Tue Feb 20

How long does back pain last? And how can learning about pain increase the chance of recovery?

Written by Sarah Wallwork, Post-doctoral Researcher, University of South Australia

Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year ^[1].

Chronic pain, of which back pain is the most common, is the world’s most disabling ^[2] health problem. Its economic impact dwarfs other health conditions ^[3].

If you get back pain, how long will it take to go away? We scoured the scientific literature to find out ^[4]. We found data on almost 20,000 people, from 95 different studies and split them into three groups:

acute – those with back pain that started less than six weeks ago
subacute – where it started between six and 12 weeks ago
chronic – where it started between three months and one year ago.

We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.

Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.

More pain doesn’t mean a more serious injury

Most acute back pain episodes are not caused ^[6] by serious injury or disease.

There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.

Factory worker deep-breathes with a sore back

Your doctor or physio can rule out serious damage. DG fotostock/Shutterstock ^[7]

Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.

The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.

The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.

Reduce your chance of lasting pain

Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:

understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.

How to reduce your pain sensitivity and learn about pain

Learning about “how pain works” provides the most sustainable improvements in chronic back pain ^[9]. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.

Physio helps patient use an exercise strap

Some programs combine education with gradual increases in movement. Halfpoint/Shutterstock ^[10]

These programs have been in development for years, but high-quality clinical trials are now emerging ^[11] and it’s good news: they show most people with chronic back pain improve and many completely recover.

But most clinicians aren’t equipped to deliver these effective programs – good pain education ^[12] is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.

When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head ^[13].

Community-driven not-for-profit organisations such as Pain Revolution ^[15] are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators ^[16] and supported them to bring greater understanding and improved care to their colleagues and community.

But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.