Millions of people around the world suffer from chronic back pain everyday, often not knowing if they’ll ever recover. Pain specialist Dr. Brenda Lau offers advice on how you can manage chronic back pain, as well as some of the newer treatment options that can offer relief.
Ann Marie Gaudon was at the gym when she injured her back. After bending down to lift something off the ground, she experienced a ripping feeling rush through her body.
“The air was sucked out of my lungs,” said Gaudon, an Ontario psychotherapist and social worker. “I couldn’t breathe, I couldn’t stand up. I didn’t know what was going on, but I knew it was serious.”
Gaudon spent years speaking with chiropractors, massage therapists and pain experts, finally finding a specialist who helped her recover.
Ann Marie Gaudon is a psychotherapist who has been living with chronic back pain since 2017. (Submitted by Ann Marie Gaudon)
But she was pain-free for a only a few years before her back pain returned. Gaudon says she has less pain now than she did when she first hurt her back in 2017, but still deals with discomfort on a daily basis.
What is chronic back pain?
Gaudon is one of the nearly eight million Canadians who live with chronic pain, and one of the hundreds of millions of people around the world with chronic back pain.
According to pain specialist Dr. Brenda Lau, co-founder and medical director of the CHANGEPain clinic in Burnaby, B.C., pain can be acute — caused by injuries, stress or disease — or chronic. Pain is typically classified as chronic after three to six months.
The persistent discomfort associated with chronic back pain affects men and women relatively equally, with most people experiencing chronic back pain between the ages of 25 and 55.
Dr. Brenda Lau, right, poses with team mambers at the CHANGEPain clinic in British Columbia. Lau is a pain specialist and co-founder and medical director of the clinic. (Submitted by Brenda Lau)
“Typically, it’s someone who’s actually been doing a lot of sitting around,” Lau told The Dose host Dr. Brian Goldman.
Smoking, poor eating habits and poor sleep habits also contribute to chronic back pain, Lau added.
What causes chronic back pain?
When Gaudon first hurt herself, medical imaging revealed a herniated disc, a disc bulge and three areas with pinched nerves.
While Gaudon had physically traumatized her back, Lau says many people living with chronic back pain often have nothing physically wrong with their bodies.
“We also know the imaging, MRI, CT scans, X-rays, whatever you see there, they don’t correlate to the intensity,” Lau told The Dose host Dr. Brian Goldman.
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Instead, Lau says, medical images done on people with back pain can look a lot like images of people without.
The term non-specific low back pain can often be applied in circumstances where there is back discomfort, but the reason isn’t clear.
“It becomes very hard to say that the structural abnormalities that you see on an X-ray or an MRI, or that you find in a physical examination are, in fact, the cause of somebody’s back pain,” said Dr. Ted Findlay, a pain physician with the Calgary Chronic Pain Centre.
“That’s what we mean by non-specific low back pain. It’s getting away from saying we have to do imaging to identify a particular tissue or structural abnormality in order to develop a treatment plan.”
How can we treat chronic back pain?
Typically when a person is injured, the body’s neurochemical processes kick in to help with recovery, according to Lau.
“There’s an inflammatory soup, if you will,” Lau said. “All types of host defences call into action when injury of any tissue occurs.”
In the event of chronic pain, however, the pain persists even after the body is done healing.
Dr. Ted Findlay is a pain physician with the Calgary Chronic Pain Centre. (Submitted by Ted Findlay)
“It changes the nerve system itself so that now [the pain is] no longer the area where there’s some sort of inflammatory response,” Lau said. “It’s more like the nerve system’s been ramped up.”
Treating chronic back pain therefore requires a “biopsychosocial model,” according to Findlay, referring to a model of care that links biology, psychology and social factors.
“The more recent guidelines suggest there can be benefits from spinal manipulation,” he said.
Spinal manipulation is a process by which specialists use their hands or small instruments to apply pressure to a patient’s spine, to help relieve pain or discomfort.
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New research suggests treating acute pain with anti-inflammatory drugs, such as ibuprofen, could have an unintended effect: increasing the chances of developing chronic pain.
Lau agrees that treating chronic back pain requires a full-spectrum approach.
“What we need to do is rehabilitate, retrain, the way those muscles are working,” she said.
“Physiotherapists, chiropractors, exercise physiologists, [and] dedicated trainers can get people back on their feet.”
Tools like pain reprocessing therapy — which use common psychological techniques to encourage patients to reframe their thinking around the pain they experience — can also be “very effective” in aiding patient recovery, Lau says.
“Pain reprocessing therapy is all about utilizing a combination of active ways of thinking that is going to inspire you to move the body, to eat well, to reduce the fears around the pain itself,” Lau said.
“You’ve already received the diagnosis.… Now is the time to start reinterpreting [the] pain signals to the extent that you can alter them.”
Can medication help?
People living with chronic back pain might be tempted to rely on medication to alleviate their discomfort, but Lau and Findlay recommend being careful about overusing anti-inflammatory drugs like naproxen.
“We know that the long-term side effects of those do, in fact, cause more harm,” Lau said. “Kidney damage, gastric issues [are] two of the main things.”
That said, Findlay says you don’t need to avoid over-the-counter medications entirely.
“If you’re a weekend warrior and you’ve been playing hockey and you’ve got back pain, then why not take an anti-inflammatory or acetaminophen,” he said.
“But for the long-term, they probably have very little effect.”
Can chronic back pain ever go away?
Lau says she’s witnessed patients recover from their discomfort over time.
However, Findlay says there are numerous instances where patients continue to experience pain, even while taking steps to improve their overall health and well-being.
A recent meta-analysis published by the CMAJ showed that patients with pain that persisted between less than six weeks and 12 weeks, “had substantial improvements in levels of pain and disability within the first six weeks.”
Patients with pain that lasted between 12 and 52 weeks continued to experience “high levels of pain and disability with minimal improvements over time,” the analysis added.
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While this might not seem like great news for people living with persistent chronic back pain, the analysis suggests that diagnosing and treating back pain early could “reduce the likelihood” of it becoming persistent low back pain.
“Pain is a call to action that most people can’t ignore,” said Lau.
“We hope that at that call to action, that you will empower yourself to say, ‘Yes, there are things that I’ve got to personally change, but I also have to link to providers who can help guide my way.'”
At the same time, Lau encourages people living with chronic back pain to seek out new approaches if relief remains out of reach.
Gaudon echoes Lau’s sentiments.
“If you truly don’t know what’s going on and you go to alternative practitioners and you’re still in pain, why would you keep doing that?” Gaudon said.
But, she added, it’s important to stick with it to find a solution.
“You’re not helping yourself if you’re still in pain.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
