Chronic Back Pain

Back pain is often defined based on the length of time that a person has been suffering, or based on where the source of the pain is. There are two types (nociceptive and neuropathic) and two levels (acute and chronic) of pain.

Again, there are two types of pain, nociceptive pain and neuropathic pain. Nociceptive pain is also known as somatic pain. Nociceptive pain involves the original transmission of a pain signal from outside the central and peripheral nervous system. The central nervous system involves all the nerves in the brain and spinal cord. The nerves of the central nervous system travel from the brain, through the spinal cord, and out the sides of the spinal cord, where they become part of the peripheral nervous system. These nerves of the peripheral nervous system divide and continue branching until its vast network reach nearly every cell in the human body. These nerve fibers respond to nociceptive pain signals, where they relay pain signals towards the spine and brain. If enough pain signals are relayed to the brain, we experience pain. Nociceptive pain involves sprain and strain injuries to the muscles and soft tissues, as well as arthritic changes to our joints. Neuropathic pain signals relay pain signals to the brain not as a result of injury or degenerative conditions within our body, but due to pathology to the nerves themselves, which cause the nerves to fire off pain signals on their own. With neuropathic pain, the nerves may intermittently or constantly fire on their own, without any clear source of injury or arthritis to be found in the body. Some nerves may begin to transmit pain signals due to a physical injury in the body, but continue firing in the absence of an external stimulus even after that part of the body has healed. Other cases of neuropathic pain may involve systemic diseases that cause pathological changes to the peripheral nerves. Systemic diseases that may cause neuropathic pain include spinal cord injuries, multiple sclerosis, fibromyalgia, cancer, immune mediated disorders. Both nociceptive and neuropathic pain may cause a patient to have acute back pain and chronic back pain.

Pain may be classified by level - based on how long a person has experiences back pain systems. These two levels include acute back pain and chronic back pain. Acute back pain is when the patient has experienced symptoms from a few days to a few months. Chronic back pain is when a person has experienced pain for a period of six months or more. Some books, doctors, and medical publications differentiate pain levels further, with acute, subacute, and chronic back pain:
  • Acute - pain lasting from a few days to a 1 month
  • Subacute - pain lasting for 1 to 3 months
  • Chronic - pain lasting for 6 months or more
Chronic back pain is a label that doctors go by to describe a symptom of a patient's overall level of health. The label is a symptom only, it doesn't suggest a specific cause of disease, imply a particular treatment for it, or suggest a particular prognosis for the patient's condition. It is simply a description of how long the patient has been suffering. The pain may be due to an injury that a patient can trace their symptoms back to, or it may have just come on one day on its own. The pain may have originated due to an injury in the body, but has continued even after the available back pain tests have revealed that the original injury has healed itself. Chronic back pain is often an enigma even to the best orthopedic doctors, and it is often treated successfully even in cases where the main pain generator is never found. The pain generator is the physical source of a patient's pain, and may actually occur in distant locations where the patient actually experiences his or her pain.

Treatments for chronic back pain include postural adjustments (The Alexander Technique), behavioral therapy, acupuncture, antibiotics, and tricyclic antidepressants.