Chronic Back Pain: Symptoms, Treatments, and Prevention

What is chronic back pain?

Chronic back pain is a type of back pain that lasts for three months or longer. It can be caused by different causes, such as muscle strains, problems with the discs in your spine, narrowing of the spine, or arthritis. 

Unlike acute back pain, which can go away with rest, chronic back pain sticks around for a long time. Its intensity can change, but it doesn't fully go away. This type of pain can significantly affect your daily life, making it harder to move around, work, or enjoy social activities. Understanding the causes and exploring effective treatment options is essential for managing and relieving chronic back pain.

Types of chronic back pain

• Mechanical pain: 

  • Often caused by issues with the muscles, ligaments, bones, or discs in the spine.

• Radicular pain: 

  • Caused by nerve irritation or compression, such as with sciatica.

• Referred pain: 

  • Occurs when an issue in the back causes discomfort in another part of the body. For instance, a problem in the lower back might lead to pain or numbness in the thighs, hips, or legs, even though these areas are not the root cause. 

Symptoms of chronic back pain

The symptoms of chronic back pain can vary widely depending on the cause and location of the pain. However, the following are common characteristics of chronic back pain:

• Persistent pain: 

  • Pain that lasts for months or longer and often flares up with certain activities or movements.

• Radiating pain: 

  • Pain that radiates down one or both legs (commonly seen in conditions like sciatica).

• Stiffness: 

  • Reduced mobility or flexibility in the lower back, making it difficult to bend or twist.

• Numbness or tingling: 

  • Often in the legs or feet, which may indicate nerve involvement.

• Muscle weakness: 

  • Weakness in the legs or feet, which can affect balance and mobility.

• Pain aggravated by movement: 

  • Activities like bending, lifting, or sitting for long periods may worsen the pain.

• Pain relieved by rest: 

  • Lying down or resting may alleviate the pain temporarily.

If you're experiencing symptoms of chronic back pain, request an appointment with our specialists at Thomson Medical for an accurate diagnosis and tailored treatment plan.

Causes of chronic back pain

Chronic back pain can be caused by a variety of problems involving the bones, muscles, and nerves in the back.Some common causes include:

• Degenerative disc disease: 

  • Intervertebral discs are cushions between the bones of the spine that absorb shock and allow movement. Over time, they can wear down, causing pain, stiffness, and reduced mobility.

• Herniated or bulging discs: 

  • A disc in the spine can rupture or bulge, pressing on nearby nerves and causing pain, numbness, or tingling sensations.

• Spinal stenosis: 

  • The narrowing of the spinal canal can put pressure on the spinal cord or nerves, resulting in pain, weakness, and sometimes numbness, especially in the legs.

• Facet joint dysfunction: 

  • The facet joints, which allow the spine to move, can become irritated or inflamed, causing localised pain.

• Sciatica: 

  • Compression of the sciatic nerve leads to radiating pain in the lower back and legs.

• Spondylolisthesis: 

  • A condition where one vertebra slips over another, often leading to nerve compression, causing pain and instability

• Muscle strain or ligament injury: 

  • Overuse, lifting improperly, or poor posture can strain the muscles and ligaments in your back. This can lead to persistent pain if the injury is not properly managed.

• Arthritis: 

  • Osteoarthritis (degenerative joint disease) and rheumatoid arthritis can cause inflammation and damage to the joints, particularly in the spine, leading to chronic pain.

• Scoliosis or spinal deformities: 

  • Abnormal curvatures in the spine can cause misalignment, leading to pain and muscle strain over time.

• Infections: 

  • Spinal infections, although rare, can cause chronic pain if the spine or surrounding tissues become infected.

• Cancer: 

  • In some rare cases, cancer that has spread to the spine can cause chronic back pain.

• Psychosomatic factors: 

  • Anxiety, depression, and stress can contribute to chronic back pain by increasing muscle tension or altering pain perception.  

