social withdrawal, depression, and feelings of helplessness.

Since the quality of care varies from one program to another, finding the right one requires careful consideration. Your doctor may be able to recommend a facility, or you can contact the Commission on Accreditation of Rehabilitation Facilities (888-281-6531 or www.carf.org), which will provide a list of accredited programs near you. (While not required, accreditation can offer some measure of assurance that the program is comprehensive. Some insurance plans cover only accredited facilities.) The American Pain Society (847-375-4715 or www.ampainsoc.org) also can provide information about local pain centers.