Humans have had Backaches Since Neanderthal Man (Maybe Earlier)


Coping with chronic back pain can feel like climbing a giant pyramid.







So Why Can’t We Fix Them?

Human beings have experienced back pain since they began standing on two feet, according to authors David Allan, MD and Gordon Waddell, MD. The earliest case presentation dates to a papyrus document from 1500 BC, but evidence suggests that Neanderthal man, and even his dinosaur ancestors suffered as well. Evidence of degenerative spine changes has been documented in Egyptian mummies (Allan & Waddell, 1989), Hippocrates recorded the first clinical case of sciatica in 400 BC, and early descriptions of rheumatic disorders date back to the late 1700s.

Given that back pain has been around for more than 3500 years, why hasn’t medical science come up with a fix? Although back pain as an acute condition is quite old, chronic back pain as a widespread medical problem is more recent. Allan and Waddell use World War II as the turning point at which chronic backache and disability became significant concerns within the medical landscape.

As the authors point out, pain and disability are not the same. Underlying causes of acute back pain tend to be physical symptoms, whereas chronic back pain and disability is more complex, reflecting the patient’s subjective impressions of pain intensity and loss of function. While chiropractic adjustments, medications and physical therapy are effective in treating the physiological causes of back pain, addressing mood disorders such as stress, depression and anxiety that frequently accompany chronic pain require active involvement by the patient.

While this might appear as another barrier to feeling better, it’s an opportunity. The second chapter of Chronic Back Pain: A Self-Management Perspective focuses on cognitive distortions, a term coined by psychologist, Dr. Aaron Beck to describe patterns of thought that may contribute to negative emotions and importantly, make your back pain symptoms more severe. These include catastrophizing (magnifying a small event to the exclusion of everything else), all-or-nothing thinking, self-blame, discounting the positive, and magnification (making mountains out of molehills).

How do these thought patterns contribute to back pain? Taking catastrophizing as an example. Catastrophizing is a subjective way of appraising your pain that consists of three components: magnification, rumination, and helplessness (Quartana et al., 2009). Magnification refers to your fear that the pain will get worse, perhaps thinking back to previous back pain episodes. This can lead to rumination, in which thoughts about your back pain continually occupy your mind, to the exclusion of everything else. This in turn leads to helplessness: the feeling that there is nothing you can do now or at any time in the future to make the pain tolerable. It is awful and overwhelming (Quartana et al., 2009). Helplessness is hard to live with.

It’s important to consider the situation objectively. If you have been living with back pain for more than three months (chronic back pain), it is likely unrealistic to expect that you will ever be completely pain free, although you may have periods of very little pain. This does not imply that the pain isn’t manageable, or that there is nothing you can do to reduce the impact of pain on your life. If you have already sought medical treatment, that’s a start. Chiropractic adjustments, acupuncture and massage are non-systematic treatments than can help reduce your experience of pain without the worries of medication tolerance or dependence. In addition, getting adequate, good quality sleep, eating a healthy diet, being physically active, maintaining friendships and socializing, and learning how to relax, particularly when you feel an acute episode coming on, can all help.

For additional information on lifestyle modifications for chronic back pain management, check out the patient workbook on this website.

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