Chronic primary back pain simply put is back pain that’s been going on a long time (over 3 months) with no definable cause. Primary pain refers to pain that is out of pro-portion to the potential cause, or has no obvious cause. Secondary pain, on the other hand, is pain resulting from another condition; arthritis, kidney disease, tumour or other cause.
Primary pain guidelines
The NICE guidelines for chronic primary pain for 2021 suggest a number of approaches to adopt when treating primary chronic pain:
– Foster a collaborative approach to solving the patients pain, presumably so the patient can feel empowered.
– Offer psychological interventions such as CBT* or ACT.**
– Stop prescriptions of opioid based pain killers, as there is scant evidence they work for chronic pain
– Recommend supervised exercise.
– Recommend a course of acupuncture.
You can read more about 2021 NICE guidelines here…www.nice.org.uk/guidance/ng193
It’s important to note that NICE guidelines form a structure for GP’s to use when treating back pain. However, GP’s are not obligated to offer any or all of the above guidance. They must use their own judgement taking into account this guidance.
I need an MRI to get to the bottom of my pain…
The correlation between what you can see on an MRI scan and pain is shaky at best. The first investigation into this was carried out in 1994 and published in the New England Journal of Medicine. ninety-eight asymptomatic people had their backs MRId. None had any back pain. On reviewing the MRIs, fifty two percent had a disk bulge and twenty seven percent had a protrusion (a more severe bulge). The incidence of disk bulge increased with age, suggesting that if you’re older and have a scan it’s likely that you’ll find a bulge, but according to this study it’s unlikely that’s the cause of your pain. This study has been replicated numerous times since and with different areas of the body.
If not a scan then what?
Discerning the source of pain is part art, larger part science. An MRI won’t necessarily tell you why you’ve got pain, but many diagnostic methods are available to the skilled therapist. These don’t necessarily definitively diagnose the cause, but they narrow the potential cause down considerably…
– Dermatone maps show the distribution of cutaneous pain according to the corresponding spine nerve root.
– Dr Janet Travell and Dr Simons did amazing work at mapping out pain referral patterns from taut bands of muscle (trigger points).
– Testing range of movement and strength of a joint and surrounding muscle can diagnose dysfunction in specific muscles or joints.
– Palpating (feeling) local tissues for temperature or tone can indicate infection or muscle strain.
All of these techniques used together build a picture and suggest a causative factor for the pain.
This is by no means an exhaustive list. There are numerous other issues with joints, nerves, disks, viscera (internal organs), moods and depression which can exacerbate or be the primary cause of pain.
If you’d like to know more on how acupuncture can help back pain give me a call on
07764 254881 to discuss.