Comprehensive Management Strategies for Chronic Back Pain

Introduction: Back pain, affecting various segments like neck, middle, and lower back, is a prevalent global health issue, impacting about 23% of adults worldwide. In Africa, particularly in Nigeria, where approximately 48% of the working population experiences back pain, it poses a substantial economic and health burden. This article focuses on chronic back pain, its types, causes, and explores holistic approaches for effective management.

Types of Back Pain:

  1. Acute Back Pain: Lasting a few days to weeks, often caused by sudden injuries, leading to stiffness and decreased movement.
  2. Subacute Back Pain: Lasting 4-12 weeks, a transitional phase between acute and chronic, with increased risk of becoming chronic.
  3. Chronic Back Pain: Persistent pain for more than three months, arising from various musculoskeletal issues or underlying medical conditions.

Causes/Risk factors of Chronic Back Pain

The causes and risk factors for chronic back pain are multifaceted and can stem from various physical, psychological, and environmental factors. Listed below are some of the key causes of Chronic Back Pain (this is not an exhaustive list):

1. Biomechanical factors – Biomechanical factors are those which put the back in pain due to poor body biomechanics, that is, how we move or carry our bodies. These factors usually make the back muscles undergo forces and movements that they are not familiar with, resulting in irritation, imbalance, and pain aggravation. These factors include but are not limited to:

I. Heavy lifting (carrying of heavy loads)

II. Running

III. Cycling

IV. Gym training

V. Higher body weight etc.

2. Psychological and Psychosocial factors – These are factors relating to social and psychological beliefs and other psychological and cognitive conditions that contribute to chronic back pain. They include but are not limited to:

I. Depression

II. General anxiety

III. Functional limitation

IV. Social isolation

VII. Maladaptive beliefs about the need for rest

VIII. Self-efficacy, etc.

3. Lifestyle and Health factors – These are factors related to lifestyle choices we make on a daily basis at work, at home and in other spheres. They have also been found by scientific research to be the prominent contributors to back pain. They include but are not limited to:

I. Sedentary lifestyle

II. Nature of work (e.g. Physical work)

III. Poor dietary choices

IV. Prolonged sitting

V. Improper lifting techniques

VI. Stress

VII. Poor fitness level

VIII. Weight gain

IX. Genetics

X. Smoking

XI. Alcohol consumption

XII. Inadequate rest

4. Medical conditions – These include medical conditions that inhibit or limit movement in affected individuals causing them to remain confined (sedentary) in an unwanted position resulting in discomfort of back muscles and the spine. They include but are not limited to:

I. Degenerative joint or spine diseases

II. Inflammatory arthritis disorders

III. Scoliosis

IV. Fibromyalgia

VI. Spinal disk degeneration

VII. Spinal fractures VIII. Spinal stenosis

IX. Herniated disks

X. Arthritis

5. Epigenetic Factors – These are environmental factors capable of causing changes in gene expression and DNA transcription. They may include most of all of the aformentioned health and lifestyle challenges and the changes they effect on the DNA of individuals.

The Holistic approach: As earlier explained in this article, there is increasing interests in the application of holistic approaches in the treatment and management of chronic back pain. Holistic therapy is an integrative approach that considers the whole person – body, mind, spirit, and emotions – in the bid to enhance optimal health and wellness. It incorporates both traditional and non-traditional techniques to treat individuals as a whole, putting into consideration physical health, mental health, social relationships, spiritual views, and environmental factors that could impact the health of individuals. This method is one of the most sought after in recent times as it looks to address the root cause of health related problems using the most probable side-effect-free or non-invasive approach. Some of the popular holistic therapies aside from traditional medical interventions include health education on lifestyle changes that can alleviate patients’ condition, acupuncture, massage therapy, homeopathy, naturopathy, breathwork, meditation, chiropractic care, and mindfulness practices among many others. Listed below are some of the most employed holistic approaches in the treatment and management of chronic back pain:

1. Anti-inflammatory drinks: These are beverages that contain ingredients which have been linked to or pharmacologically proven to possess anti-inflammatory properties and may help reduce inflammation in the body. These drinks often include natural ingredients such as herbs, spices, and certain tea types that are potentially rich in antioxidants and other compounds that have been associated with anti-inflammatory functions. Some important examples include: Turmeric milk, tart cherry juice, and ginger-green tea among many others.

