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Chronic Low Back Pain
There are two main reasons your chronic low back pain or associated pain in the legs, also called sciatica, doesn’t get better. Find out why....

Do you experience stubborn chronic low back pain on spine, or sciatica that seems never to go away? Are you dealing with low back pain for longer than 6 months?  Have you tried medications, injections, physical therapy, chiropractic, and other procedures, and yet pain is not getting better but rather worse over time?

Has your pain taken over your life and isolated you from social functions and activities? If so, you’re not alone. Millions of men and women are affected by chronic pain and its lasting effects on daily activities and their physical, mental, and emotional well-being. Globally, 1 in 4 people has chronic pain. So what is this phenomenon causing people worldwide to struggle with such strong discomfort?

1 out of 4 people struggle with chronic low back pain on spine

There are two main reasons your chronic low back pain or associated pain in the legs, also called sciatica, doesn’t get better.

1) Chronic Low Back Pain on spine or sciatica is not treated as a Biopsychosocial Problem.

2) Nervous system retraining is not addressed in chronic low back pain or sciatica

Let’s look at each one in more detail:

Chronic Low Back Pain on spine or sciatica is not treated as a Biopsychosocial Model.

The biopsychosocial Model consists of three major components in treating pain.

1) Biological Factors

2) Psychological Factors

3) Social Factors

Pain is Biopsychosocial problem

Biological Factors :

Biology is what’s going on physically in your body. Your overall health matters, including things like:

·  Physical structures of the body

·  Genetics

·  Nutrition

·  Sleep

·  Caffeine consumption

·  Alcohol consumption

·  Smoking

Traditional medicine does a fairly decent job of addressing the biological factors that affect chronic pain but not so much on the Psychological and Social factors. Let’s look at the psychological factors and how they affect pain.

Psychological Factors:

Psychology is what’s going on in your mind and emotions that impact on your chronic low back pain on spine or sciatica. Let’s explore and gain some understanding of the science behind what pain is from the psychological side. I’ll break down the definition of pain and shed some light on this dark, heavy cloud that is pain.

IASP Announces Revised Definition of Pain – International Association for the Study of Pain (IASP) (iasp-pain.org)According to the IASP’s 2020 revised definition of pain, pain is: “an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage.”

Definition of pain by IASP

The meaning of this definition can be quite confusing, right? It contains a lot of information, so let’s break it down into smaller parts to get a clearer understanding. 

“An unpleasant sensory AND emotional experience.”

The fact is pain is a complex experience that encompasses both physical discomfort and emotional factors. The emotional aspect is inseparable from the sensory aspect; they are intertwined. Consequently, a pain rating scale from 0 to 10 may seem impersonal as it fails to consider the emotional toll and suffering associated with any painful experience. In Traditional Medicine, chronic low back pain on spine treatment only addresses physical symptoms and ignores emotional suffering. 

Pain is different in the normal people and chronically ill people

“Pain is an experience.”

As you know pain is a deeply personal and unique experience. Each individual has their own perception and expression of pain, even when diagnosed with the same condition. Therefore, it is crucial to honor and respect individuals’ descriptions of their pain, as it is a reflection of their personal experience.

Scientifically or objectively measuring pain, such as through an X-ray, MRI, or blood test, is not possible. Therefore, the most reliable approach to quantify or qualify pain is to attentively listen to and respect individuals’ criptions of their pain. Whenever someone expresses their discomfort, it is important to validate their experience and provide them with the support they deserve. 

“Caused by, or resemble actual or potential tissue damage.”

What this snippet is trying to explain is that you can have pain when you have actual tissue damage, like a sprained ankle, for example, but that isn’t always the case. It is possible to have actual tissue damage and no pain. Let’s look at two different scenarios  to understand this:

(see this example)   Man shoots nail into the brain and thinks nothing of it | US news | The Guardian In this amazing scenario, there is actual injury and tissue trauma, but no pain is experienced.

In another scenario, it’s possible to experience pain even if you don’t have anything stimulating the pain (ever heard of phantom limb pain?). Or, you can have a small injury associated with very high levels of pain, like with a paper cut or stepping on a sharp object. So you can have a really severe injury like a nail in the head and feel no pain at all, or have no injury or only a slight one and experience quite a lot of pain!

