Low back pain

Learn about safe, effective options for managing back pain

Disclaimer: No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or another qualified clinician.

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Understanding Low Back Pain

Low back pain is a symptom rather than a disease itself. It can result from several general conditions or unknown ones. The exact etiology of back pain may be challenging to diagnose though the lumbar discs, facets, and sacroiliac joints make up a large portion of mechanical low back pain. [1] Low back pain may be due to underlying medical conditions in rare circumstances. A global burden of disease study in 2012 found that 80% of people will experience low back pain at some point in their life, while 20% of people suffer from low back pain at any one time. [2,3]

Back pain may start with an initial injury or insult to and of these structures leading to some level of discomfort. The duration of affliction a person experiences varies from one person to the next. Some may last days, while others experience an ache that can persist for weeks. Treatment goals can include pain management strategies and return to activities you enjoy. [4]

Many factors contribute to low back discomfort. Some are modifiable or can be changed, resulting in improvements in pain, while others are not. Modifiable factors include physical activity, overall health, and smoking status. Non-modifiable elements can consist of age and prior history of low back discomfort, to name a few. This list is by no means exhaustive but provides a few starting points to consider. [5] Posture is not part of this list though prolonged periods of sitting do directly influence your overall physical activity.

Pain management strategies

Treatment strategies include continuing daily activities even if you experience some mild discomfort. It is essential to recognize that pain management strategies are meant to assist you with maintaining daily activities without additional discomfort. Participation in your care with a healthcare provider is always a good option, especially if you have concerns, discomfort endures or progresses. 

When should I get evaluated? [4]

Treatment can help manage your discomfort and return to activities that you enjoy. Symptoms that you should consult your healthcare provider include:

• Unexplained swelling, redness, or deformity to the area of skin

• Weakness not due to pain

• Fever/chills/feeling ill

• Troubles breathing or shortness of breath

• Inability to perform movements or activities

• Pain at rest

• Sudden weight loss or loss of appetite

• Pain down one or both of your legs

• Previous therapies or treatments are not as effective in managing your discomfort

Other symptoms of concern include:

• Loss of sensation through the legs, groin &/or the anal region

• Loss of control of bowel movements or difficulties passing urine

• Pain as a result of trauma

• Pain associated with a loss of consciousness

I have back pain. What should I do?

Continue with daily activities that you are comfortable performing and consult your health care provider should you have specific questions about management strategies. Put simply – motion is lotion for your joints. 

Treatment options include: [4]

• Manipulation or mobilizations

• Strengthening or stretching exercises

• Massage 

• Acupuncture

• Talk therapies

• Medications

Concluding remarks

Low back pain is widespread, with most people experiencing at least one episode in their lifetime. People with similar injuries have varying pain levels, meaning that higher levels of pain do not indicate higher levels of damage. In the absence of a traumatic event, medical imaging is commonly not required before starting care. For many, low back pain can be recurrent with various levels of intensity. If you are uncertain of ways to best manage your discomfort it is a good time to consult with a member of your healthcare team.

Resources [4,6,7,8]

Telephone Resources

BC Pain Support Line: 1-844-880-7246

BC Mental Health Support Line (Available 24/7 for BC residents) - 310-6789 (no area code)

BC Crisis Line (Available 24/7 to everyone) - 1-800-784-2433

Canada Crisis line (Available 24/7 to everyone) - 1-833-456-4566

Paramedics: Contact the Critical Incident Stress Team through the Ambulance Paramedics of BC

References
[1] DePalma, M. J., Ketchum, J. M., & Saullo, T. (2011). What is the source of chronic low back pain and does age play a role? Pain medicine, 12(2), 224-233.

[2] Hurwitz, E. L., Randhawa, K., Yu, H., Côté, P., & Haldeman, S. (2018). The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. European Spine Journal, 6.

[3] Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., ... & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037

[4] Low back pain. Canadian Chiropractic Guideline Initiative. 2021 [cited 8 December 2021]. Available from: https://www.ccgi-research.com/lowbackpain

[5] Wong A, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis and Spinal Disorders. 2017;12(1).

[6] Proper Lifting. BC Chiropractic Association; 2021 [cited 8 December 2021]. Available from: https://www.bcchiro.com///wp-content/uploads/2019/06/proper-lifting-web-final.pdf

[7] Chiropractic Care and Back pain. Canadian Chiropractic Association; 2021 [cited 8 December 2021]. Available from: https://www.chiropractic.ca/wp-content/uploads/2013/12/Chiro-and-Back-Pain.pdf

[8] Sit less, Move more. American College of Sports Medicine; 2021 [cited 8 December 2021]. Available from: https://www.exerciseismedicine.org/wp-content/uploads/2021/04/EIM_Rx-for-Health_Sit-Less-Move-More.pdf

What is pain?

Learn about safe, effective options for managing ongoing pain

Disclaimer: No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or another qualified clinician.

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Understanding Pain

Pain is a complex communication between the brain and spinal cord dependent on social, biological, and psychological factors. [1] Together, these factors form a picture of the “danger” or threat level based on a situation. Nociception is the neural process of encoding noxious stimuli where physical, chemical, or thermal insult to our tissues and translating that into a signal our body can interpret. From here, it is encoded into several automatic behaviours or actions that allow a response to the stimulus. However, this does not always translate to the sensation of pain or, more appropriately, a signal of “danger.”

