Previous: Pain Intensity, Location and Type
Pain Patterns
The "when" of back pain -- if it comes on suddenly or gradually, if it is present constantly or just sometimes, or if there is a particular time of day when it always shows up -- is very important information to your doctor as she or he goes through the process of determining a diagnosis. Doctors evaluate changes in pain patterns to monitor your progress and to be on the lookout for new problems. Patterns of pain also help doctors determine the best time for you to take medication.Chronic pain has a constant presence, but varies in intensity at different times and in response to different stimuli. Sometimes there are layers of pain that combine together, resulting in more than one type of pain to be felt.
The "when" of back pain may also be a subtle influence on your decision whether to seek treatment at all. Many people go for help with their back pain only after an initiating event, but in reality even if your pain has crept up on you over time, it is best to get it checked by your physician.
Interruption of Function
Pain is more than a set of unpleasant sensations. It has the power to disrupt daily activities and lifelong dreams. Back pain can impair your ability to perform work and play activities, and to do very basic things such as coughing and sneezing.Your expectations and attitudes play a determining role as to how much disability you experience when you have back pain. The ICSI, a group that provides guidance to doctors treating back pain, asserts that a patient’s lack of involvement in their self-management activities can perpetuate their chronic pain. They also indicate that social support and spirituality are factors affecting lifestyle adjustment to pain. Your own perception or appraisal of yourself as able to perform actions and tasks has a great deal to do with your ability to function. This is called self-efficacy. A 2007 study published in the European Journal of Pain found that higher levels of self-efficacy in patients with low back pain were associated with less disability.
During your exam, the doctor should ask questions about your functioning and how it has changed since you have been in pain. She or he should also try to determine the level of pain you experience while at rest and during activities.
Psychological Issues
Many times depression accompanies back pain, especially chronic back pain. Your doctor should ask you if you have depression, anxiety, substance abuse or other types of problems currently or in your past.Cognitive behavioral therapy is a short-term therapy focusing on identifying and changing the thinking patterns that bring unwanted results into our lives. It has a good reputation for helping people with chronic back pain to avoid disability. A study done in 2001 at the Orebro Medical Center in Sweden showed that cognitive-behavior group therapy can lower the risk of developing long-term disability in patients with chronic back pain.
Related:
- How does Distorted Thinking Affect Your Chronic Back Pain?
- Acceptance and Committment Therapy
- History of Cognitive Behavior Therapy
Sources:
Linton, S.J., & Andersson, T. (2000). Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain. Spine, 25(21).
Woby, S.R., Roach, N.K., Urmston, M., & Watson, P.J. (2007). The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. European Journal of Pain.
Gould, H.J. III, M.D., Ph.D. (2007). Understanding Pain. Saint Paul, MN: Demos.
Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring method. Pain, 1(3).
Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain. August 30(2).
Registered Nurses Association of Ontario (RNAO). Assessment and management of pain. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2002 Nov.
Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2005 Nov.
Menefee, L. Katz, N. 2003 The PainEDU.org Manual: A Clinical Companion. Newton, MA.
