Chronic low back pain (CLBP) is the most common chronic pain condition seen by medical and rehabilitation providers. Unfortunately, most medical, rehabilitation and fitness practitioners do not understand the multi-dimensional, biopsychosocial nature of the pain experience and approach all pain conditions with a similar tissue-based approach. When it comes to CLBP, individuals will be told their back pain is due to core weakness, spinal instability or some degenerative process and be prescribed ‘core stability’ exercises.
The problem with this very biomedical approach is that research has over and over again demonstrated that symptoms associated with chronic pain are less likely to be related to bodily tissues and more associated with maladaptive changes to the nervous system. As such, other factors may be more responsible for the lingering pain response, including psychosocial variables. These variables can include anxiety, fear, depression and stress, to name a few.
Considering the multi-dimensional nature of pain outlined here, current science suggests that a multimodal care plan may be the best approach to managing chronic pain conditions. A multimodal plan would be one that addresses the complete biopsychosocial framework of health and includes a collaborative approach between mental health, rehabilitation and fitness practitioners.
Müller-Schwefe G et al. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin. 2017.
Written by Dr. Tom Walters @rehabscience, a member of team EBT.