Chronic non-specific lumbar or cervical pain
We use this term for patients who experience pain related to movement and muscle contractures in the cervical or lumbar spine, which responds poorly to usual treatments, persists for months with high intensity, and in whom a serious anatomical cause has been ruled out.
It is often associated with mental distress or stress, and in a high percentage of cases it is linked to work-related issues (such as dissatisfaction with the job or working hours) or to relationship or family conflicts.
Why does it occur?
Pain arises from the interaction between irreversible changes caused by the passage of time in the body (degenerative changes in the spine) and reversible factors (muscle tension, overload, poor posture, physical deconditioning, obesity, stress…).
Pain is perpetuated by:
- lack of functional adaptation of the whole body to this situation,
- avoidance behaviours toward movements or situations associated with pain,
- the phenomenon of sensitization: the brain remains in a constant state of alert and reacts excessively to stimuli, even those that are not painful, magnifying the sensory information it receives from the environment.
The process worsens with:
- personal experiences and beliefs (“this job is killing my back”, “I feel like I’m living in the body of an 80-year-old”).
- catastrophizing (“I probably have cancer”, “I’ll never be able to live a normal life again”).
- personal stress (family, work-related, internal conflicts…).
Healthcare providers (or the healthcare system) can also worsen the process:
- lack of access to medical consultation
- lack of information about how the spine works
- receiving negative messages (“your back is in terrible condition,” “sports are prohibited”)
- receiving contradictory messages from different physicians
What is the vicious cycle of chronic pain?
The patient enters a vicious cycle: physical activity is reduced due to pain, this leads to muscle atrophy and postural deterioration by avoiding movements that cause pain, weight gain may occur, physical condition worsens, self-perception deteriorates, the patient experiences anxiety/depression, nighttime rest is affected, pain worsens, movement decreases progressively….
Who is at risk of falling into this process?
If you maintain an avoidant attitude toward pain, you are more likely to fall into the vicious cycle without realizing it. This attitude is characterized by:
- mistakenly believing that pain results from a structural spinal injury
- reducing physical activity and even abandoning work due to fear of pain
- adopting a catastrophic attitude toward the future: believing that pain will permanently limit quality of life
- overusing analgesic medication
How to break the cycle?
To break the vicious cycle, the first step is to REALIZE YOU ARE IN IT and that getting out depends on yourself. Physicians can explain, recommend treatments, and support the patient, but only the patient can break the cycle through their own will.
The sole objective of the proposed treatments is not to reduce pain, but to improve the patient’s functionality and participation.
Treatment must always be ACTIVE:
- reassure the patient, always rule out a serious anatomical cause
- provide information about degenerative changes and how the spine functions
- motivate lifestyle changes
Patient collaboration and participation are essential; otherwise, no treatment will be effective.
Exercise should be started as soon as possible.
Psychological intervention is sometimes necessary to improve patient motivation, beliefs, and modify pain-related behaviors.
Any invasive treatment must be strictly indicated and supervised by a specialist without neglecting the above. For example, an injection may be recommended, but always in combination with physical therapy, exercise, and psychological treatment.
Ensure that the person evaluating your spinal condition is a spine specialist. Poor advice or a negative or catastrophic assessment does not help your process.
Trust your physician if no anatomical cause for your pain is found after testing.
What protects against pain chronification?
PATIENTS who CONFRONT PAIN experience symptoms of shorter duration and are less likely to have recurrences. It is recommended to:
- trust the physician’s explanations when indicating that pain is not due to an injury but to a temporary dysfunction or muscle imbalance problem
- remain as active as possible and continue working, avoiding only movements that worsen pain while maintaining proper body posture
- accept that pain tends to improve over time and that in cases where this does not occur, it is possible to adapt to it without having to give up almost anything
- take pain medication only in exceptional cases and temporarily when discomfort worsens.
Functional pain disorder- more than a nociplastic syndrome. Popkirov S et al Neurorehabilitation 2020