Pain is hard to pin down; it is very inconsistent. That is because the way pain is generated is a very complex process that involves the tissues in your body, your nervous system, your environment, mood, beliefs, past experiences, body chemistry, and more.

This does not mean that your pain isn’t real, made up, or all in your head. This doesn’t mean that your injury isn’t real or doesn’t matter. The key point here is that pain is inconsistent and is a very complex process. Simply put, pain is not a reliable tool to measure the extent of injury or structural damage.

Understanding pain is important not only to treat the whole person but also to lessen the fear and anxiety relating to the pain.

Important points to remember regarding Chronic Low Back Pain on Spine:

·  Pain encompasses both sensations and emotions; the presence of both is necessary for experiencing pain.

·  Pain cannot be quantified through X-rays, MRIs, or blood tests. It is entirely subjective and varies from person to person.

·  Pain is personal and should not be compared or judged against one’s own experiences.

·  Pain is complex and inconsistent and does not necessarily indicate injury or structural damage.

·  Effective pain treatment depends on an individualized approach, as no one-size-fits-all solution exists. Generic approaches do not provide lasting relief.

Social Factors:

Let’s not forget the third part of how we handle pain: Social Factors. They play a huge role when it comes to chronic pain and include:

·  The environment where the injury occurs

·  Relationships, social support

·  Access to medical care

·  Physical surroundings at home and work

·  Neighborhood

·  Role in the society

·  Ethnicity/culture

For example, you may sprain your ankle while wearing high heels going out on a date with your boyfriend, or you sprain your ankle while crossing the street with a bus coming at you. Your pain tolerance will be different in each scenario. The same applies to those who are injured in a stressful, toxic work environment vs. those injured at home doing household chores; the same injury occurs, but the pain experience will be different.

In summary, Pain is a complex and multifaceted experience with its own unique characteristics and can best be treated with a Biopsychosocial model to consider all the aspects of a person’s life to get the best results.

NERVOUS SYSTEM RETRAINING IS MISSING IN PAIN CARE:

Traditional medicine only focuses on structures or tissue like bones, joints, muscles, ligaments, or discs but completely ignores the nervous system.

Let me ask you, when you step on a sharp nail or touch a hot stove, what tells you that you touched the hot stove or stepped on the nail? Do you have eyeballs under your foot or in your hands? No… Your Nerves, right? Nerves fire up and take the message to your brain that tells you to get out of danger. The primary role of the nervous system is to protect you from all kinds of injury. Your brain, spinal cord, and nerves play a huge role in your pain experience.

When you are dealing with pain longer than 6 months, you have Nociplastic changes in your nervous system. For an explanation of nociplastic pain, read the blog “ Are you dealing with Neuropathic pain, Nociceptive pain or Nociplastic Pain” to learn more.

There are two ways chronic pain can be treated:

1) Bottom-up approach

2) Top-down approach

In the Bottom Up Approach:

The treatment uses medications, injections, electrical stimulation, massage, and radiofrequency nerve ablations on the tissues, joints, muscles, ligaments, disc, or nerve endings. This may eventually calm down the pain, but it is not directly addressing the nervous system.

Bottom up approach in treating chronic low back pain on spine

In the Top Down Approach:

In this approach, You first treat the Brain by learning more about pain, calming down the hypersensitive nervous system, retraining the nerves with proper drills, and eventually targeting dysfunctional mobility and strength to have lasting pain relief.

Top down approach in treating chronic low back pain on spine

My coaching program was designed to give you a greater understanding of pain from a neuroscience perspective and nervous system retraining, followed by entire body functional mobility training.

To receive a detailed evaluation of your pain problem, check out the Detailed Biopsychosocial Assessment opportunity.

Interested in learning more about pain, keep reading valuable information about pain.

Remember, Knowledge is power.

References: 

1] Louis Gifford, Pain, the Tissues and the Nervous System: A conceptual model,

Physiotherapy, Volume 84, Issue 1, 1998, Pages 27-36,- ISSN 0031-9406

2]Biopsychosocial Assessment and management relationships and Pain by Louis Gifford published in the Physiotherapy Pain Association yearbook 

3]Puentedura, Emilio J, and Adriaan Louw. “A neuroscience approach to managing athletes with low back pain.” Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine vol. 13,3 (2012): 123-33. doi:10.1016/j.ptsp.2011.12.001

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