What is Chronic Lower Back Pain?
Chronic lower back pain, defined as pain that lasts longer than 12 weeks, is unfortunately a very common problem. While the vast majority of cases are benign with no serious underlying condition and do not require spine surgery, a small percentage of cases are from severe underlying structural problems with the spine that should be ruled out.
Chronic Lower Back Pain Causes
The specific anatomic cause of chronic lower back pain is in most cases difficult or impossible to identify, due to the complex and multifactorial nature of back pain. Chronic lower back pain can be caused by degenerative disc disease, facet joint degeneration, weak muscles and ligaments, poor posture, or spinal deformity such as scoliosis or kyphosis. Patients who are overweight, or sedentary and spend long periods of time sitting at a desk are at higher risk for back pain.
Smoking causes a disruption in the blood supply to the spinal discs and the tissues of the back and leads to accelerated disc degeneration and is a risk factor for chronic back pain.
Additionally patients with high levels of stress, anxiety, or depression can influence how closely patients focus on their pain and can also affect how that pain is perceived. In most cases it is a combination of these factors that leads to chronic lower back pain.
Chronic Lower Back Pain Treatment
The initial step in appropriate chronic lower back pain treatment is to rule out a structural cause that can potentially be “fixed” through non-operative strategies or potentially with surgical treatment. Spine surgery is most effective at treating leg pain caused by a pinched nerve or spinal stenosis. It is also effective at realigning the spine in cases of severe spinal deformity which can help with maintaining an upright posture and may help with back pain. A detailed history, physical exam, x-rays, and in some cases an MRI are usually sufficient to rule out any dangerous causes of chronic lower back pain.
In the majority of cases, however, the causes for chronic lower back pain cannot be precisely determined and surgery is not recommended. A non-operative spine specialist such as a physiatrist is the best type of physician to guide and treat chronic lower back pain. The treatment of chronic lower back pain focuses on physical therapy to strengthen and rehabilitate weak lower back muscles and ligaments, and to strengthen the core muscles that help with upright posture. A regular low-impact exercise program performed 20-30 minutes daily is critical to the treatment and prevention of lower back pain. Often patients must be creative to find a type of exercise they can perform without aggravating the pain, but anyone can do this if they are dedicating to controlling their lower back pain. Additional modalities that can be helpful are yoga, acupuncture, massage, and cognitive behavioral therapy. Reducing stress levels, and obtaining optimal control of depression and anxiety are important as well. Medications such as acetaminophen, non-steroidal anti-inflammatories (NSAIDS), and muscle relaxers used sparingly can also help. Opioid or narcotic medication should be avoided as these have not been shown to be effective for the treatment of chronic lower back pain, and these medications are addictive and often require escalating doses. Lastly, interventional procedures performed by physiatrists or anesthesiologists trained in pain management such as epidural injections, facet injections, or radiofrequency ablations can be helpful.
In summary, chronic lower back pain is typically caused by a variety of factors and is most effectively treated with conservative measures such as physical therapy and a regular low-impact exercise program. Medications and injections may also be helpful, while surgery is rarely indicated unless the primarily symptoms are leg pain or an inability to stand upright due to a structural spinal deformity. It is important to have a comprehensive evaluation by a spine surgeon or non-operative spine specialist to rule out dangerous causes of lower back pain prior to initiating treatment.