Have you ever had back pain that hurts so bad that you can't stand up?
For 64% of people with back pain, back pain can be both agonizing and debilitating. The intense pain their backs are in is a common culprit in missed work days, with most people being forced to miss work at least once. Shockingly, around 4 million adults struggle to find (or keep) a job due to debilitating back pain.
In this article, we delve into both chronic and acute low back pain, exploring the fascinating phenomenon of neural sensitization. We'll uncover potential causes of your relentless pain and, more importantly, offer practical solutions that can help you find relief.
Ready to take control of your pain and reclaim your life? Let's dive in!
When Pain Hurts So Bad It Majorly Impacts Our Lives
For most people back pain is something that happens at least once in their life but it generally goes away by itself after a few days, or weeks, at most. Unfortunately this is not the case for everyone.
For many lower back pain sufferers the pain persists and becomes agonizing, often lasting for weeks, or even months, or keeps recurring from time to time.
What Is Chronic Back Pain?
The National Institute of Neurological Disorders And Stroke defines chronic back pain as “pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.”
Around 20% of those who experience acute low back pain will go on to develop chronic low back pain with more persistent symptoms within a year. Low back pain is one of the most common causes for missed work days and adults with back pain spend almost 200 million days in bed each year!
When speaking to people who have experienced that “pulled my back, can’t stand up straight” feeling, they often describe their experience as scary and "very worrying". One minute you are fine, the next you can’t walk or stand up straight.
A simple round of golf or a weekend workout that normally doesn't cause any issues can suddenly leave you wondering what went wrong? Back pain can range from an acute, sharp type of pain, to feelings of numbness in your legs, which can be quite disconcerting.
How Serious Is My Back Pain?
Often we can think that the more serious the pain, the more serious the injury. Interestingly enough, this is actually not generally the case with low back pain.
With this belief in our minds it isn't really a surprise to hear that people still believe in the old advice to lie down on the couch and rest. The most excruciating back pain can actually end up resolving on its own, while more serious conditions, like degenerative disc disease, are more sneaky and chip away at your spine over months and years.
Who Is Most At Risk?
And it’s not just older folk that experience low back pain. While back pain affects men and women of all ages, it actually seems that adults of working age are the most vulnerable.
Data from the South Manchester Back Pain Study and the Southampton Back Pain Survey suggest that the prevalence of back pain actually decreases sometime in our 60s, although more research is still needed to confirm this.
This means that we are actually most likely to experience back pain during our 30s, 40s and 50s. It is theorized that older patients tend to suffer more from joint pain and osteoarthritis rather than nonspecific low back pain.
When Should I Be Worried About My Back Pain?
There are some sensations that can indicate something more serious than just a pulled back.
Radiating pain - this is pain that moves towards your legs and/or glutes. It is sometimes described as a “shooting pain”. This type of pain could indicate a compressed/pinched nerve.
A sudden weakness in your legs - conditions like sciatica or spinal stenosis can be caused by compressed nerves in the spine, leading to weakness in your limbs. If you are experiencing a sudden weakness in your legs this could also be an indication of a stroke, even though this is pretty rare.
Sharp pain - pain that is sharp versus pain that is dull and achy can indicate the presence of a torn ligament or muscle. Sharp pain can also indicate an issue with internal organs located towards the back or side of your body.
Numbness / pins and needles - if you are experiencing numbness in the area around your glutes or groin you should seek immediate medical attention. This type of pain is referred to as “saddle anesthesia” and it can be a sign of a serious spine or nerve condition.
Incontinence - if you have a loss of control over your bladder or bowels, combined with low back pain, you might have a spine infection such as discitis. It could also be a sign of a serious nerve compression.
If you have weakness, numbness, and incontinence all together, you could have a condition known as cauda equina syndrome - a serious illness that is a medical emergency and usually requires immediate surgery to prevent permanent spinal cord nerve damage.
Getting Help For Chronic Pain
Many patients with chronic pain go though endless medical appointments and tests and rely on prescription medications, including opioids, in their search for relief.
Unfortunately, opioid-associated deaths have reached epidemic proportions. In the United States alone, opioid overdoses cause an estimated 115 deaths every day. In 2023, drug overdoses claimed more than 107,543 lives, marking a staggering increase from previous years. While it's hard to pinpoint exact numbers, it's likely that many of these deaths were linked to chronic pain.
