Pain Management for Chronic Back Pain
Intractable or chronic lower back pain used to be something many patients simply had to learn to “just live with”. In recent years, however, researchers have learned a great deal about pain and its physiological and psychological basis, leading to pain management treatments that can provide complete or partial pain relief. Untreated pain can interfere with the healing process by affecting the immune system and leading to other deleterious results. With lower back pain, discomfort can impede the rehabilitation process by interfering with exercise and increasing the risk of psychological distress.
New Understanding of Chronic Pain
Patients who report continuing pain in the absence of a definitive findings of the cause (negative MRI, negative lab tests, etc.) are sometimes dismissed by health professionals. Even in the absence of such an identifiable cause, however, chronic pain can lead to neurological feedback processes that only serve to worsen the pain and make it more difficult to treat. Pain is inherently subjective, and a greater awareness of the need for taking pain seriously is growing among the health community as well as the public at large. This is particularly true for chronic back pain sufferers. While a great majority of back pain cases resolve on their own, the risk of recurrence and development of chronic disease is significant. Chronic back pain can be very difficult to treat, especially in cases involving failed back surgery or nerve pain. The above considerations have led to a proliferation of services available to patients seeking both medical and alternative treatment for back pain.
Pain Management for Lower Back Pain
Pain management, also known as pain medicine, draws on many disciplines in science and the healing arts to systematically study pain, its prevention, evaluation, diagnosis and treatment, as well as the rehabilitation of painful disorders. Pain relievers and related drugs are used at every stage of the medical treatment of back pain, from the initial onset of acute pain to facilitation of rehabilitation, treatment of chronic back pain and alleviation of pain in cases of failed back surgery. The most common noninvasive pharmacologic treatments for chronic back pain are:
Analgesics – or pain medications, including acetaminophen. Long-term use may involve risk of kidney or liver damage.
Nonsteroidal anti-inflammatory agents (NSAIDs) – includes aspirin, ibuprofen, naproxen and COX-2 inhibitors. Long-term use may cause gastrointestinal ulcers, and may slightly raise the risk of heart attack.
Muscle relaxants – used to treat muscle spasms due to pain and protective mechanisms.
Narcotic medications – most appropriate for acute or post-operative pain.
Antidepressants and anticonvulsants – used to treat neuropathic (“nerve”) pain.
Gianola, S., Castellini, G., Andreano, A. et al. Effectiveness of treatments for acute and sub-acute mechanical non-specific low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 8, 196 (2019). https://doi.org/10.1186/s13643-019-1116-3
Neuromodulating medications – used to treat neuropathic and muscular pain.
At Denver Pain Management Clinic, Dr. Andrew Hong has been helping patients manage their lower back pain for over a decade. Dr. Hong relies upon the most recent research in the field of pain medicine to create individualized treatment plans for each patient. Drawing on his years of experience, Dr. Hong has successfully decreased or eliminated lower back pain in hundreds of patients using non-invasive pain management techniques and medications.
Prevention and treatment of low back pain: evidence, challenges, and promising directions
Prof Nadine E Foster, DPhil
Prof Johannes R Anema, PhD
Dan Cherkin, PhD
Prof Roger Chou, PhD
Prof Steven P Cohen, MD
Prof Douglas P Gross, PhD
Show all authors
Published:March 21, 2018DOI: https://doi.org/10.1016/S0140-6736(18)30489-6