Diagnosing chronic back pain

Diagnosing chronic back pain typically starts with a careful review of your medical history and a physical exam. Your doctor will ask about your symptoms, past medical issues, daily activities, and any recent injuries. Depending on the suspected cause of your pain, your doctor may recommend some tests, including:

• X-rays: 

  • To look for fractures, joint problems, or alignment issues in the spine.

• MRI or CT scans: 

  • Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used to assess soft tissues such as discs, nerves, and ligaments. This allows your doctor to find herniated discs, spinal stenosis, or other structural problems.

• Electromyography (EMG): 

  • To assess nerve function and detect nerve compression or damage.

• Blood tests: 

  • To rule out conditions like infections or inflammatory conditions like ankylosing spondylitis, rheumatoid arthritis, or other autoimmune diseases that could be causing pain.

• Bone scans: 

  • To detect infections, fractures, or tumours in the spine.

Treatments for chronic back pain

Non-pharmacological management

1. Physical approaches

   • Posture correction: 

     • Improving how you sit, stand, and sleep can help reduce stress on your spine and muscles. A physical therapist can check your posture and give you tips on keeping your spine in a good position during your daily activities.

   • Stretching and flexibility:

     • Tight muscles, especially in the hamstrings, hips, and lower back, can lead to back pain. Doing stretching exercises can help make these muscles more flexible and reduce tightness. Some good stretches to try are hamstring stretches, cat-cow stretches, and hip flexor stretches.

   • Core strengthening: 

     • Strengthening the muscles that support your spine, especially the core muscles like your belly and back muscles, is important for keeping your spine stable and reducing pain. Good exercises to help with this include planks, pelvic tilts, bird-dog movements, and abdominal bracing.

   • Manual therapy: 

     • Techniques like spinal manipulation or mobilisation may help relieve pain, particularly for conditions like muscle spasms or misalignment.

   • Low-impact aerobic exercise: 

     • Low-impact activities like walking, swimming, or cycling can help you improve cardiovascular health, maintain a healthy weight, and increase circulation to the back muscles without straining the joints.

   • Weight management

     • Being overweight can put more pressure on your spine, especially your lower back. Keeping a healthy weight with good food choices and regular exercise can help reduce chronic back pain and make it easier to move.

   • Nutrition

     • Eating a diet rich in anti-inflammatory foods (e.g., omega-3 fatty acids, fruits, vegetables, and whole grains) may also help reduce pain and inflammation.

   • Heat or ice therapy

     • Applying heat can help relax tense muscles, while cold therapy can reduce inflammation and numb acute pain.

   • TENS (Transcutaneous Electrical Nerve Stimulation)

     • A device that delivers low-voltage electrical currents to the skin to block pain signals and stimulate endorphin release.

2. Psychological approaches

   • Cognitive behavioural therapy (CBT): 

     • CBT is a proven therapy that helps people change negative thoughts and behaviours related to pain. It can teach ways for you to reduce chronic back pain by handling factors such as stress, anxiety, and frustration.

   • Mindfulness and relaxation techniques: 

     • Techniques like mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce stress and muscle tension, improving overall pain management.

   • Biofeedback: 

     • This technique allows you to learn to control certain bodily functions (such as muscle tension or heart rate) that may be contributing to your pain. By gaining awareness and control over these processes, you can reduce the intensity of pain.

3. Ergonomic modifications

   • Workplace modifications: 

     • If you spend a lot of time at a desk or have bad posture, changing your workspace can help lessen strain on your back. Use an ergonomic chair, ensure your desk and keyboard are at the right height, and adjust your computer screen so it’s at eye level. Remember to take regular breaks to stand up and move around.

   • Sleeping position: 

     • Using a medium-firm mattress and sleeping in positions that support spinal alignment (such as sleeping on your side with a pillow between your knees) can help reduce pain. Poor sleeping positions can aggravate back pain.

   • Avoiding prolonged sitting or standing: 

     • Staying in one position for too long can make your back pain worse. Alternate between sitting, standing, and walking throughout the day to reduce pressure on your spine.

