Chronic Back Pain and Neuropathic Pain

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Back pain is a very common problem in our society. Most of them are self-limited. Some become chronic back pain which is disturbing and difficult to treat. I am going to explain how neuropathy contributes to the development of chronic back pain.

Neuropathic pain is distinct from other types of pain. If a person breaks a bone or got a cut, pain signals are carried via nerves from the site of the trauma to the brain. That is how we can feel pain when we have an injury. With neuropathic pain, however, pain signals originate in the nerves themselves.

How Neuropathic Pain Develops

In many cases, the nerves become damaged or dysfunctional after responding to an injury or trauma, causing hypersensitivity to pain. The nerves then send faulty signals of pain even when the injury has healed. Neuropathic pain or neuropathy, is a chronic condition, meaning it does not go away. Instead, the pain becomes the disease process. An estimated 7 to 10% of people have neuropathic pain. Chronic back pain is a common example of neuropathic pain.

When Back Pain Causes Neuropathy

Neuropathy can result from any type of pain that compresses or impinges on a nerve. A slipped disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:

• Chronic pain radiating down the leg (sciatica) or the arm (cervical radiculoapthy)
• Chronic back pain

Why Early Treatment is Crucial

Early treatment is important, since more aggressive treatment may be needed if symptoms are not addressed soon. Over time, exposure to significant pain can cause changes to the central nervous system that make the body become more sensitive to even a slight touch. This phenomenon is known as central sensitization.

As with other types of chronic pain, delays in treatment may also make other health problems more likely. Depression, anxiety, difficulty sleeping, and an inability to work and take part in other activities are some health issues associated with untreated neuropathy.

Managing Chronic Pain

Chronic back pain does not go away completely even with the right treatment. The treatment aims to manage the pain so that the person can be functional. The first step is to get a thorough medical evaluation to determine the cause of the pain. It can be muscle strain, arthritis, slipped disc, or other things.

The medical treatment depends on the cause of the pain. Whatever the problem is, there are a number of effective strategies for coping with chronic back pain.

1. Reduce the stresses in your life. It may be your job or problems in the family. You have to try your best to sort out this problem
2. Have enough sleep. Our body carries out repair work when we are asleep.
3. Avoid activities that worsen your pain. E.g. bending down, prolonged sitting, and carrying heavy things.

I hope this information is useful to all of you.

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.