1. health and fitness
2. disease
3. chronic pain

mANAGING Chronic
Low back pain
Use This Workbook to:
• Keep a pain profile and a pain log
• Be an active member of your health care team
• Make an action plan to manage your pain
Learn to Manage Your
CHRONIC LOW BACK PAIN
Is chronic low back pain affecting your life?
Your back may hurt all the time or only once in a while. If it continues for over
3 months, it’s called chronic pain.1
It can keep you from doing the things you want to do, like working, exercising, and
playing with your children.
It can lead to depression, as well as problems with sleeping and eating.2
You may feel like your pain will never go away. And this feeling can keep you from
doing things that will help you feel better. Use this booklet to help you learn how to
cope with chronic low back pain.
Take control of your treatment
Chronic low back pain may never completely go away. But there are ways to manage
the pain. And there are many things you can do to take control of your pain.
You are the best person to manage your pain. You know more about your pain
than anyone else. Understanding pain may help you talk to your doctor about
your condition.
2
Be a part of your health care team
You are the most important person on your health care team—which includes your
doctors, therapists, pharmacists, and others. Each person’s pain is different, so your
team needs your help to understand your pain.
There are many treatments for chronic low back pain. Some treatments will work
better for your pain than others. And some will fit into your life better than others.
To choose the best treatment for you, work closely with your health care team.
Help your doctor better understand your pain
This booklet can help you make sure that your health care team really understands
your pain. You can help them help you.
This booklet will help you manage your pain by teaching
you how to:
1. Talk to your health care team.
2. Work with your health care team to determine how to use this booklet.
3. Make an action plan.
Turn the page to find your:
• Pain Profile
• Pain Log
• Questions to Ask Your Health Care Team
• Questions to Ask Your Doctor or Pharmacist About Your Medicines
• Pain Management Action Plan
3
Step 1: Pay Attention TO YOUR CHRONIC
LOW BACK Pain and Take Notes
My pain profile
Only you know exactly where your pain is and how it
affects you. However, talking to your health care team
about how you experience your chronic low back pain
can be hard. The information in your pain profile—
and in your pain log on the next page—may help you
start a conversation with your health care team.3
Questions4
1. Where is my pain?
2. When did it start?
3. What does my pain
feel like?
4. When do I feel the pain?
5. What makes the pain
feel better?
6. What makes the pain
feel worse?
7. Which over-the-counter
pain medicines help?
You will also find helpful tools to keep track of your
pain on the American Chronic Pain Association Web
site (www.theacpa.org). These tools can help you give
useful and accurate information about your condition
to your doctors and therapists.
Answers: You can circle more than one answer.
near the surface very deep at my tailbone
just below my waist
on my left side
other:______________________________________________________________________________________________
today
last week
last month
a few months ago a year ago
other:______________________________________________________________________________________________
sharp
dull
aching
crampy
burning
tingling
shooting
other:______________________________________________________________________________________________
morning
afternoon
evening
night
always
other:______________________________________________________________________________________________
heat
ice
rest
massage
stretching
Exercise:___________________________________________________________________________________________
other:______________________________________________________________________________________________
sitting
lying down
walking
driving
exercising
other:_________________________________________________
Advil®
Tylenol®
aspirin
standing
lifting
other:______________________________________________________________________________________________
Adapted from National Institute on Aging. Advil is property of Pfizer Consumer Healthcare. Tylenol is property of McNeil–PPC, Inc.
4
on my right side
My pain log3
Another useful tool is a pain log. It helps you keep track of your daily experiences with low back pain.
• Try to keep the log for at least a week.
• You can make copies of this form.
