How bad does it hurt? Intensity is a measure of how strong the pain is that you are feeling. As a back pain sufferer, this is probably the most important part of the ordeal for you. Intensity levels fluctuate, so it is impossible to get a useful, accurate measurement of them from objective testing. Instead, doctors and other health care providers usually use visual tools to help you communicate your level of pain. This is usually in the form of a pain chart. It can be very helpful to both you and your doctor if you keep a pain chart and track your pain daily.
Type of Pain
Location of Pain
The location of your pain may or may not be related to damage or an injury in your spine. If a nerve is affected, the pain may radiate down an arm or leg, as is the case in sciatica. If you have trigger points or other myofascial pain, you might experience referred pain — pain located in an area that is seemingly unrelated to the actual site of the problem. Pain is often located in more than one area of the body.
A body diagram can be used to map and track the location of the pain as it changes (or doesn’t) over time. The body diagram is also a tool to help you communicate your symptoms of back pain clearly and accurately to your doctor.
In an effort to identify the cause of your back pain, your doctor might use the information you provide about the location of your pain to probe for more details.
The “when” of back pain — if it comes on suddenly or gradually, if it is present constantly or just sometimes, or if there is a particular time of day when it always shows up — is very important information to your doctor as she or he goes through the process of determining a diagnosis. Doctors evaluate changes in pain patterns to monitor your progress and to be on the lookout for new problems. Patterns of pain also help doctors determine the best time for you to take medication.
Chronic pain has a constant presence, but varies in intensity at different times and in response to different stimuli. Sometimes there are layers of pain that combine together, resulting in more than one type of pain to be felt.
The “when” of back pain may also be a subtle influence on your decision whether to seek treatment at all. Many people seek help with their back pain only after an initiating event, but in reality even if your pain has crept up on you over time, it is best to get it checked by your physician.
Interruption of Function
Pain is more than a set of unpleasant sensations. It has the power to disrupt daily activities and lifelong dreams. Back pain can impair your ability to perform work and play activities, and to do very basic things such as coughing and sneezing.
Your expectations and attitudes play a determining role as to how much disability you experience when you have back pain. The ICSI, a group that provides guidance to doctors treating back pain, asserts that a patient’s lack of involvement in their self-management activities can perpetuate their chronic pain. They also indicate that social support and spirituality are factors affecting lifestyle adjustment to pain. Your own perception or appraisal of yourself as able to perform actions and tasks has a great deal to do with your ability to function. This is called self-efficacy. A 2007 study published in the European Journal of Pain found that higher levels of self-efficacy in patients with low back pain were associated with less disability.
During your exam, the doctor should ask questions about your functioning and how it has changed since you have been in pain. She or he should also try to determine the level of pain you experience while at rest and during activities.
Many times depression accompanies back pain, especially chronic back pain. Your doctor should ask you if you have depression, anxiety, substance abuse or other types of problems currently or in your past. Cognitive behavioral therapy is a short-term therapy focusing on identifying and changing the thinking patterns that bring unwanted results into our lives. It has a good reputation for helping people with chronic back pain to avoid disability. A study done in 2001 at the Orebro Medical Center in Sweden showed that cognitive-behavior group therapy can lower the risk of developing long-term disability in patients with chronic back pain.