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How is chronic low back pain treated?

Living with chronic back pain can feel like a struggle between putting on a brave face and feeling vulnerable as you work to manage it. Your best efforts to find relief have left you feeling disappointed and frustrated. You don’t want to feel like you failed yet another treatment.

Here’s the thing….

You have never failed a treatment. Treatments have failed YOU.

The wrong treatment targets

Many people believe that treatment for chronic back pain should only focus on the back. Sounds reasonable, right?

Not necessarily.

Let’s take a step back and look at what we know about chronic pain. In the medical setting, it is arbitrarily defined as pain that lasts for more than 3-6 months. This arbitrary definition of chronic pain is not used in much of the research on the topic. So how do researchers define it? “Chronic” is used to describe pain that remains after an injury has more than enough time to heal.  In other words, chronic pain, by definition, has long outlasted normal pain.

The last 40 years of research on chronic pain show that it is the result of adaptive changes in the body and brain that have lost their original adaptive value. The signs of “pathology” that preoccupy many health care professionals are not the original causes of pain. They are the effect. This is why treatments targeting the factors that first initiated low back pain will often not resolve it once it becomes chronic.

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Aivo’s HEAL framework

Here at Aivo we’ve created the HEAL mnemonic device to help you remember the steps of how pain becomes chronic.

Health.  An important part of staying healthy is the ability to detect threats and injury as early as possible.

Efficient. Sensory signals related to threat are important for survival. Therefore our nervous systems naturally become more efficient at relaying them to the brain.

Amplify. The brain associates sensory signals with strong emotion and cognitive attention. That amplifies the importance of these signals. The final result is pain perception, which happens only in the brain.

Learn. The brain builds a strong emotional memory when any sensation, thought, movement, or situation is linked with strong emotions. This helps us learn how to adapt in the future. The brain builds a strong emotional memory of pain perception because your survival depends on remembering pain.

Chronic, or ongoing, pain begins during the Amplify step and is encoded into the brain through the Learn step. Scientific studies led by Aivo Co-Founder, Dr. Apkarian, first identified brain changes related to learning in people with chronic back pain in research. In other words, the symptoms that make it up include pain experienced in the back that are accompanied by long-term brain changes. This tells us that when back pain becomes ongoing, it likely reflects a combination of the Amplify and Learn steps. We must treat both to alleviate the pain.

Common treatment options for chronic low back pain

Chronic low back pain is notoriously tough to treat because we understand very little about what causes and maintains it. Scientific studies don’t favor any single medication or treatment to fully relieve chronic back pain. That means that there is no way to match your unique pain symptoms with a specific medication.

Analgesics are medications that produce immediate pain relief for acute pain. These are not effective, or provide only short-term relief for chronic pain. Common analgesics might decrease the sensation of pain for a short duration. That is, they may manage it, but have no lasting effects, and thus they do not treat chronic low back pain.

When it comes to medications for managing chronic low back pain, doctors prescribe medications out of habit and convenience. The medical profession has relied on the same analgesic medications for the last 30 years. During this time, the only “new” medications the FDA approved for chronic pain were originally developed for other health conditions and only offer partial pain relief in some people.

However, you shouldn’t lose hope, because there are scientific studies showing that the right combination of treatments can work.

A look at the science

After years of testing, there is evidence that cognitive behavioral therapy (CBT) and mindfulness provide relief for many people with chronic low back pain. Unlike analgesics that just manage symptoms, these therapies have the potential to address the learned aspect of it. This scientific evidence is consistent with Dr. Apkarian’s brain imaging studies, including his high impact work published in the Nature Neuroscience. His high profile studies first revealed the specific brain circuits that are critical for the onset and long-term maintenance of low back pain.

Yet even these studies are not optimized to address an individual’s unique pain. Learning may play a primary role in some chronic back pain and play a supporting role in other. To tell the difference, you must peer into the brain. That way you can observe how it adapts to chronic back pain and how individual factors play a role in shaping these adaptations.

Pioneering brain imaging research led by Dr. Vania Apkarian has found dramatic brain changes in people with chronic low back pain. Dr. Apkarian refers to these changes as “reorganization”. These changes in brain activity and anatomy reflect learning, not brain damage or pathology. The brain reorganizes as it adapts to the new movements, new habits, and new emotional meanings of chronic back pain. The brain can adapt back following effective treatment. Most importantly, Dr. Apkarian’s work reveals that the brain also predicts how chronic back pain can be relieved. International research groups at Harvard University, Stanford University, and UCLA have also extended Dr. Apkarian’s findings to many other chronic pain conditions.

Bridging the gap

You might be wondering why this knowledge isn’t being used to treat pain patients, right now? It takes at least 10 years for pain research to make its way to medical schools’ educational curricula and professional meetings attended by doctors and other health care professionals. After learning new material, it can take up to 5 years for new treatments to be provided to patients as a part of standard care.

At Aivo we harness the clinical potential of Dr. Apkarian’s research by bringing the forefront of pain science directly to the pain patient, now.

The Aivo approach captures three simple ideas:

1. Science can conquer chronic pain.

2. The brain shapes the pain experience.

3. Pain relief depends on the brain.

The Aivo Program provides you with the only science-based pain management program for chronic low back pain that continuously adapts to your symptoms, personality, and your pain relief goals. We’ll go much deeper into these in the following posts, so stay tuned and also visit our website to learn more!

Remember always that you are not your pain.

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