How to Deal with Chronic Back Pain Without Medication

Most recent data (Australian Bureau of Statistics 2017–18 National Health Survey (NHS) tells us that 16% of Australians experience chronic back pain. This is a significant contributor to decreased quality of life for individuals and disease, economic and productivity burdens on a national level. Chronic back pain is pain experienced for a duration of longer than three months and felt in the low back, or lumbar area.   

How to Deal with Chronic Back Pain Without Medication? Chronic back pain doesn’t have to be a ‘forever diagnosis’.  With the right team and management it can successfully be treated without long term medication or surgery. 

Causes of Chronic Back Pain

The best way for How to Deal with Chronic Back Pain is a multimodal and multifaced approach.  Chronic pain is complex, and as such, has numerous ways that we can intervene. Pain exists as a response to an anticipated or potential threat to our body.  This can be initiated from:

• Internal changes: such as arthritic changes to spinal joints, spinal stenosis (a narrowing of spaces in the spine where nerves pass through), disc changes (eg herniation or prolapse), muscle or ligament strains. 
• Protective changes: muscle spasms, restricted movements, joint stiffness, neural irritation, responses to excessive increased movement/load or sedentary behaviours.
• Systemic changes: inflammation or hormonal changes, increased stress, decreased sleep.

Most of the time chronic back pain is a result of a combination of the above factors.  Therefore, when we consider How to Treat Chronic Back Pain, we aim to influence multiple factors.  Even though we can’t change some of the internal factors (such as arthritis or stenosis), we can change the threat level that is perceived and how the body responds by targeting some of the other contributing factors.

Sometimes back pain can be an indicator of something more sinister.  If you have any of the following contact your health professional. Red flag back pains include unremitting, localised pain; bladder or bowel changes; clumsiness in both feet or changes to gait; associated fevers or unexplained weight loss; recent trauma to the area.

How to Deal with Chronic Back Pain Without Medication

As just mentioned, there are many reasons that we can experience pain. In chronic back pain, our body has learnt to become overprotective and the pain we experience is no longer an accurate measure of tissue damage or threat. Once a thorough assessment has been completed, your physiotherapist can work with you to begin a management plan to help decrease your symptoms, improve your function, and retrain your protective strategies to a “normal” level. Some of strategies utilised may include the following:

• Manual Therapy: hands on treatment to muscles and joints to help improve available movement ranges and decrease pain or spasm. We can utilise all of the neurophysiological effects of hands on therapy to help change the reactivity of the body and give you more options for movement.

• Exercise: You will likely receive a combination of specific and general exercises to help your chronic back pain. Specific exercises such as pelvic tilts or cat/cow can help encourage mobility through the back joints and muscles. Activation and strengthening exercises can change the muscle patterning, tolerance and endurance for movement and day to day tasks.  Depending on what you need there may be a focus on core strengthening exercises such as table-tops, plank, or other pilates inspired exercises.  If glute strength needs to be improved, squats, lunges and deadlifts (or variations of) might be given.  General exercise such a walking on land or in the pool can be helpful for overall changes to systemic inflammation, mood and cardiovascular function.

• Lifestyle changes: we can influence the overall irritability and inflammation of our bodies by making changes to our nutrition, sleep and stress.
  • Nutrition:  An easy place to start is by drinking more water and eating a larger variety of colours in your foods. If you have specific dietary needs or just want more help we always recommend speaking to a dietician. 
  • Sleep: There is a feedback loop between pain and poor sleep, with one influencing the other.  It’s cliché, but aim to avoid screentime before bed, create a sleep routine and make sure the room is dark and at a comfortable temperature.  Your physio can discuss making changes to your sleep position using pillows to decrease any discomfort while sleeping.
  • Stress: while there are some stresses that we can’t change (i.e work, global events, kids etc), we can change how tolerant we are of them.  Often people think of mediation as a stress management tool, usually conjuring up the image of sitting cross legged with your eyes closed in the early morning. Meditation and mindfulness can be implemented in so many different ways. Pay attention to what you are eating or drinking without distractions; sit in nature and name what you observe/feel; count your breath (try a 4 count inhale/exhale); go for a walk with a close friend.

• Activity Pacing: one of the most important elements in improving chronic pain is feeling like you’re the one in charge! Alongside your physiotherapist you can work out how to pace activities to minimise and prevent flare ups.  The aim is to rebuild your tolerance for the things you love and need to do.

How to Treat Chronic Back Pain Without Surgery

Sometimes we need to use medical interventions when giving the Best Treatment for Chronic Lower Back Pain.  However, it is important to realise that medication or injection-based treatment is just one element of treatment and isn’t a long-term solution. Depending on what your body needs you might be encouraged to discuss longer-term or stronger anti-inflammatories or pain relief with your GP.  This type of medication can be used to support our bodies in settling the symptoms and aid in participation of physiotherapy management.  Your physiotherapist might trial the use of a TENS (transcutaneous electrical nerve stimulation) device at home.  This is useful in disrupting the signalling of input that gets perceived as a threat, and therefore pain. This is also called pain-gating.  A TENS device can also be used to encourage the release of endogenous (i.e. made naturally within the body) opioids.

If there are structural changes within the spine, especially those that impact the nearby nerves, that aren’t responding to conservative treatment there may be a need for therapeutic injections.  This is a combination of local anaesthetic and corticosteroids to reduce the inflammation and swelling in the area.  This is often enough to then make changes in a rehab setting without having to undergo surgery.

Can You Cure Chronic Back Pain?

We find that recovery from chronic back pain is different for every person.  Chronic back pain is a complex condition and there is no one guaranteed way for how to cure chronic lower back pain. However, as mentioned in this article, there are so many ways that we can intervene to help manage it. Some people find that their symptoms are completely resolved.  Others find that their back pain comes back in times of stress.  Others never fully get rid of it but find strategies to minimise both intensity of symptoms but also the impact the symptoms have.

Treatment for Chronic Pain in Brisbane

If you have been suffering from chronic low back pain and want to start on your management journey, book in with the team at Barefoot Physiotherapy. Booking in for an initial assessment will get you started with a plan! Click here if you’d like to read more about neck and back pain.