Chronic back pain: causes, consequences and how to learn to cope with it

What is chronic back pain?

If you've been dealing with back pain for more than six months, we call it chronic back pain or persistent back pain. For a lot of people, back pain becomes a long-term issue that really affects their lives. Perhaps you recognise this: you have tried various treatments, but the back pain persists or keeps coming back. In this article, you can read about what chronic back pain is, how it develops and how you can learn to cope with it.

Back pain usually goes through several phases. The first six weeks after the onset of back pain are referred to as the acute phase. During this period, the back pain subsides on its own in many people. If the symptoms persist between 6 and 12 weeks, we refer to it as subacute back pain.

Chronic back pain occurs when the symptoms persist for more than 12 weeks. The word “chronic” often conjures up the image of something permanent, something that cannot be remedied. Fortunately, this is not true. “Chronic” only refers to the duration of the symptoms, not to whether they can be treated.

Persistent back pain can occur in different parts of the back: in the lower back (lumbar region) – also known as lower back pain – between the shoulder blades (thoracic region) or in the transition between the back and neck.

The difference with acute back pain

Acute back pain usually has a clear cause: an unusual movement, lifting something heavy, or a fall. The body responds with pain as a signal that tissue damage has occurred. In most people, this pain subsides within a few weeks as the tissue heals.

Chronic back pain is different. The pain persists, even when the original tissue damage has long since healed. The pain system has become hypersensitive, as it were. Your nervous system continues to send out alarm signals, even when it is no longer necessary.

Do you recognise these signs? Symptoms of persistent back pain

Chronic back pain is more than just pain in your back. The symptoms can affect your entire life:

Physical symptoms:

Persistent or recurring back pain, sometimes radiating to the legs or buttocks

Stiffness, especially in the morning or after sitting for long periods

Difficulty bending over, lifting or performing certain movements

Reduced muscle strength and fitness

Sleep problems due to pain

Impact on your daily life:

Difficulty at work: concentration problems, inability to work or adjustments to work tasks

Limitations in social activities: cancelling outings, seeing friends and family less frequently

Household chores take more effort or are avoided

Sports and hobbies are limited or temporarily stopped

Dependence on others for daily activities

Emotional consequences:

Frustration and anger about persistent symptoms

Gloominess or feelings of depression

Fear of making certain movements (fear of movement)

Uncertainty about the future

Feeling that one is not being taken seriously

Why does back pain become chronic?

In many people with chronic back pain, the original tissue damage – such as a herniated disc or muscle injury – has healed. Yet the pain persists. How is this possible?

The answer lies in the way our nervous system works. Prolonged pain can cause changes in the pain system. The nerve pathways can become more sensitive and transmit pain signals to the brain more quickly. The brain interprets these signals, with factors such as stress, fatigue or anxiety about the pain influencing the pain experience.

This does not mean that the pain is “all in your head”. The pain is real. But it does mean that there is more going on than just a problem with your back. Your pain system has changed.

Factors that can perpetuate chronic back pain:

• Stress and prolonged tension

• Disturbed sleep

• Fear of movement and avoidance behaviour

• Worrying or catastrophising about the pain

• Stressful work or home situation

• Previous traumatic experiences

• Limited understanding or support from those around you

The good news is that many of these factors can be influenced. By dealing with back pain differently and learning new strategies, you can reduce the impact of the symptoms and be able to do more again.

Treatment of chronic back pain

The treatment of chronic back pain differs from the treatment of acute back pain. Because chronic back pain is influenced by various biological, psychological and social factors, a different approach is needed.

The power of a multidisciplinary approach

In cases of persistent back pain, multidisciplinary treatment is often the most effective. This means that various specialists work together: physiotherapists, psychologists, psychomotor therapists and doctors. Together, they look at all the factors that contribute to your back pain - physical, psychological and social.

RealHealth pain rehabilitation for chronic back and neck pain

The RealHealth treatment is an intensive group programme that combines physical and mental aspects:

• Physical components: releasing tension, moving more smoothly, building up your strength

• Psychological components: learning to accept that the pain is there, discovering how you can deal with your symptoms differently, so that you have more space again to do what is important to you

This approach is called “biopsychosocial” – it looks not only at your physical symptoms, but also at how you deal with them and how they affect your daily life.

The goal is not to take away your pain, but to help you function better again, even if the pain is still there.

Staying active and exercising

Prolonged rest is often ineffective for chronic back pain. Scientific research shows that staying active and gradually increasing your level of exercise actually helps. This strengthens your muscles, improves your fitness and helps you regain confidence in your body. Exercise also stimulates the production of substances in the body that can relieve pain.

Physiotherapy and exercise therapy

A physiotherapist can help you to start exercising again in a responsible manner.

They can teach you exercises that strengthen your back muscles and show you that exercise can be safe, even if you experience some pain during the exercise.

Pain management and psychological counselling

• Learning to cope with chronic pain requires more than just physical exercises. Psychological counselling can help with:

• Overcoming fear of movement

• Coping with stress and tension

• Recognising and adjusting thoughts that intensify the pain experience

• Better understanding how pain works

• Finding a balance between activity and rest

Learning to live with persistent back pain

For many people with chronic back pain, the most important shift in thinking is from “the pain must go away” to “I can learn to live with this pain and still do what is important to me”.

This does not mean giving up hope of recovery, but it does mean being realistic about what is possible and focusing on what you can influence.

Staying active despite pain

One of the most important lessons is that pain does not always mean you are causing damage. With chronic back pain, your pain system has become hypersensitive. Pain is then an unreliable alarm signal. You can learn to do more again, within limits, even if it feels uncomfortable.

This does require guidance and must be built up gradually. It is about finding the right balance: not too much at once (which leads to relapse), but also not too cautious (which prevents you from making progress).

The importance of understanding

Understanding chronic back pain – understanding how pain works, why it persists, what makes it worse and what helps – is an important part of recovery. When you understand what is happening in your body, pain often becomes less frightening.

Understanding your environment is also valuable. Chronic pain is not visible. People around you often cannot properly assess its impact. Explaining what you are going through and what you need can help.

Is RealHealth right for you?

RealHealth is for people with long-term back or neck pain who, despite various treatments, remain limited in their daily lives. In the programme, you will learn:

• To understand how chronic pain works

• To regain confidence in your body

• To gradually build up activities

• To deal with setbacks and adversity

• Finding a balance between stress and resilience

The goal is not to become pain-free, but to be able to do more of what is important to you. Scientific research shows that participants continue to benefit from what they have learned even years after the programme.

Read more about the results of scientific research into the RealHealth programme here.

What have other people tried before coming to RealHealth?

The pain rehabilitation programme for chronic back pain at RealHealth has been specially developed for people who have already tried many treatments and are still experiencing pain. Most participants have therefore already been through a long process before coming to RealHealth.

You may recognise some of these treatments:

• Medication such as painkillers or anti-inflammatories

• Physiotherapy aimed at “repairing” the back

• Manual therapy or osteopathy

• Acupuncture

• TENS (transcutaneous electrical nerve stimulation)

• Injections or surgery

These treatments can provide temporary relief, but in cases of chronic back pain, the symptoms often return or do not improve sufficiently. This is because these treatments usually focus on a single aspect – for example, eliminating pain or “repairing” structures in the back – whereas multiple factors play a role in chronic back pain.

The RealHealth approach is therefore different: instead of focusing on eliminating pain, the programme focuses on functioning better with back pain. By working on all the factors that perpetuate chronic back pain – exercise, understanding pain, thoughts and behaviour – you can learn to get your life back on track, even if the pain does not completely disappear.