I recently received an email from someone who came across my blog and was completely overwhelmed by problems with low back pain. Just like many of my patients, this problem started when they were young after a motor vehicle accident. As is often the case, every diagnostic study appears relatively normal, and one has ongoing pain in the low back region. First conservative care was performed, then injections. Most of these things had a minimal effect. Then surgery was done, nerve damage occurred and then later more surgery and a fusion. Unfortunately, pain continues despite all the efforts to take care of possible changes in the spine.

This is unfortunately a typical story I have heard from countless patients in my practice. The one thing no one can do is go back in time and change history. Once surgery is has been done, it cannot be reversed and permanent changes usually result.

The Brain and Pain

Pain is the brain’s interpretation of sensory signals it is receiving. Furthermore, it perceives both sensory signals and emotional aspects of pain. The signals are also coming from multiple structures in the low back region including multiple joints, nerves, discs, bones, tendons, ligaments, and muscles at the very minimum. We have no way to test most of these structures to see if they are sending sensory signals. The brain is usually left guessing where the signals are coming from and if multiple structures are sending sensory outputs, the brain can only manage one or two of them and then ignores the others. Eliminate one source and another signal that once was being ignored now becomes perceived. Thus pain is a complex symptom of system overwhelmed with noxious sensory signals.

Naturally the body is meant to adapt to a certain amount of change that is constantly occurring within it. Once an injury happens, hopefully mechanisms within the body will allow it to heal. Sometimes just a slight mechanical difference in the body is the source of ongoing sensory signals. These signals can be perceived as pain. Unfortunately, pain also is an emotional experience, and therefore it can become very distressing.

Realizing that pain has both sensory and emotional qualities is very important. If the perceived sensations are indicating a physical problem in the body that needs to be corrected to prevent loss of body function, then an intervention, like surgery that is not reversible, may need to be performed. If there is no permanent damage being done to the body but pain is occurring, the most important intervention is make sure you are not changing mechanically or physically any structure that absolutely does not need to be altered. Once surgery is done, there are often permanent consequences and the cure may be worse than the original problem. Before considering any surgery, ask yourself if the pain gets worse and my functional abilities are less, can I live with that, or can I adapt to what I have and find a way to move forward?

Pain Care Isn’t Simple

Whenever someone does have pain, there often is not a simple answer why and not a simple solution to cure the symptoms. Once you change the body with surgery, the change is permanent and there may be constant sensory signals being produced and perceived as pain. The goal in treatment of any patient with pain is to manage all the possible sources sending abnormal sensory signals and to normalize the brain’s perception and management of the signals. Ideally one can make the situation where the signals do not interfere in life. For those who have ongoing pain, the goal is changed to manage the perception of pain. There is not yet a way to regenerate nerves, muscles and disc reliably with new technology. Stem cells in the body can only do limited things currently as well as other regenerative technologies. The research is showing some limited results in only certain situations. Medicine may improve the results of treating certain conditions, but once we have changed the body permanently by surgery or significant degeneration, we are not miraculously going to change it back to a youthful status.

Good pain management and physical medicine focuses on improving function, ability, strength, endurance, flexibility and perception of pain. It is often more important to deal with emotional aspect of pain and its perception than to try to eliminate some sort of physical change seen in the body. Retraining the body to maximize its ability despite having abnormal sensations is often the solution versus doing excessive medications, interventions and chasing elusive cures. The brain and its perception of the body as well as its emotional wellbeing may be the most important aspect of treating the pain. Chronic pain may not have a medical solution, but maximizing functional and emotional abilities goes a long way towards a more normal life.