Live Better
With Pain Log
Pain Level
Stress
Exercise
Activity
Sleep
Appetite
Mood
Interaction/
Isolation
Finances
Alcohol Use
(drinks each day)
Date ________________________
Name ________________________
No pain Worst pain
1
2
3
4
5
6
7
8
9
10
No stressVery stressed
1
2
3
4
5
6
7
8
9
10
Exercise dailyNo exercise
1
2
3
4
5
6
7
8
9
10
Normally activeNo activity
1
2
3
4
5
6
7
8
Fully rested
1
9
10
Poor-quality sleep
2
3
4
5
6
7
8
9
10
Normal appetiteNo appetite
1
2
3
4
5
6
7
8
Cheerful & calm
1
2
2
10
Depressed, anxious
3
4
5
6
7
8
A lot of interaction with family & friends
1
9
3
4
9
10
Always alone
5
6
7
8
9
10
No money worriesSerious money worries
1
0
2
3
1-2
4
5
3-4
6
7
5-6
8
9
10
7 or more
Adapted from the American Chronic Pain Association.
Other ways that pain affects my day-to-day life:___________________________________________________________________________
_________________________________________________________________________________________________________________________
5
Step 2: PARTNER With Your
Health care Team
Now that you have written down information about your chronic low back pain, the
next step is to work with your health care team to manage your pain. Here are some
steps to do that.
Make the most of your appointments
• Bring your pain logs to your appointments.3
• Make a list of your questions and ask them.3
• Make sure you understand what your health care team tells you. Repeat things
in your own words.5
• Bring someone with you.3
• Make a follow-up appointment to discuss whether or not your treatments
are working.3
DON’T WAIT: Some
people put off seeing a doctor about their low
back pain. Others
stop going because
nothing seems to
help. It’s important
that you keep your
health care team
informed about
changes in your pain
or other symptoms.
Work with your health care team
to set goals and
complete your action plan (page 13).
6
Questions to ask your health care team6
Ask for a physical exam. Make sure any injury or medical problem is cared for. In most cases, though, a specific
cause for chronic low back pain is not found.
Questions
Answers
1. W
hat might be causing
my back pain?
2. Could my back pain be a
sign of a more serious
health problem?
3. W
hat activities should
I avoid?
4. W
hat treatments should
I consider to relieve my
back pain and help me
get back on track?
5. What exercises should I
do to strengthen my back
and stomach muscles?
6. Can stress at work or at
home cause back pain?
7. W
hat can I do to prevent
my pain from continuing
or coming back?
Adapted from WebMD.
My additional questions_______________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
7
treatments
for chronic
low back pain
Medicines
Pain medicines can reduce chronic low back pain and may make it easier for you to
do things. Pain medicines are also called analgesics.
Some Examples of
Nonprescription
Pain Medicines7
Over-the-counter pain medicines
Acetaminophen
You can buy these without a prescription from your doctor. They do not cost a lot.
But you still need to work with your doctor, pharmacist, and others on your health
care team to find out if the medicines are right for you. Ask them what you should
take, when, how, and how much.1
Ibuprofen
Aspirin
Prescription pain medicines
You need a prescription from your doctor for some pain medicines. Talk to your
doctor to make sure you understand exactly how to take your pain medicine.
What about side effects you may experience?
All pain medicines can have side effects. Talk to your doctor or pharmacist if you
have a question or concern about your prescription drug’s side effects.7
What about the risk of addiction?
Many medicines are not addictive. Some people worry about becoming addicted
to pain medicines. If you are concerned about addiction, talk to your doctor about
medicines that are not addictive. Research shows that most people who take pills
for pain do not get addicted.8 Always follow your doctor’s directions.
8
Some Examples
of Prescription
Medicines Used
for Pain
COX-2 inhibitors7
Narcotic pain
medicines1
Muscle relaxants7
Antidepressants1
Questions to ask your doctor or pharmacist about medicines9
Basic information
• Why am I taking this medicine?___________________________________________________________________
• What is the name of my medicine?________________________________________________________________
• Does this prescription mean I should stop taking other medicines?________________________________
• When will it start working?_______________________________________________________________________
• Is there a generic form of the medicine?___________________________________________________________
Taking the medicine
• How do I take it?_____________________________________________________________________________________
• How much should I take?_________________________________________________________________________
• How long do I need to take it?_____________________________________________________________________
• Can I stop taking it if I feel better?________________________________________________________________
• What should I do if I forget to take my medicine?__________________________________________________
Side effects and interactions
• What are the side effects?________________________________________________________________________
• When should I tell my health care provider about a side effect?____________________________________
• Do I need to stop taking any other medicines, vitamins, or herbs?__________________________________
• Will this medicine interact with medicines that I’m already taking?_________________________________
• Do I need to avoid any food, drinks, or activities?__________________________________________________
Adapted from Agency for Healthcare Research and Quality.
