In many modern societies, back pain is among the most prevalent conditions. In acute cases, pain medication can help. But if the pain becomes chronic, it can be difficult to control.
Her school bag, still packed, has been standing in the house for the last thirty years. She has never been able to bring herself to throw away the books. “I was passionate about being a teacher,” Birgitta Gibson explains. “It was very hard to give it up.” But a hellish pain sank its teeth into her back and, like a predator that has latched onto its prey, it refused to let go. Every step she took was agony. “I couldn’t climb stairs. I couldn’t carry my bag.” The last time she stood in front of a class, the teacher from Dietzenbach, near Frankfurt am Main in Germany, was 36 years old. “When they classified me as disabled, I was devastated. I lost all hope for a pain-free life.”
Back pain is the most common cause of disease-related conditions and around the world.
Birgitta Gibson’s story is the story of a life marked by pain. She has suffered from chronic back pain for more than forty years. At times, the pain was so bad that all she could do was lie down. And if she had to stand, she could only move forward one tiny step at a time, centimeter by centimeter.
It began with an operation to correct a slipped disc. There were complications. Birgitta had to lie in bed, in a body cast, for four months. But even when her wounds had healed, the slightest movement caused sharp pains in her back that shot through her entire body like lightning. The pain had become an independent entity, a chronic condition.
The causes of such a clinical picture are varied. It always begins with an acute pain. The nerves receive impulses and relay these to the brain. This warning system is what makes us conscious of danger, and is therefore a vital mechanism.
But nerves can learn. The result – if the impulse is particularly intense and persists for an extended period – is that what is known as “pain memory”. The nervous system changes acutely. At the slightest provocation, the nerves send pain signals to the brain. “One can compare it to turning up the volume on a stereo system as far as you can,” explains Nathaniel Katz. “For patients like this, bringing such intense outbreaks of pain back down to a normal level is a long and difficult process.”
Up to 84% of people in industrialized countries suffer from back pain at least once in their lives.
Nathaniel Katz is the CEO of Analgesic Solutions, a consulting firm based in Massachusetts in the US that researches treatment methods. He is also assistant professor of anesthesia at Tufts University School of Medicine in Boston, and founder of the Pain & Symptom Management Program at Dana Farber Cancer Institute and a clinical analgesics research unit at Brigham & Women’s Hospital.
Katz has seen first hand how pain treatment has developed in recent decades. “These days, anesthetists administer strong analgesics to patients, even while they are still under a general anesthetic,” he explains. “The aim is to prevent the patient from feeling the pain that occurs during the healing process, because then no pain memory develops.”
Analgesics: The all-purpose weapon against acute pain. The effectiveness of over-the-counter medicines for mild to moderate pain is as simple as it is effective. If an injury occurs, certain enzymes in the body produce prostaglandins. These messenger substances attach to the pain receptors on nerve endings, triggering a signal that is perceived by the brain as pain. Analgesics block these enzymes, meaning no more prostaglandins are produced and no more signals reach the brain.
Risk factors for back pain
• Physical behaviour: e.g. not enough exercise, working while sitting down
• Individual factors: e.g. age, height
• Psychological factors: e.g. stress, depression
• Environmental factors: e.g. vibration, unsuitable furniture
• Poor physical constitution: e.g. because of weak torso musculature
Nathaniel Katz advises those suffering from pain to begin treating it with physical measures, such as resting for a short time, applying ice or heat, or elevating the affected part of the body. It is also advisable to take pain-relieving medications early to restore function, as long as there are no contraindications. “Of course, with pain medication one should pay attention to the correct dosage and timing.” And then, of course, the sufferer should visit a doctor to find out the cause of the pain and talk about ongoing pain therapy.
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After surgery on Birgitta Gibson’s herniated disc, she didn’t received any strong analgesics – but they were what she needed most of all. “I might never have developed the pain memory at all, and the pain would then not have become chronic.”
Chronic back pain is now among the most common conditions of modern society. And patient numbers are rising. The causes of this development are numerous, and a specific event is far from being the most common trigger. Usually, the back pain results from other factors: “These include changed nutritional habits, a lack of exercise, incorrect physical loading, but also stress and time pressure,” Katz explains. “It’s a mixture of physical and mental causes. This is why the only thing that helps for the many complex or intractable cases is a multimodal treatment plan individually tailored to each patient.”
Help for acute pain
Almost everyone suffers from back pain at least once in their lifetime. According to the US National Institute of Health, in the USA alone, at least 50 billion dollars is spent on lower back pain every year – and it is the most common reason for work-related disability.
Sitting for hours at a workstation, one-sided mechanical activity, and too little exercise strain the back. Tense muscles, stretched ligaments and shortened tendons are subsequently the chief causes of acute back pain.
In such cases, when the pain occurs suddenly, analgesics can provide fast, reliable relief: “Modern versions of proven medications make use of technological advances,” explains Dr. Michael Voelker, Global Therapeutic Area Lead at Bayer HealthCare. “Once an Aspirin tablet, for example, has been taken, it breaks up rapidly in the body, allowing the active ingredient to dissolve and enter the bloodstream quickly.” The pain subsides noticeably after a short time. However, one should take such a physical warning signal seriously and have the cause clarified.
With chronic back pain, however, such medicines are not the answer. In chronic cases, achieving long-term improvement means tackling the cause of the complaint using a complex treatment approach. Other kinds of medication are required, and are employed as one aspect of a multimodal therapy.
Pain therapists work with patients. The pain therapist will thoroughly investigate the possible causes of the patient’s pain, then create a multimodal, interdisciplinary treatment plan, which can include such measures as physiotherapy, psychological counseling, medication, autogenic training, acupuncture and acupressure.
Help for pain patients
Twenty five years ago, pain patient Birgitta Gibson started a self-help group in Frankfurt am Main, Germany. That group has steadily grown into the Deutsche Schmerzliga (German Pain Association). The aim of the association is to improve the quality of life of people suffering from chronic pain. Today, the Schmerzliga has around 4000 members, while some 90 self-help groups across Germany offer support and assistance for those afflicted.
Internationally, the American Chronic Pain Association (ACPA) has been championing the cause of pain patients for 35 years. The organization offers support and information to those affected and their families. In the United States, Canada, Great Britain and other countries, several hundred self-help groups exist.
In addition, in England, the Chronic Pain Support Group works to network pain patients with one another. The organization is primarily concerned with promoting the exchange of information, and to foster the social integration of those afflicted by pain. The self-help group is based in Bury St Edmunds, where regular meetings are held in West Suffolk Hospital.
Deutsche Schmerzliga e.V.
Tel. 0049 6171 286053
American Chronic Pain Association
Tel. 001 800-533-3231
Chronic Pain Support Group
Tel. 0044 7719 497 989
(Monday to Friday 11.00 to 13.00 and 16.00 to 19.00)
After countless visits to doctors, Birgitta Gibson found herself visiting a pain therapist in Frankfurt, who put together a comprehensive treatment plan that finally began to show results. “I still suffer from pain from time to time, but it’s bearable,” she says. “These days, I can enjoy my life again – I’d almost forgotten how to do that.”