Chronic pain after spinal injury:
Hi everyone this is Nicolas from King Chiropractic. I am writing to tell my story of spinal injury and my experiences recovering from a serious spinal accident.
If any of you have checked out our website at www.kingchiropractic.com.au you would have seen a photo of a beautiful beach on the south coast of Western Australia. It was at this beach approximately two years ago that I broke my back whilst surfing. I badly wiped out on a big, powerful wave and was slammed into the hard concrete like sand of the sea floor. I instantly felt and heard a horrible snapping and crunching sound underwater. I managed to swim into shore, being washed and battered by the relentless waves and struggling to keep my head above water. Once on the beach I composed myself and then started the walk up the steep track to the car.
A week later I had x-rays of my spine as the pain was getting worse and worse. It was found I had a compression fracture of one of my vertebrae that was at risk of being unstable.
This injury completely stopped me from doing any of the yoga and fitness training I loved to do and put me out of the water for almost a year. Understandably for the next 12 weeks after the injury I was very careful with any exercise that I did, being fearful of re-injuring or further damaging my spine. However, I noticed that after about 12-14 weeks I started to develop persistent low back pain, as well as pain waking me from sleep every morning and night. This pain was present even though follow up scans had revealed that my bony structures had healed. For the next 8 months this pain was present every day and night and I could get no relief. The fear of the pain increasing if I exercised prevented me from doing any training at all. What I did not realise is I had developed a chronic pain syndrome after severe spinal injury.
The change came when I decided I was fed up with not doing any exercise. For my own mental health I decided to push through the pain and start gently exercising once more. Miraculously in a few week’s I woke from a full sleep having not been woken with pain. I noticed I also had minimal discomfort or pain in my lumbar spine. How was this so? I thought that I would have been more sore from training and exercising.
What I had just experienced is what the scientific literature has been telling us in relation to Chronic Pain and its treatment.
Chronic pain is pain that lasts beyond the normal tissue healing time of 12 weeks (Geneen, 2017) and can contribute to anxiety, depression, sleep disturbances, decreased quality of life and increased health care costs. The prevalence of Chronic Pain annually is up to 30% (Anderson GBJ, 1997).The majority of persons (>90%) with acute pain will recover with full function within days to weeks with no residual pain, a small number however can develop chronic low back pain lasting between 3-6 months. A high percentage will fail to respond to treatment (JW, 1988;318).
So, if you have been suffering chronic pain how should you treat it? The prevailing philosophy of the medical profession in relation to chronic pain has been to focus on the pain and prescribe opiates to take down pain scores (Jane C Ballantyne, 2015;373). However, the evidence shows that it is more beneficial to start moving and exercising to the best of your ability and pain tolerance.
It is common for persons suffering chronic pain to not want to start physical activity due to the fear of making their condition and pain worse, or even doing further damage. A study looking at the effects of physical activity on spinal structures found that in persons who did not engage in physical activity had narrower intervertebral discs, higher fat content in lumbar stabiliser muscles and higher pain scores (Andrew T Teichtahl, 2015;17). These findings show that the lumbar discs are healthier with physical exercise, not less. High fat content in the supporting muscles is a sign of muscle atrophy and this study showed on MRI that patients who did not exercise whilst suffering pain had early stages of muscle atrophy and weakening. Most interesting was that even though the patients that were exercising had pain, their pain experience after starting exercise was less intense than those who were not exercising.
Another systematic review in 2017 showed that pain levels in those suffering chronic pain decreased with physical activity and that improvements in physical function and some improvement in psychological function were noted (Louise J Geneen, 2017;).
It is very important for those of you suffering chronic pain after an injury to get moving and do some physical activity. Mild discomfort is normal and healthy. It has been shown your pain may in fact decrease, your spinal structures will become healthier and you will start to improve your physical function. Often the hardest thing is starting. Do not fear! You will get better and it is unlikely you will be making yourself worse.
What are some of your experiences with chronic pain and how have you dealt/dealing with it? We would love to hear from you. At King Chiropractic we can help you regain control and power over your pain with expert advice and Chiropractic care to improve your function. We are not only skilled in providing expert care, we have firsthand experience as to what it is like to suffer severe injury and pain.
Anderson GBJ, F. J. (1997). The Adult Spine : principles and practice. In Vol 2 (pp. 93-141). Philadelphia: Lippincott-Raven.
Andrew T Teichtahl, D. M. (2015;17). Physical inactivity is associated with narrower lumbar intervertebral discs, high fat content of paraspinal muscles and low back pain and disability. Arthritis Research and Therapy, 114.
Geneen, L. J. (2017). Physical Activity and Exercise for Chronic Pain in Adults: an overview of Cochran Reviews. Cochrane.
Jane C Ballantyne, M. D. (2015;373). Intensity of Chronic Pain – The Wrong Metric? New England Journal of Medicine, 2098-2099.
JW, F. (1988;318). Back Pain and Sciatica. New England Journal of Medicine, 291-300.
Louise J Geneen, R. A. (2017;). Physical activity and exercise for chronic pain in adults : an overview of Cochrane Reviews. Cochrane, 1002.