Do you have back pain?

Updated 6/19/2023

Back pain can be scary, especially when an MRI finds something abnormal. While they can seem scary, structural findings on a diagnostic scan don’t always equate with pain or are the cause of the pain.

Abnormal MRI findings are normal in people without pain, especially as age increases. Over 50% of 30-year-olds with no pain show signs of disk degeneration increasing up to 80% at age 50 (Brinjikji, et al, 2015).

And although chronic back pain is a common medical complaint, no specific cause is found in up to 85% of cases with central sensitization as a potential contributing factor (Sanzarello, et al, 2016) along with fear of pain and activity as maintaining factors.

Remember, all pain is biopsychosocial contributors Research has found that "when individuals with low back pain consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features" (Costa, et al, 2021).

Check out these back facts from OSullivan, et al, 2020:

1. Persistent back pain can be scary, but it’s rarely dangerous
   Persistent back pain can be distressing and disabling, but it’s rarely life- threatening and you are very unlikely to end up in a wheelchair.
2. Getting older is not a cause of back pain
   Although it is a widespread belief and concern that getting older causes or worsens back pain., research does not support this, and evidence-based treatments can help at any age.
3. Persistent back pain is rarely associated with serious tissue damage
   Backs are strong. If you had an injury, tissue healing occurs within three months, so if pain persists past this time, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movement. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.
4. Scans rarely show the cause of back pain
   Scans are only helpful in a minority of people. Lots of scary -sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.
5. Pain with exercise and movement doesn’t mean you are doing harm
   When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflect how sensitive your structures are – not how damaged you are. So it’s safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain.
6. Back pain is not caused by poor posture
   How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending, and lifting with a round back – in fact, it’s more efficient!
7. Back pain is not caused by a ‘weak core’
   Weak ‘core’ muscles do not cause back pain, in fact people with back pain often tense their ‘core’ muscles as a protective response. This is like clenching your fist after you’ve sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
8. Backs do not wear out with everyday loading and bending
   The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, the activities, like running, twisting, bending and lifting, are safe if you start gradually and practice regularly.
9. Pain flare-ups don’t mean you are damaging yourself
   While the pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving up.
10. Injections, surgery, and strong drugs usually aren’t a cure
    Spine injections surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come to risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.

 
Learn more

• RESTORE Clinical Trial for Back Pain
• Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
  
• Dr. Peter O'Sullivan: Disabling Chronic Back Pain - The Mechanical Care Forum (47:32)
• Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (sourced in article)
• Central sensitization in chronic low back pain: A narrative review (sourced in article)
• Low Back Pain Flares: How do They Differ From an Increase in Pain? (sourced in article)
• Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
• Back to basics: 10 facts every person should know about back pain (sourced in article)

• 10 Facts every person should know about back pain. Presented by patients (4:15)
• Patient Stories Behind the 10 Back Pain Facts Every Person Should Know (9:40)

• Making Sense of Disabling Back Pain - Peter O’Sullivan Koadlow Lecture 2021 (1:30:29)
• The Empowered Beyond Pain Podcast (includes several discussions about back pain and back pain myths/facts)
• Communicating with people seeking help for lower back pain (a quiz for providers but also beneficial for patients)
• Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain
• Your Back Is Not Out of Alignment
• Low Back Pain​
• Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
• 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good
• DIM SIM Therapy 
• Back in Control (a resource center created by a retired spine surgeon)