2. Meditation: Meditation is a practice that involves training the mind to focus on a particular object, thought, or activity to achieve a state of calmness and relaxation. It is an ancient practice that has been used for thousands of years to improve brain health and overall well-being. Mindful meditation can improve concentration, release endorphins, and decrease anxiety and stress, helping control the perception of pain.

3. Acupuncture: Acupuncture is an ancient practice originating from traditional Chinese medicine, involving the insertion of fine needles through the skin at specific points on the body. These strategic points are believed to be connected by pathways or meridians through which the flow of energy, known as “qi” or “chi,” is thought to circulate. By inserting needles into these points, acupuncture practitioners aim to re-balance the flow of energy and improve overall health. This technique can release natural opioids, hormones, and neurochemicals to relieve pain.

4. Massage therapy: Massage therapy is the systematic manipulation of soft tissues, including muscles, tendons, ligaments, and connective tissue, through various techniques such as stroking, kneading, and rubbing. It is often performed by a licensed massage therapist for therapeutic purposes, aiming to relieve pain, promote healing, and improve physical functioning. It can reduce anxiety levels, cure depression, and provide relief for chronic or nonspecific back pain.

5. Yoga: Yoga is a mind-body practice that involves physical postures, breathing techniques, and meditation or relaxation. It is often recommended as a complementary therapy for individuals with chronic back pain. Yoga can help improve mobility and strength while stretching tight and aching back muscles. The practice aims to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles, multifidus muscles, and transverse abdominis in the abdomen, which help stabilize the spine.

6. Alexander Technique: Alexander Technique is a treatment which encourages people to improve their posture and refrain from slouching so their muscles are relaxed and back is supported at all times. Many private sessions are held where coaches teach different ways to carry your body through verbal instructions.

7. Magnesium supplementation: Magnesium is one of the most abundantly found elements in the human body and is required for more than 300 biochemical reactions. It maintains normal nerve and muscle function and also regulates the immune system. Magnesium supplements are another treatment for back pain.

8. Vitamin B12 supplementation: Vitamin B12 injections are another remedy used to cure chronic back pain. They are injected into the lower back to reduce pain and disability. Many studies conducted in Europe have proved the injection work and statistically improve mobility and manage the pain.

9. Capsaicin Cream: Capsaicin though unheard of is a very common active ingredient found in chili peppers. It is applied to the skin externally and diminishes the neurochemical substance that transmits pain. Capsaicin cream is basically an analgesic. 10. Vitamin D supplementation: Vitamin D is an essential fat-soluble vitamin that plays a crucial role in maintaining overall health. Vitamin D is essential for bone and immune system function, and taking a supplement can help reduce back pain by improving bone strength. Other supplements such as glucosamine, chondroitin, omega 3 fish oils, and collagen are also useful.

11. Use of devices such as Lumber Support devices.

12. Other preventive and management techniques include: regular exercise, limiting prolonged inactivity, heat and cold therapy, and making ergonomic adjustments in the working area.

Summary

Chronic back pain has become a global menace which requires huge and urgent attention. Although there are lots of contributing causal factors, standing out as major contributing factors include work-related factors such as prolonged sitting, heavy lifting, and poor posture as well as consequences of poor lifestyle habits such as sedentary behavior and obesity (usually attributed to poor dietary choices). Thanks to the fast pace of transformation in the health sector in the 21st century, the treatment and management of this prevalent and debilitating health challenge have witnessed robust transformation having evolved to encompass holistic and multidisciplinary approaches, addressing its physical, psychological, and social aspects. Moreover, treatment modalities have also expanded to include pharmacological, interventional, surgical, non-pharmacological, and alternative approaches, providing a wide array of options to address the diverse etiologies of back pain.

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