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Back pain can make even the most minute of movements excruciating, hinder your daily activities and quality of life, and induce panic and despair — especially when the cause is unknown and the pain lingers.
“Chronic back pain is one of the most common causes of disability, not working, and frequent doctor visits, and there is no magic pill or formula that will work for everyone,” notes Nalini Sehgal, MD, a professor and director of the UW Interventional Pain Medicine Program.
A UW Health study, the largest of its kind in the nation to date, is studying pain management strategies in adults who are prescribed opioids to treat severe, chronic back pain. Other than cancer, there’s no other condition that opioids are prescribed for more frequently.
Strategies to Assist with Management of Pain (or, STAMP) is a study to learn new skills designed for people with back pain.
“We don’t have great treatment modalities for these patients who are already in an advanced stage of back pain and require daily opioids, yet still aren’t doing well,” explains principal investigator Aleksandra Zgierska, MD, PhD, an associate professor with the UW Department of Family Medicine and Community Health. “Back pain can be treatable, but for chronic pain, the goal medically may not be to take away pain completely — this might be wishful thinking because we may not be able to do that. Instead, the goal is to help patients have a happy, productive life despite being in pain.”
Back pain is very common; nearly everyone experiences it at some point in their life, and an estimated 13 to 30 percent of people go on to develop chronic low back pain. Muscle, ligaments, discs and joints are common sources of pain. Poor posture and incorrect spinal movements contribute to chronic pain, and older patients are more likely to have pain from degenerative changes in the spine. In many cases, it may not be possible to diagnose a single, specific physical cause of chronic low back pain, but that doesn’t mean that the pain isn’t real.
“Spine pain in general is very anxiety-producing. Patients wonder: ‘Am I going to be wheelchair bound?’” Sehgal explains. “When patients get anxious, they unconsciously tighten muscles and adopt protective postures. Over time, muscles, ligaments and joint capsules tighten, resulting in limitation of movements and more pain with activity, so they move even less. This process over time leads to a vicious cycle of pain, decreased movement, more pain, decreased function, social interaction and isolation. The end result is chronic pain.”
Chronic back pain can also exacerbate mental health problems and trigger new mental health issues. “We know anxiety, depression and sleep problems commonly co-exist with back pain, and, unless we address these mental health problems, they’re likely to get worse and pain is less likely to improve,” Zgierska says.
Tips to Help Manage Back Pain
You may not be able to erase the pain completely, but there are some actions you can take to make the pain more tolerable. Zgierska and Sehgal share these tips:
If the pain develops after an injury, seek medical treatment.
If you know you just got into a car accident, fell off a ladder or experienced other physical trauma, you may need to be checked for fractures or other structural problems. But what if the pain just came on without an obvious cause? “Look for red flags,” Zgierska says. See your doctor if you have a history of cancer; are over the age of 50; develop pain that starts in the back and shoots down the leg, with numbness or muscle weakness, or new bladder, bowel or erection issues; or if you have a fever with the pain.
Without red flags or trauma, give it time.
“A majority of patients don’t have any of those worrisome symptoms, but the pain can be excruciating, and they may not be able to get out of bed. But if there are no other concerning ‘red flag’ symptoms, pain by itself may not be something to worry about from a medical perspective,” Zgierska says. If it’s acute pain caused by muscular tightness or a sprain, heat and massage can help. “If the pain doesn’t settle down in 48-72 hours and you can’t get out of bed, then you should go see your doctor,” Sehgal suggests.
Know when to see a specialist.
Your primary care provider should be your first step, but if your pain persists beyond 6-10 weeks, “that’s a good time to see a pain specialist,” advises Sehgal.
“The best treatment is to stay active,” Zgierska says. “You do not want to be stuck in bed or a chair.” If your pain is chronic, it’s especially important that you resume activities as much as possible. “Some patients have put their life on hold,” Sehgal says. “Your pain should not be controlling your life; you should be controlling your pain. What we’re doing through treatment is empowering patients to control their pain and remove the mental shackles that are holding patients back from returning to normal active life.”
Do your research.
“Learn as much as you can about your pain because education is really empowering and helps control fear and worry,” Sehgal says. The American Chronic Pain Association is a good resource of information and self-care tips for patients.
Don’t assume the worst.
“Patients worry about their spine crumbling or disintegrating, and ending up in a wheelchair because they were told they have a degenerative condition of the spine,” Sehgal notes. “While pain can be disabling, by itself, it does not lead to becoming ‘wheelchair bound’ unless there is accompanying serious nerve damage or other serious underlying problems.”
“One of the strongest predictors about whether a person can improve or not is ‘pain catastrophizing’: negative thought processes when people who may not even be in pain in that moment start to fear it and worry it might come back, and their life starts to be shaped by pain or an anticipation of possible pain. People who catastrophize have worse outcomes,” Zgierska says. “And we know that people who apply healthier coping skills, including acceptance of pain, do better. Acceptance doesn’t mean being passive; it’s about living your life despite pain. When you change your relationship or mindset with pain, pain starts improving as well.”
Pain-coping strategies, including learning to reduce your negative reactions to pain, can make a difference.
During a UW Health pilot study, many participants were able to reduce or get off opioid use and able to resume normal activities, Sehgal notes.
Consider psychological treatment.
Because of the stigma around mental health, many patients resist the idea and can take offense if they think a doctor is suggesting the pain is “in their head.” “Pain IS in the head; that’s where the brain is. The brain is the nerve center for interpreting and processing all sensations from the body and determining the response to the sensations,” Sehgal says. “The brain has enormous power to magnify or amplify pain, or to minimize pain. We are harnessing the power of the brain to suppress that pain.” Zgierska cites a famous case of an individual who stepped on a nail and was taken to the hospital in severe pain. But when hospital staff took off the patient’s shoe, they found the nail had harmlessly passed between his toes. At the same time, there have been reports of people with horrific injuries not feeling pain in the moment.
A psychologist can help you retrain your brain and counter negative thought patterns, including catastrophizing.
“People in chronic pain feel hopeless and helpless. The goal is to make them feel empowered, to be able to manage everyday pain,” Sehgal says. The ongoing UW Health study aims to help patients retrain their brains to better manage pain.
Take care of yourself.
“Stress, lack of good sleep and untreated mental health problems can make people more vulnerable so that even lower levels of activity can lead to injury or worsened pain,” Zgierska says. “Getting good sleep, being well nourished, being physically fit — all of that helps.” At the same time, avoid smoking and alcohol. “Smoking is really bad for people with back pain,” Sehgal says. “Smoking shrinks blood vessels that supply oxygen and nutrition to the spine. It also interferes with clearing up toxins and other metabolic products, which linger and cause pain by stimulating the pain-sensing nerves. Smokers are known to have more back pain and worse response to treatments as compared to nonsmokers.”
Try physical therapy, tai chi or yoga to prevent future problems.
Physical therapy can identify movement patterns that might be causing or worsening your pain, and tai chi and yoga are good mind-body practices. “Most of the time back pain is due to or aggravated by poor posture and body mechanics,” Sehgal says. “Tai chi and yoga, and staying physically active, can help.”