Your brain and spinal cord are constantly learning and adapting through a process known as neuroplasticity. The longer your body feels under threat, the more perceptive it can become to possible threat or danger. While walking through a forest in British Columbia, it is customary to look around to avoid a bear. Imagine if you never stop looking for the bear, including when you are safe at home. While this sounds nonsensical, it happens when your body evaluates a threat to consistently be present. Consider another time were learning a task or being “fluid” was difficult. Over time it became something that did not require any thought and seemed effortless. Now imagine that whole process taking place specifically for threat evaluation. 

It is estimated that up to 1 in 5 Canadians live with chronic pain. [2] Pain is broadly defined into two different categories, acute & chronic pain. Typically, acute pain occurs from onset or injury up to three months in duration. After three months, pain is defined as chronic and may be associated with functional disability or emotional distress. One person’s experience of pain is not likely to be the same as another as it can depend on the body part affected and its impact on a person’s life.

Things that make you go, hmm. [3]

• The World War II veteran found out he had a bullet in his neck on a routine chest x-ray 60 years later.

• Those who suffer traumatic amputations describe the sensation as nothing more than a “thump” or a “bump.”

 On the other hand, innocuous injuries causing significant discomfort, such as

• Getting a papercut while working in the office

• Stepping on Lego

Pain management strategies (Check out LivePlanBe)

• Begin easy movements

• Try relaxation and meditation techniques

• Get in touch with a friend

• Try to maintain a regular sleep schedule

• Cut back on-screen time

• Talk with your medical practitioner about medication reduction

Communication Strategies [5]

• Create a diary of your pain and activities to help identify patterns or trends

• Write down questions or concerns before meeting members of your healthcare team. Write down answers so you can review them

• Bring medication lists, test results to new practitioners

• Discuss treatments that you have tried and be prepared to discuss results 

Other health care providers [5]

• Chiropractor/physiotherapist – can work with you to maintain meaningful activities while promoting joint range of motion, mobility, and strength activities.

• Occupational therapy – Help you live independently through education and specialized equipment such as wheelchairs or other home-based modifications 

• Psychologist/Counsellor – Help manage the mental health and emotional aspects of living with chronic pain. 

• Massage therapists – Help reduce tension, improve blood flow, and promote relaxation 

• Acupuncture – A form of traditional Chinese medicine that concentrates on the flow of energy through the body by unlocking blocked energy by placing needles in specific points.

Access to pain care [6]

If you have not already consulted your health care practitioner, now would be an excellent time to have that conversation. Accessing pain care can start through the community providers listed above. Symptoms that suggest consulting a healthcare practitioner include:

• When pain is restricting your daily activities

• Pain that affects your mood or mental health

• Medications or therapies have become less effective in managing discomfort

• Sleep is being interrupted by pain

• Pain that continues to cause worry

Concluding remarks

Pain can be weird, particularly when it does not indicate damage. Frequently this type of conversation occurs when medical images such as X-rays, CT scans, and MRIs come back normal. Pain is pain. While this sounds straightforward, we are aware that several factors contribute to a pain experience. Locating where it hurts and identifying tasks that cannot be completed due to the pain are an excellent place to start.

Telephone Resources

BC Pain Support Line: 1-844-880-7246

BC Mental Health Support Line (Available 24/7 for BC residents) - 310-6789 (no area code)

BC Crisis Line (Available 24/7 to everyone) - 1-800-784-2433

Canada Crisis line (Available 24/7 to everyone) - 1-833-456-4566

Paramedics: Contact the Critical Incident Stress Team through the Ambulance Paramedics of BC

Online Resources [7,8]

References

 [1] IASP Task Force on Taxonomy. 2021. Terminology | International Association for the Study of Pain. [online] International Association for the Study of Pain (IASP). Available at: <https://www.iasp-pain.org/resources/terminology/#pain> [Accessed 30 November 2021].

[2] Schopflocher, D., Taenzer, P. and Jovey, R., 2011. The Prevalence of Chronic Pain in Canada. Pain Research and Management, 16(6), pp.445-450.

[3] Butler, D. and Moseley, L., 2003. Explain Pain. Adelaide City West: Noigroup Publications, p.13.

[4] Liveplanbe. 2021. Action plan. [online] Available at: <https://www.liveplanbe.ca/manage-my-pain/pain-plan> [Accessed 30 November 2021].

[5] Access chronic pain care [Internet]. Fraserhealth.ca. 2021 [cited 8 December 2021]. Available from: https://www.fraserhealth.ca/health-topics-a-to-z/chronic-pain/access-chronic-pain-care#.YbAx8C-94Us

[6] Fraserhealth. 2021. Access chronic pain care. [online] Available at: <https://www.fraserhealth.ca/health-topics-a-to-z/chronic-pain/access-chronic-pain-care#.YaZ81y-95mA> [Accessed 30 November 2021].

[7] Pain BC Society. 2021 [cited 8 December 2021]. Available from: https://painbc.ca

[8] Canadian Chiropractic Guideline Initiative. Sleep and pain. 2021 [cited 8 December 2021]. Available from: https://5fd9fdec-587d-4499-9f32-a02895f41f3b.filesusr.com/ugd/21ecf4_4b2ac8573d824f2ca67741bf46a3ffd5.pdf