So How Should Chronic Pain Be Treated?

Not with drugs.

The drugs don’t work – though in this case they don’t seem to make you worse. Rather, they don’t really do much at all. They do help with acute back pain, but the main ones that get used, NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs like Aspiring, paracetamol and ibuprofen, don’t do much at all for chronic pain. Sadly neither do stronger painkillers much of the time, and muscle relaxants are completely ineffective in the majority of cases of low back pain – only as good as placebos.

The pain you fell is in your brain – but there isn’t some specific spot in the brain where pain comes from, so put down that drill.

Your nerves send a signal to your brain that something has happened, and your brain factors in everything else that’s happening around you, your mood, stress levels, similar events in the past ad how hey felt, and a whole pile of other things, and the decides whether what’s happening is ‘pain’ or not.

That’s why pain gating is so effective.

Pain gating works

Pain gating consists of a number of cognitive techniques designed to reduce your experience of pain by ‘gating’ – stopping – the pain before you become consciously aware of it. In other words, it’s designed to stop pain becoming pain, rather than interfering with nervous transmission or trying to treat inflammation, tension or other mechanical causes which don’t actually exist. It’s highly effective and it’s part of the standard treatment plan for people with untreatable degenerative or chronic conditions.

Other approaches use specialised forms of cognitive behavioural therapy techniques. They aren’t pain gating as such, but they use similar methods and aims to produce a similar result: the same nerve signals reach your brain, but they don’t translate into the same amount of pain.

Two other approaches bear looking at in more detail. First, the single most effective treatment for chronic pain of all types is easily accessible, easy to implement, convenient and totally free. It is more effective than surgery or drugs. Yet it’s the most unpopular treatment there is. What is?

Do nothing

Yes. Doing absolutely nothing about your pain – no drugs, special exercises, and especially no surgeries – tends to result in an improvement over three to six months.To be clear, doing nothing outperforms or matches all other treatment choices for most chronic low back pain. It's way, way better than surgery.

Or maybe we do understand it.

Because there is a medical condition that has a very strong correlation with chronic back pain and pain of all kinds. That medical condition isn’t any kind of biomechanical dysfunction, though.

It’s depression

Here’s what Harvard Medical School has to say about this:

Three times.

If you have chronic pain, the most effective tools at your disposal are probably to treat yourself as if you have minor depression – focus on your mood first and foremost, and learn to take care of yourself and avoid negative self-talk. Reward yourself for reaching small goals and learn to forgive yourself. Hopefully working on that will help you not to develop the pain to go with depression – or the depression that goes with pain.

Chronic back pain doesn't have anything to do with structures in the back, statistically speaking. Its strongest link is with anxiety and depression. Meanwhile people suffering from chronic pain get told 'it's all in your mind' or 'there's nothing wrong with you' by doctors who can't find anything on scans. But it's not in your mind: it’s in your brain.

See Also: Can Massage Really Help Relieve Back Pain?

Credit for many of the ideas in this article is due to Armi Legge, writing for Jonathan Goodman's ThePTDC blog. Benjamin Ross, of RossViolins, taught me about pain gating.

Important note: If you have pain your pain is real and something is wrong. This article might challenge your beliefs and assumptions about what that is, but it isn’t in any way intended to belittle your struggles or pretend your pain somehow doesn’t hurt or isn’t real.