Chronic Pain what is the best treatment? The kinda pain that wont go away.

First things first

Firstly you should see a Doctor to rule out any red flags like fractures or tumors, etc, then come in an see us at Myotherapy and Massage.   We can see if it is an acute fresh injury or  re-injury or bordering on chronic.  Treatment I use are a combination a combination of all below, which is suited to your individual needs.  Come in and tell me your story, I’ll really listen to you and together we will workout a plan of action for you based on your specific wants.

Cognitive Behavoral Therapy

The most significant treatment for chronic low back pain is ‘Cognitive Behavioral Therapy’, believe it or not. A lot of our beliefs about pain and what we have been told in the past can actually limit us.  Words like misaligned, your back being out, I have knots in my muscles that need removing, don’t bend or twist, watch your posture, hollow in your belly, you have no stability in your muscles can really change the way we move and experience life.

Here is what current evidence based science says:

In this recent study, Efficacy of cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial K. Vibe, et el 2013.  they were trying to see how ones beliefs on their condition impacted on their pain levels.

Non-specific chronic low back pain disorders have been proven resistant to change, and there is still a lack of clear evidence for one specific treatment intervention being superior to another.  This randomized controlled trial aimed to investigate the efficacy of a behavioral approach to management,  cognitive functional therapy, compared with traditional manual therapy and exercise. Aged between 18 and 65 years, diagnosed with non-specific chronic low back pain for >3 months, localized pain from T12 to gluteal folds, provoked with postures, movement and activities A total of 121 patients were randomized to either classification-based cognitive functional therapy group or manual therapy and exercise group.  Results: The classification-based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group, both statistically and clinically.  For pain intensity, the classification-based cognitive functional therapy improved by 3.2 points, and the manual therapy and exercise group by 1.5 points. Conclusions: The classification-based cognitive functional therapy produced superior outcomes for non-specific chronic low back pain compared with traditional manual therapy and exercise. So this would be the first point of call.

I also dug up a recent review which is top grade evidence based study, that says the same: These kind of studies research, pick out the best evidence with no bias and measure the data. The conclusion was Intensive, daily biopsychosocial rehabilitation with a functional restoration approach improves pain and function in chronic low back pain.

Another high grade recent meta-analysis study,  “Meta-Analysis of Psychological Interventions for Chronic Low Back Pain”, concluded:  Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive– behavioral and self regulatory treatments were specifically found to be efficacious (effective). Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.

General Exercise

According to the literature out there at present, general exercises seem to be an effective treatment for non-specific Low Back Pain in therapy.  The benefits include: pain reduction, improved working ability, increased function, reduced depression and reduced fear of pain. However, the results are comparable to those with specific exercise, especially in the longer term. The short term benefits for specific training methods are potentially even more effective in reducing pain.according to a study”The Effect of Graded Activity on Patients with Subacute Low Back Pain: A Randomized Prospective Clinical Study with an Operant-Conditioning Behavioral Approach”in 1992, graded activity program made the patients occupationally functional again, as measured by return to work and significantly reduced long-term sick leave. So graded movement is key, find ways to keep moving, what do you enjoy doing? Swimming, getting on a bike, dancing etc. This would be the next point of call.

Manual therapy

Consider the addition of non pharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or sub-acute low back pain, intensive interdisciplinary rehabilitation, acupuncture or dry needling, remedial massage therapy,  yoga ,or progressive relaxation.

Manual therapy for low back pain, has been studied extensively. The analysis of valid trials provided clear evidence that manual therapy, particularly manipulation, can be an effective modality when used to treat patients who have low back pain. A preliminary “profile” of the patient with low back pain who would likely benefit from manual therapy included acute symptom onset with less than a 1-month duration of symptoms, central or para vertebral pain distribution, no previous exposure to spinal manipulation. Suggestions for future manual therapy research are discussed. Efficacy of manual therapy.Di Fabio RP1.

Massage is effective in adults for chronic low back pain and chronic neck pain. It can tone down the pain signals and help with mechanical issues.