Pharmacological management

Medications can be used together with other treatment methods to help manage chronic back pain, especially during flare-ups or when pain makes it harder to do everyday activities.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): 

  • Drugs like ibuprofen and naproxen can help reduce back pain, swelling, and inflammation. However, they should be used carefully and for a short time because long-term use can cause stomach problems or harm the kidneys.

• Acetaminophen: 

  • Acetaminophen is another option for pain relief, especially for people who can't take NSAIDs. It's generally safer to use over a long period but doesn’t reduce inflammation.

• Muscle relaxants: 

  • Muscle relaxants like cyclobenzaprine can provide short-term relief from muscle spasms that often come with back pain. These should be used carefully because they can make you feel sleepy and may be habit-forming.

• Topical analgesics: 

  • Creams, gels, or patches containing ingredients like capsaicin, menthol, or lidocaine can offer relief right where you feel pain. They are good for mild to moderate discomfort and usually don’t cause other side effects.

• Opioids: 

  • Opioids may be prescribed for very severe pain, but they are usually avoided for chronic back pain because of the risk of addiction and other side effects. If they are given, a doctor must monitor their use closely.

• Antidepressants and anticonvulsants 

  • Antidepressants like amitriptyline and duloxetine, as well as anticonvulsants like gabapentin, can help manage pain that comes from nerve issues or doesn’t respond to other treatments. These medications are helpful for conditions like sciatica or herniated discs. 

Interventional treatments

When methods like physical therapy and medication don't help enough, doctors may suggest interventional treatments. Here are some common options:

• Epidural steroid injections: 

  • These are injections of strong anti-inflammatory medicine into the space around the spinal cord. They can help reduce swelling and ease pain from problems like herniated discs or spinal stenosis. While these injections usually help for a short time, you may need several over the course of your treatment.

• Radiofrequency ablation:

  • This procedure uses heat from radio waves to target the nerves that are causing pain. It is often used for lower back pain related to conditions like arthritis or worn-out discs.

• Spinal cord stimulation:

  • This method involves placing a small device that sends electrical signals to the spinal cord. These signals can help block pain messages from reaching the brain. It may be a good choice for people with long-lasting pain that hasn't responded to other treatments.

Surgical interventions

Spine surgery is generally considered a last resort for chronic back pain when conservative treatments have failed and the pain is severely affecting daily life and may be recommended in cases of:

• Herniated discs that don’t improve with non-surgical treatment.

• Spinal stenosis causes nerve compression.

• Spondylolisthesis (slipping of a vertebra).

• Degenerative disc disease that severely limits mobility or causes nerve damage.

Preventing chronic back pain 

Preventing chronic back pain from returning involves maintaining a healthy lifestyle and continuing positive habits. Here are some tips to help:

• Maintain a healthy weight to avoid putting extra stress on your back.

• Exercise regularly to keep your muscles strong and flexible, particularly the muscles that support your spine (core muscles).

• Practice correct posture when sitting, standing, and lifting. Make sure your workspace is ergonomic and that you use proper body mechanics.

• Avoid prolonged sitting or standing. If you sit for long periods, stand up and move around every 30-60 minutes.

• Sleep in a proper position. Make sure your mattress supports your spine, and try sleeping on your side with a pillow between your knees to reduce pressure on your back.

• Manage stress effectively, as stress can contribute to muscle tension and worsen pain.

When do I need to see a doctor?

Early diagnosis and treatment can help prevent complications such as permanent nerve damage. You should seek medical attention if you experience any of the following symptoms:

• Your back pain persists for more than three months without improvement.

• The pain is severe or prevents you from doing daily activities.

• You experience numbness, tingling, or weakness in your legs or feet, which could indicate nerve compression.

• The pain is associated with bladder or bowel dysfunction (a medical emergency that may indicate cauda equina syndrome).

• You have a history of cancer, unexplained weight loss, or a recent trauma (such as a fall or accident).

• Your pain is not relieved by over-the-counter pain medications or rest.