Shifting the focus from potentially harmful treatments to effective, nonpharmacologic pain management methods is not only possible - it's essential! Educating patients about how their pain works has been proven to help their understanding and improve their ability to manage symptoms.
By teaching patients and their families about central sensitization, we can empower them to understand what's happening in their bodies and discover the best ways to manage their pain.
Tips To Help Your Back Pain Go Away Faster
For chronic low back pain there are some things that you can do to speed up the healing process.
Do NOT rest for too long. This advice is very much outdated and the new international guidelines for treating low back pain recommend that you maintain mild to moderate activity levels after a back pain episode.
Gentle stretching. Stretching to the point of gentle tension - not to the point of pain - can help to warm up the muscles and gently help you improve your flexibility again.
Exercise therapy. Activities such as yoga, tai chi, and Pilates are recommended as activities that can help to strengthen muscles, improve flexibility, and reduce pain.
Psychosocial interventions. Stress plays a huge role in low back pain injuries. When we are stressed and rushed our muscles are more tense and are more susceptible to injury. Taking time each day to engage in mindfulness activities, deep breathing, or meditation, can make a big difference to your back health.
Neural Sensitization - When Pain Hurts So Bad You Can't Stand Up Straight
Neural sensitization, also known as allodynia and also sometimes referred to as central sensitization, is a process in which the central nervous system becomes hypersensitive to pain signals, leading to an exaggerated and prolonged pain response.
Neural sensitization basically refers to situations where the responsiveness of the neurons in our central nervous system get over excited and "nerve" too hard for our bodies, especially in areas like the spinal cord and brain.
10 Interesting Facts About Neural Sensitization
Triggering Pain: Neural sensitization happens when you feel pain over and over again, like from a hurt muscle or tissue swelling. The pain comes from special nerve fibers called nociceptors, which tell your brain that something hurts.
Feeling More Pain: With neural sensitization, your body becomes super sensitive to pain. Even small things that wouldn't usually hurt much can make you feel a lot of pain. This can happen even if there's no more damage to your body.
Pain Spreads: Sometimes, the pain can spread from where you got hurt to other parts of your body nearby. This spreading pain is why some people feel pain in many places even if only one part is hurt.
Pain Doesn't Match Up: In neural sensitization, the amount of pain you feel doesn't match how bad the thing that caused the pain was. Basically, even something small can make you feel a lot of pain for a long time.
Things That Make It Worse: Lots of things can make neural sensitization worse, like your genes (what you inherit from your parents), hormones (things that control your body), stress, being hurt again and again, or being sick for a long time.
Chronic Pain: Neural sensitization can make pain stick around for a long time, like in your back, head, or jaw. It can make it hard to do things and make you feel very uncomfortable.
Changes in the Brain: When you feel pain a lot, your brain changes a bit. It gets better at sending pain signals, even if there's no more damage.
How You Feel Matters: Feeling stressed or worried can make neural sensitization worse. It can make pain feel even stronger and harder to deal with.
Helping with Pain: Doctors and scientists are trying to figure out how to help people with neural sensitization. They use different things like medicine, talk therapy, or biofeedback devices to try to reduce the pain sensations.
Getting Back to Normal: The goal of treatment is to help people feel better and to be able to get back to doing their regular activities, even if they have neural sensitization. It might take some time, but there are ways to make things better.
Conclusions
Back pain is often painful and scary and yes, it can hurt so bad that you can't stand up. It is very important, though, not to give in to any temptation to lie down and rest for too long. Guidelines recommend trying to maintain a moderate level of your usual activities as long as it doesn't cause more pain.
If you are concerned about your pain you should definitely consult with your healthcare provider to make sure that there are no red flags or anything more serious going on.
Studies have shown the importance of maintaining activity levels to ensure that your back pain heals as quickly as possible. A recent publication from Harvard Medical School stated that “we now know that an extended period of bed rest isn’t helpful for moderate back strain at any stage of therapy”.
If you are looking for ideas on how to stay active and exercises that you can do that won't make your back pain worse, check out our article on Best Exercises For Low Back Pain.
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