9
Physical and behavioral therapies
There are many therapies that may help with chronic low back pain.
You can do more than one thing to manage your pain. Read the list
of therapies below and think about what you want to do.
Check the therapies that you want to ask your health care provider
about. Do not start any of these therapies without talking to your
doctor first.
Check the therapies that you want to ask about.
o A chiropractor can move or adjust the
spine and the muscles around the spine.10
o A massage therapist uses touch and
pressure on tissue and muscles.10
o An acupuncturist uses very thin needles
inserted into the body.10
o Yoga involves a variety of body postures
and breathing techniques.10
o A physical therapist or an exercise
therapist can teach you stretching and
strength-building exercises.10
o Other therapies that may be helpful
include biofeedback and TENS. These
therapies use electricity. Biofeedback
helps people control muscle tension, heart
rate, or blood pressure.1 TENS directly
stimulates nerves to reduce pain.10
Ask your health care team about all the treatments that might help you. Then work with your
team to decide which ones would work best for you. When your doctor or nurse recommends a medicine or therapy, ask why.
10
STEP 3: MAKE A chronic low back PAIN
MANAGEMENT ACTION PLAN
You can do some simple things at home to help reduce your low back pain. Always talk to your doctor first.
• Putting ice or heat on your back might help relieve
pain. Or a warm bath might relax tense muscles
and feel soothing to your body.1
• Some studies suggest that being inactive may
make back pain worse.1 Exercise may be the
best way to speed recovery of low back pain.1
Stretching, walking, and other gentle exercises can
help you strengthen and take the strain off your
lower back muscles.1
• Having good posture can help you prevent
back injury.1
• Keeping a positive attitude also makes a difference
and can make it easier to recover.11
• Losing extra weight, especially around your waist,
will reduce the strain on your back muscles.1
Lifting or pulling heavy objects may strain your lower back. If you must
lift, either get someone to help you or bend your knees and hold the
object close to your body.1
11
A sample chronic low back pain management
action plan12
Setting an action plan involves identifying a goal, then completing an action that
helps you get nearer to your goal.
Example: Let’s say that your goal is to lose weight and your doctor recommends that
you walk more. You like the idea and agree. You decide that this will be your action.
1. Choose an action. Make sure it is something you can really do: I will walk more
than I do now.
2. Make sure you can measure your action: I will walk for 10 minutes, 5 days
a week.
3. Give your action a time frame: I will walk for 10 minutes, 5 days a week for
4 weeks.
4. Make an action plan: An action plan helps you follow through on your goal.
Sample Action Plan
My action
I will walk for 10 minutes, 5 days a week,
for 4 weeks.
What days?
On Monday, Wednesday, Thursday, Friday,
and Sunday.
What time of day?
• On my lunch hour on Monday, Wednesday,
Thursday, and Friday.
• Before dinner on Sunday.
How will I keep track
of my success?
How will I reward myself
when I complete this action?
What will I do after
I complete this action?
12
I will write how many minutes I walk each day on
my calendar.
I will buy myself a fruit smoothie.
I will add 5 minutes each week until I walk for
30 minutes, 5 days a week.
Good sleep can
help your body
heal. Put a pillow
between your
knees. If you want
to sleep on your
back, put a pillow
under your knees.
Raising your
knees helps take
pressure off your
low back.11
My Chronic Low Back Pain Management Action Plan12
1. Choose an action. Make sure it is something you can really do.
2. Make sure you can measure your action.
3. Give your action a time frame.
4. Make an action plan. Talk to your doctor about how to complete the action plan.
An action plan helps you follow through on your goal.
My Action Plan: Write your action plan in the spaces below.
My Action Plan
My action
What days?
What time of day?
How will I keep track
of my success?
How will I reward myself
when I complete this action?
What will I do after
I complete this action?
13
Congratulations!
