Lower Back Pain Management

In 2018, Angie started experiencing lower back pain that impacted her ability to do everyday activities. She went to a physical therapist, who introduced her to exercises that helped reduce her pain levels. But a few months later, the pain returned and started radiating down her leg.

This pain left Angie bed-bound. In search of relief, she tried steroid injections and nerve blocks. She ultimately had two back surgeries, a laminectomy and a spinal fusion. And still, the pain in her back and leg did not completely disappear.

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What is Lower Back Pain?

As its name implies, lower back pain refers to the presence of pain in the lower part of the spine (also called the lumbar region). This type of pain can be either acute (i.e., lasting for less than six months) or chronic (i.e., recurrent and/or lasting for longer than six months). It is also very common. In fact, more than 25% of people living in the U.S. struggle with lower back pain that negatively impacts their ability to work (1). Perhaps you’re one of the 40 million Americans who suffer from this type of pain.

Low back pain symptoms can include: dull pain in the area of the lower back, shooting pain that radiates from the lower back through the backs of the thighs and sometimes down the legs (this is called sciatica), and spasming of the muscles found in the hips, pelvis, and lower back. Some people  find that they have more intense lower back pain after they’ve sat or stood for a long period of time. Others find it difficult to walk, stand up fully straight, or move from standing to sitting (2).<div class='anchor-id' id='causes-of-lower-back-pain'></div>

Causes of Lower Back Pain

What are the causes of low back pain? The World Health Organization (WHO) divides chronic pain conditions, including low back pain, into two categories: primary pain and secondary pain. The physical sensations of primary and secondary lower back pain are the same, but the causes driving the pain are very different. If you’re experiencing lower back pain, it’s crucial that you find out what type of pain you have. 

So, what is the difference between primary and secondary low back pain, and how can you tell what category your pain falls under? The following guidelines can help you find out. 

Primary pain: 

It’s estimated that 80% of cases of low back pain are primary. In primary low back pain, pain is driven by nervous system sensitization. This means that the pain processing system is on high-alert and sending excessive pain signals. Pain is not driven by tissue damage or structural problems in the back. 

The following criteria are characteristic of primary low back pain:

• Your pain has persisted more than 6 months
• Your pain appeared suddenly, and the onset was not linked to a physical injury (such as a car accident, fall, strenuous activity). 
• You’ve had similar pain symptoms in your lower back before
• Your pain is symmetrical or affects both sides of the body
• Your symptoms are inconsistent. For example, pain appears in different areas of your back at different times; pain disappears during certain activities or times of the day; pain intensifies during times of stress or grows less intense during times of calm. 
• You pain arose during a time of stress or transition

The more of these criteria your pain matches, the more likely it is that you have primary back pain. It’s important to note that most people who have received diagnoses such as spondylolisthesis, herniated lumbar discs, osteoarthritis, facet or sacroiliac joint dysfunction, and spinal stenosis are properly diagnosed with primary pain.
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Secondary lower back pain:

In a minority of cases, low back pain may be secondary pain. This means that the pain is driven primarily by a physical injury or illness, rather than by sensitization of the body’s pain processing system. 

The following criteria are characteristic of primary low back pain:

• Your pain onset was linked to an injury such as a fall, an impact, lifting a heavy object, or a car accident
• Your pain has lasted less than 6 months 
• You’ve never had back pain before this current pain episode
• You have consistent pain that is always present in a specific part of your lower back (it hurts the same amount at all times of the day and week)
• You have an current injury (such as a fracture) or a growth (such as a tumor) 
  

Keep in mind that it’s recommended to confirm your diagnosis with a medical professional who is trained in diagnosing primary and secondary pain. Lin Health offers a diagnostic consultation as part of your membership to ensure that you get a diagnosis aligned with the WHO’s latest standards.
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Ways to Treat Lower Back Pain

The vast majority of lower back pain cases are classified as primary pain. Recovery from primary back pain is possible, and the guidelines are clear: to recover, people need a brain-first treatment approach which targets their pain processing system. Over time, brain-first treatment changes the way the brain interprets and communicates physical sensations, causing pain to go down (and sometimes disappear completely). 

Lin’s brain-first program draws upon primary pain treatment techniques with the strongest evidence base, including Pain Reprocessing Therapy (PRT), Psychophysiologic Symptom Relief Therapy (PSRT), and Emotional Awareness and Expression Therapy (EAET). 

Your experience in the program will be comprised of six elements:

Pain Neuroscience Education (PNE): You’ll take a deep dive into the biopsychosocial model of pain, which explains how pain works and why it can become chronic. Research shows that studying the neuroscience of pain can have significant therapeutic benefits for chronic pain sufferers. 

Evidence building: In partnership with a diagnostic professional and a pain coach, you’ll receive an accurate diagnosis and gather evidence from your pain experience to reinforce this diagnosis. This lays a crucial conceptual foundation for effectively practicing pain recovery techniques. 

Somatic Tracking: This evidence-based technique helps you to process pain signals as non-dangerous. Over time, somatic tracking promotes the development of new neural pathways, changing the way you experience and respond to pain. 

Addressing stress and other threatening emotions: Research shows that threatening emotions keep the nervous system in high alert and perpetuate chronic pain. To take long-term control over your pain, you’ll identify stress and other emotions feeding your pain, and learn to relate differently to them when they arise. 

Return to movement: If pain has limited your ability to participate in any physical activities, you’ll receive guidance from a physical therapist and from your Lin coach in order to safely and steadily reintroduce movement into your daily life. 

Meaning and intentionality: Living with chronic pain can make it harder to do the things that give your life meaning. With help from your coach, you’ll be empowered to take an active role in adding meaning into your daily life, and celebrate wins (big and small). The goal is for you to live life without pain at its center. 

Secondary back pain treatment

If you have secondary pain, it’s likely that you can benefit from brain-first treatment similarly to people with primary pain. 

While healing from an acute injury, you may also benefit from traditional treatments such as over-the-counter medications, topical pain relievers, muscle relaxants, ice or heat packs, physical therapy, massage, yoga, or tai chi. These should be considered short-term treatments to reduce pain as your back injury heals, not treatments that you are dependent upon for long-term low back pain management. 

If your pain persists for more than 6 months, this is a strong indication that your pain is primary and will be resolved most effectively by brain-first treatment. Make sure to get a proper diagnosis in order to receive the proper treatment and ensure recovery. 

Recovery is possible

After being bedbound for 40 months, Angie has started walking again. Her back pain is down, as well as other pain symptoms including migraines. 

The Lin program has given her an accurate primary pain diagnosis, as well as ongoing support for learning brain-first pain recovery techniques. 

Angie reports that somatic tracking is the most powerful tool she’s received from Lin, allowing her to process her pain in a completely new way. 

She also cites the importance of her coach's support throughout the process, knowing that her coach has been through pain too and “gets it.”

In her words: “It's been truly remarkable.”