This article is part of our comprehensive guide to living with fibromyalgia.
Chronic back pain is a problem that many people diagnosed with Fibromyalgia deal with on a daily basis, with some studies showing that potentially up to 50% of those diagnosed have back pain. For more on this, see our guide to the neuroscience of chronic pain and fear.
However, it is not just those with Fibro, chronic back pain affects people all over the world and is now one of the leading causes of disability. The Global Burden of Disease studies the leading causes of years lived with disability, and low back pain has been the number 1 cause since 1990, affecting 7.5% of the world population at any time. Despite the best efforts of the healthcare community and researchers, back pain has become more prevalent over time, and despite an ever-growing body of research into back pain, we still aren’t exactly sure what the causes or the mechanisms behind it are.
In this article, I would like to take a dive into the topic of back pain and Fibromyalgia. This is an area fraught with misinformation, bad science, bias and some really conflicting evidence and guidelines.
As you will find in the paragraphs to come, the overwhelming majority of chronic back pain isn’t down to anything nefarious, however, there are some red flags that we should look out for. So, let’s take a look into the common myths about back pain, treatments, potential causes, and where the research stands.
Diagnosing Back Pain With Fibro
For many with Fibromyalgia, frustration can be caused when healthcare professionals come back with the inevitable diagnosis of “non-specific low back pain”. This essentially means that they don’t know the precise cause of the pain. However, this doesn’t mean that the care provided is inadequate or pulling a fast one: pain is just complicated, a lot like people!
Likewise, the same is true for other diagnoses such as patellofemoral pain syndrome (PFPS), which roughly translates to pain in the front of the knee. Telling the doctor your knee hurts often leads to a diagnosis of PFPS, essentially diagnosing you with the same complaint you came in with, just in a fancier way. A lot of issues seem to come with a description of our symptoms, rather than any straight-to-the-point or specific diagnosis of a cause: take Fibromyalgia for instance. This really highlights just how complex pain is and how its causes are multifactorial and almost limitless.
While it is important to try and determine a specific diagnosis, as some cases of back pain (albeit rarely) can be serious, a definitive diagnosis is not always possible. Currently and most common to us as humans, is a strong emphasis on finding a quick solution to the problem, rather than addressing the potential underlying causes of pain.
As someone with Fibromyalgia, you have more than likely found that this approach often relies heavily on diagnostic tools like MRI’s & X-Rays etc. Yet, these treatments often have limited long-term effects and often in the case of surgery, are irreversible.
Out With The Old Back Pain Treatment
If you are reading this then you have almost certainly been through the wringer when being diagnosed with Fibromyalgia. You will most likely already be aware of the standard ways most professionals approach back pain treatment. Most of these current therapies aim to alleviate pain and correct potential structural causes, bulging disks, degeneration, posture, etc.
Spinal adjustments, massage, and posture training are a few of the techniques that healthcare providers may use to help. While these therapies most often come with good intentions, research repeatedly shows that they only offer minor, short-term benefits, and are often clinically insignificant. Likewise, with most treatments, it becomes very apparent from the research that most of the mechanisms driving any relief, if any, are most likely not what is touted by the practitioner.
Many different types of exercises have been created over the years to deal with back pain, ultimately, looking to fix these so-called structural causes of back pain. Most, unsurprisingly, they come with very limited evidence that they are any more helpful than any other type of exercise, and this is something that we will look at in more depth later.
Despite the massive funding for research being thrown at back pain over the years, the current approach to managing chronic back pain just isn’t as effective as it should be. We need to focus on finding evidence-based solutions that address the root causes of the problem, rather than just managing the symptoms, and this is where the problem really lies.
There are many factors at play in the process of deciding whether or not you will produce pain. When we focus on the back, we often lose focus on the person and the myriad of potential pain-driving factors that come with: genetics, work, education, sleep, fear, coping skills, trauma, etc.
Things need to change, and to be honest, they are starting to: it’s just that science is a slow beast.
Busting Myths Around Fibromyalgia And Back Pain
When diagnosed with a chronic pain condition like Fibromyalgia, we tend to turn to the internet for help. Whilst the internet can be a great resource for information and support, it can often be plagued with misinformation. In this section, we will explore some of the most prevalent myths around lower back pain and debunk the bad info.
The same is true for most back pain: generally, there is no structural cause, and the pain is more so about the nervous system and top-down processing. Factors such as the brain, nerves, immune system and endocrine system can all contribute to our experience of pain. The brain ultimately decides how much pain we experience, and the pain response can persist long after an injury has healed.
It is estimated that 90-95% of back pain has no structural cause. However, it is advisable to look out for any potential red flags, and we will cover these in a little while.
As you can see from the chart below, degenerative changes a very common in people without pain, occurring often more as we age.
Reference:
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