You have taken the first steps to manage your chronic low back pain. You have…
✓ Kept track of your pain and taken notes.
Pain management
starts with you.
✓ Become an active member of your health care team.
✓ Set a goal and completed an action plan to get to your goal.
Remember, your pain is unique. Your health care team needs your
help to understand your pain and suggest treatments that work for you.
Where to Find More Information
American Chronic Pain Association
www.theacpa.org
Phone: 1-800-533-3231
Information and peer support for people with chronic
pain and their families.
American Society for Action on Pain
www.druglibrary.org/schaffer/asap
Patient organization interested in pain management
issues/concerns.
MedLine Plus
www.nlm.nih.gov/medlineplus/backpain.html
A government site that links to Web sites with information
about back pain. It also offers newsfeeds related to back
pain and new treatments.
National Center for Complementary and Alternative
Medicine
nccam.nih.gov
Phone: 1-888-644-6226
Information about meditation, yoga, and biofeedback.
National Institute of Arthritis and Musculoskeletal
and Skin Diseases
www.niams.nih.gov/Health_Info/Back_Pain/default.asp
Phone: 1-877-22-NIAMS (226-4267)
Information about back pain diagnosis, treatments,
and research.
National Pain Foundation
www.painconnection.org
Education and support resources for people with chronic
pain, and their families and doctors.
PainACTION
www.painaction.com
An online self-management program for pain patients,
with customized information, interactive skill-building
tools, monthly newsletter, and opportunities to share selfmanagement tips.
National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
Phone: 1-800-352-9424
Provides education on the back and low back pain.
Spine-health
www.spine-health.com
A physician-supported site with articles on back pain, spine
videos, discussion forums, and blogs.
14
Notes
15
References
1.National Institute of Neurological Disorders and Stroke. Low back pain fact sheet. February 18, 2011. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed May 18, 2013.
2.American Geriatrics Society. Pain management. http://www.healthinaging.org/aging-and-health-ato-z/topic:pain-management/. Accessed May 18, 2013.
3.Cowan P. Consumers’ guide: Practice guidelines for low back pain. American Chronic Pain
Association. 2008. http://www.theacpa.org/uploads/documents/Consumer%20Guidelines%20for%20
Low%20Back%20PainFinal%202-6-08.pdf. Accessed May 18, 2013.
4.National Institute on Aging. Pain: You can get help. http://www.nia.nih.gov/sites/default/files/pain_
you_can_get_help.pdf. Accessed May 18, 2013.
5.Weiss BD. Health literacy and patient safety: Help patients understand. Manual for clinicians. Second
edition. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed May 18,
2013.
6.WebMD. Pain Management Health Center. 10 questions to ask doctor about back pain. http://www.
webmd.com/pain-management/guide/questions-doctor-back-pain. Accessed May 18, 2013.
7.American Chronic Pain Association. The ACPA consumer guide to pain medication and treatments
2013. http://theacpa.org/uploads/ACPA_Resource_Guide_2013_Final_011313.pdf. Accessed May 18,
2013.
8.Friedman DP. Perspectives on the medical use of drugs of abuse. J Pain Symptom Manage 1990; 5: S2-S5.
9.Agency for Healthcare Research and Quality. Your medicine: Be smart. Be safe. 2011. http://www.ahrq.
gov/patients-consumers/diagnosis-treatment/treatments/safemeds/yourmeds.pdf. Accessed May 18,
2013.
10.Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: A joint clinical practice
guideline from the American College of Physicians and the American Pain Society. Ann Intern Med.
2007;147:478-491.
11.American Pain Foundation. Back pain: Tips for prevention & self-care. 2010. https://securews.
bcbswny.com/web/content/dam/BCBSWNY/PDF/Tips_for_Prevention_self-care.pdf. Accessed May 18,
2013.
12.Lorig K, Sobel D, Gonzalez V, Minor M. Becoming an active self-manager. In: Lorig K, Sobel D,
Gonzalez V, Minor M, eds. Living a Healthy Life With Chronic Conditions. 4th ed. Palo Alto, CA: Bull Publishing Company; 2012:15-26.
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