The idea that long standing low back pain means there must be something severely wrong with your back that requires more invasive treatment like nerve ablation, injections, or surgery, is flawed. If this was true, there would be strong evidence suggesting good outcomes from these interventions - however, no such evidence exists.

Pain is complex, particularly when it has become chronic, and can rarely be attributed to a single structure as it’s cause.

Pain is not always indicative of damage; sometimes it is your body sending a warning signal to protect against anticipated danger. This system can become hyper vigilant for many reasons (fear around pain and future prognosis; having long standing pain; etc).

Often, rehab programs are underloaded and too heavily focused around immediate pain relief and addressing a single structure, rather than addressing a whole person.

Bottom line: pain does not correlate well to “damage”. Long term pain is complex. Surgery is not necessarily (very unlikely to be) the magic fix. A lot of what is traditionally advised for back pain (scans, rest, stopping activity) actually is associated with worse outcomes.


References:


1. Harris, I. A., Traeger, A., Stanford, R., Maher, C. G., & Buchbinder, R. (2018). Lumbar spine fusion: what is the evidence? Internal Medicine Journal, 48(12), 1430-1434. doi:10.1111/imj.14120

2. Maas, E. T., Ostelo, R. W., Niemisto, L., Jousimaa, J., Hurri, H., Malmivaara, A., & van Tulder, M. W. (2015). Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev(10), Cd008572. doi:10.1002/14651858.CD008572.pub2

3. Webster, B. S., Bauer, A. Z., Choi, Y., Cifuentes, M., & Pransky, G. S. (2013). Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine, 38(22), 1939-1946. doi:10.1097/BRS.0b013e3182a42eb6