Summary: A new study shows who responds poorly to low back pain treatment: people living with several painful conditions. When doctors treat them only for back pain, they do not get better. These people also have more fatigue, mood problems and sleep issues. Low back pain is the most common cause of disability in adults. As many as one-fifth of adults live with low back pain. Sadly, most people do not respond well to standard drug therapy for it. So researchers tried to find out why. They also found that the pain scale did not predict who would respond. So they propose that doctors check for pain in other body parts in people with low back pain, and plan treatment around it.
People and even clinicians view chronic low back pain as a homogenous disorder. However, that is far from true. Back pain, quite like many other chronic conditions, is also associated with many other painful conditions. Furthermore, researchers think that if chronic low back pain is associated with other painful conditions, it appears to respond poorly to drug therapy.
Chronic low back pain is often linked with other painful conditions. Knowing this matters, because many people do not respond to treatment. The only way to treat them is to find these overlapping conditions and manage them too. Chronic pain specialists play a key role in this whole-person approach.
Chronic low back pain is a widespread problem. Even worse, the issue of back pain and other chronic pains is increasing even in young adults. It is estimated that about one-fifth of adults aged 20 to 59 are living with chronic low back pain1.
Often the cause of back pain is never found. The cause of chronic low back pain is also often mixed. It could come from injury, inflammation, nerve damage, and more. And it affects the lower spine and the soft tissue around it2.
Since so many things cause low back pain, finding the cause is often hard. Even imaging does not help much in many cases. So it is no surprise that doctors struggle to treat it.
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Researchers at Stanford University think cases with several linked painful conditions are harder to manage. Sadly, these patients do not respond well to standard therapy.
Very little is known about the other conditions that make low back pain worse. So, in one of the first studies of its kind, researchers set out to find them.
Researchers presented their findings at a yearly meeting of the American Academy of Pain Medicine3.
The study looked at data from 8,783 patients. To the researchers’ surprise, a full 94.5% had other painful conditions. These overlapping conditions were more likely in women. And in many people, the other pain started long before the chronic low back pain.
They split these patients into two groups. The first group had pain in one or two other areas (intermediate widespread). The second group had pain all over.
Pain all over did not mean higher pain scores. But the other painful conditions significantly hurt quality of life. So these patients had the worst results.
Common complaints along with pain were fatigue, sleep problems, less physical function, pain getting in the way of life, and anxiety. These symptoms got worse as the pain spread.
This research taught us something about chronic low back pain. A pain score alone is not the best way to track how these patients are doing. Doctors need to look at the other problems in their lives.
It also shows that the treatment plan must change. For example, depression, anxiety and sleep problems need to be treated along with low back pain.
Researchers say that identifying patients with widespread pain is essential for providing personalized care. This study can also help provide a more holistic or comprehensive treatment plan. These findings do not contradict early findings that advocate a multidisciplinary and more comprehensive approach to painful conditions.
Frequently asked questions
Why won’t my lower back pain go away?
Often because the back is not the only thing that hurts. A study of 8,783 patients found that 94.5% of people with chronic low back pain had other painful conditions too. People with several painful conditions do poorly when doctors treat only the back. The cause of the back pain itself is often mixed and hard to pin down, even with imaging.
What conditions are linked to chronic low back pain?
Most people with chronic low back pain also have pain in one or two other areas, or pain all over. In many, that other pain came first. Overlapping pain is more common in women. It comes with fatigue, sleep problems, less physical function, anxiety and mood problems. Those symptoms get worse as the pain spreads.
Does a higher pain score mean worse back pain?
No. In the study, pain all over did not mean higher pain scores. And the pain scale did not predict who would respond to treatment. What set patients apart was quality of life. People with pain in more places had the worst results. That is why a pain score alone is a poor way to track progress.
How common is chronic low back pain?
Low back pain is the most common cause of disability in adults. About one-fifth of adults aged 20 to 59 live with chronic low back pain. The problem is growing, even among young adults. And most people do not respond well to standard drug therapy alone.
How should chronic low back pain be treated when other pain is present?
By treating the whole picture, not just the spine. The other painful conditions have to be found and managed along with the back. So do depression, anxiety and sleep problems. Spotting pain all over early allows care tailored to the person and a fuller plan from a team of providers.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
