Changing Pain: Making Sense of Rehabilitation in Persistent Spine Pain

Abstract

When acute pain persists beyond the expected healing time following an injury, important neurological changes occur that allow pain to transition from adaptive to maladaptive. Spine pain has become an important global problem, with significant increases in prevalence, disability, and subsequent healthcare costs over the past several decades. Low back pain is now the number one cause of disability in the world. Because of the magnitude of the effect of low back pain, and especially chronic low back pain, it has become imperative that we embrace the best available evidence and clinical sensibilities as we work with patients to find appropriate solutions. Intrinsic to the successful care of persons with spine pain is the acknowledgment that the experience of pain is a biopsychosocial one. There is no universal experience of pain and thus our solutions must accommodate variation in the meanings of pain. Experiential (qualitative, subjective) knowledge of spinal pain can be integrated with our understanding of spinal pain neurobiology (quantitative, objective) in rehabilitation contexts to improve health outcomes. Ultimately, the rehabilitation of persons with spine pain exists at the intersection of the objective and subjective goals of care. Clinical Implications: Understanding the full biopsychosocial scope of spinal pain allows clinicians to strengthen their therapeutic alliance with patients, reinforce self-efficacy, identify patients at risk for poor outcomes and intervene early, stratify care appropriate to the individual’s needs, reduce or prevent pain chronification, reduce direct and indirect costs to patients and society, and improve overall quality of life.