Low Back Pain

Back pain can be felt anywhere along the spine, from the neck down to the tailbone.  The most common area of pain is in the lower back. The pain might also travel to other areas such as the buttocks, the back of the thigh, and down to the lower leg and/or foot.  This type of pain is often called “radicular pain”.  Senses may include tightness, aching, sharp pain, or other feelings such as tingling, numbness, or electric shock-like pain in the back or down the legs. 

Risk Factors

Low back pain affects people of all ages.  It is more common in women than in men, and occurs more often in people aged 40-69 years of age. 

People who have low back pain in childhood are more likely to have it again as adults. Risk factors for developing low back pain are:

  • Smoking
  • Being overweight or obese
  • Depression
  • Frequent heavy lifting at work

Fact or Fiction?

There are a lot of misconceptions out there about chronic pain.
Try this Fact or Fiction quiz to test your knowledge about the facts.

Diagnosis of Low Back Pain

Chronic low back pain is diagnosed by a primary care provider.  To assess your low back pain, your clinician will 

  1. Get your history of back pain to rule out other causes.
  2. Perform a physical exam to determining whether your pain is related to muscle, joint, or ligament structures and to determine treatment options

Your primary care provider won’t need to order diagnostic testing unless they need to rule out certain medical conditions (such as an infection, fracture, or tumour).

Treatments & Self-Management

For new or acute episodes of pain (pain less than three months) the majority of people recover without specific medical or physical therapy.  There is strong research recommending that a person should remain as active as possible while gradually resuming usual activity levels, bedrest is not helpful. Evidence does not support the use of strong pain relievers such as opioid medications.

No treatment has been scientifically proven to cure chronic low back pain. Even common treatments such as injections, acupuncture, medications, and surgery all have conflicting evidence around their effect on pain and function. When people actively manage their pain on a daily basis, through self-management and exercise they get the best results.  Don’t feel pressured to pay for treatments that you can’t afford as there is no evidence that they will have any lasting improvements on your pain.

For patients with chronic or persistent low back pain (pain longer than three months) research recommends these effective treatments

  • Self-management programs
  • Psychological therapies such as cognitive behavioural therapy and mindfulness based stress reduction
  • Physiotherapy
  • Yoga
  • Interventions

    Include various techniques performed by a specially trained physician or nurse practitioner to either inject a pain relieving medication into the affected joints or nerves, or to burn the nerves to relieve the pain temporarily (12-18 months).

  • Medications

    May include various types of medicines including medications aimed at relieving pain and at targeting certain processes in the brain that reduce the excitation of nerves, relax muscles, or improve mood.

  • Surgery

    Can be considered an option when there is pain and weakness. Non-surgical options such as self-management, physiotherapy and psychological treatment may have better outcomes.

Self-Management

Low Back Pain can be managed. Self-management is one of the most important treatments in your chronic pain journey. Studies have shown that when people actively manage their pain on a daily basis, they get the best results.

There are many self-management strategies that can help reduce pain.

  • Becoming knowledgeable about chronic pain and what is happening in your body.
  • Staying active every day by stretching and walking to improve your pain levels.
  • Pacing your activities throughout the day to reduce your risk of flare up.
  • Practicing daily relaxation techniques.
  • Learning how to communicate with family, friends, and care providers.
  • Learning how to cope with the emotions of having chronic pain including depression and anxiety.
  • Improving your sleep so you can get more rest and cope better with your pain.
  • Listening to your body to learn which treatments work best for you and to better manage flare ups.

Physiotherapy and Exercise

Physiotherapy will help you improve your posture, physical function and quality of life as you become more active.  A physiotherapist can advise you about different relaxation techniques as wells as exercises to improve muscle strength and endurance.

Active physiotherapy involves using movement-based treatments requiring the active participation of the patient such as flexibility, strengthening, and breath work. 

Passive physiotherapy involves treatments that do not require the patient to use energy. These include massage, therapeutic ultrasound, traction, and the TENS machine. 

For chronic pain patients, active physiotherapy is preferred as it will lead to long-term improvements in function.

  1. Complete a self-assessment to see if you are eligible for a TAPMI referral.
  2. Connect yourself to physiotherapy and exercise groups in your community:
    Internet key word search:
    • Low Back group physiotherapy in [Community]
    • Low Back exercise groups in [Community]
    • Exercise groups in [Community]
    • Chronic pain self management programs with physiotherapy in [Community]
    When calling clinics or programs ask about
    • Exercise based physiotherapy
    • Self management programs with physiotherapy
    • Graded exposure physiotherapy

Counselling

Psychological approaches to pain management address the emotional aspects of pain and fibromyalgia.  Therapies such as Cognitive Behavioural Therapy, Mindfulness Based Stress Reduction, Acceptance and Commitment Therapy (ACT) can help you focus on how to deal with your pain and the emotions that come with it.

 

  1. Complete a self-assessment to see if you are eligible for a TAPMI referral.
  2. For free information regarding Mental Health Services in Ontario visit http://www.mentalhealthhelpline.ca/ A referral specialist will answer
  3. Crisis Lines/Mobile Crisis Units (If you are very distressed and need immediate assistance):
    Gerstein Crisis Centre: 416-929-5200 (downtown Toronto, York). Telephone crisis intervention and mobile crisis team.

Resources

Back Care Canada:

An online resource created by low back pain experts from the Canadian Spine Society. Includes key facts, patient stories, and resources about assessment and treatment of back pain

http://backcarecanada.ca/

Exercises for low back pain

A set of videos demonstrating exercises that may be helpful for certain patterns of back pain, including stretches, mobility exercises and core strengthening.

http://www.isaec.org/isaec-exercise-videos.html

76 Grenville St. Toronto, ON M5S 1B2 Canada

TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday

Administration

Dr. Tania Di Renna, Medical Director Laura Pus, Administrative Director