Chronic back pain can have a serious effect on your personal life, but with proper medical guidance, many patients can experience significant improvement. To discuss your situation and identify the best procedures suitable for you, book an appointment with our experienced specialists at Thomson Medical.

FAQ 

What are the common types of back surgery?

• Discectomy: 

  • Removal of a herniated or damaged disc to relieve the nerve pressure.

• Laminectomy: 

  • Removal of part of the vertebra (lamina) to relieve pressure on the spinal cord or nerves, often done for spinal stenosis.

• Spinal fusion: 

  • Fusing two or more vertebrae together to stabilise the spine, typically used in cases of degenerative disc disease, spondylolisthesis, or spinal instability. 

How do I know if my chronic back pain is related to nerve damage?

Nerve-related pain is often described as sharp, shooting, or burning pain that may radiate to the legs (e.g., sciatica). Signs of nerve involvement can include:

• Radiating pain down the leg, buttocks, or feet.

• Numbness or tingling in the legs, feet, or toes.

• Weakness in the legs or difficulty with balance.

• Loss of bladder or bowel control (which requires immediate medical attention).

Are there any alternative therapies for chronic back pain?

Yes. In addition to traditional treatments, some people with chronic back pain may find relief through complementary and alternative therapies. These therapies are generally safe, but it’s important to consult your healthcare provider before starting any new treatments.

• Chiropractic care: 

  • Spinal manipulation and adjustments by a licensed chiropractor may help alleviate pain and improve mobility, particularly for musculoskeletal back pain.

• Acupuncture: 

  • Inserting thin needles into specific points on the body may stimulate the release of endorphins (natural pain relievers) and help reduce pain and inflammation.

• Massage therapy: 

  • Therapeutic massage can help reduce muscle tension, improve circulation, and alleviate stress, which can be beneficial for chronic back pain, especially when muscle tightness or spasm is contributing.

• Yoga: 

  • A gentle yoga practice can help improve flexibility, posture, and muscle strength. Specific yoga poses (like child's pose, cat-cow, and down dog) can stretch and strengthen the back muscles, helping to reduce pain over time.

• Herbal remedies: 

  • Some herbs like turmeric (with curcumin) or ginger have anti-inflammatory properties and may provide relief when taken as supplements. 

How can physical therapy help with chronic back pain?

Physical therapy is one of the most effective treatments for chronic back pain. A physical therapist will design a personalised program of exercises to:

• Strengthen the muscles that support the spine, especially the core muscles, which help stabilise the back.

• Improve flexibility in the spine, hips, and legs, which can reduce tension and improve movement.

• Correct posture to prevent back strain during daily activities.

• Teach ergonomic principles for sitting, standing, and lifting to avoid putting unnecessary stress on the back.

Can I still exercise with chronic back pain?

Yes, exercise is a key part of managing chronic back pain. In fact, staying active is important for strengthening the muscles around the spine and reducing pain. However, you should focus on low-impact activities that don’t exacerbate your pain, such as:

• Walking

• Swimming or water aerobics

• Cycling on a stationary bike

• Yoga (especially gentle or restorative yoga that emphasizes stretching and strengthening)

• Pilates for core strength

Can back pain be related to emotional stress or mental health issues?

Yes, chronic back pain is often linked to psychological factors such as stress, anxiety, and depression. Emotional stress can:

• Lead to muscle tension and spasms.

• Worsen pain perception, making the pain feel more intense.

• Cause difficulty in focusing on recovery, affecting sleep and daily activities.

In some cases, chronic pain can also lead to mental health issues, creating a vicious cycle. Managing stress through relaxation techniques such as yoga, mindfulness, or CBT can help improve both physical and emotional well-being and reduce the intensity of back pain. If mental health is a contributing factor, therapy or counselling can be beneficial. 

Can back pain be completely cured?

While it may not be possible to completely cure chronic back pain for everyone, most people can manage it well using a mix of medical treatments, physical therapy, lifestyle changes, and emotional support. 

The main goals are to lessen the pain, improve movement, and help individuals live active and fulfilling lives. Continuous self-care and regular check-ins with healthcare providers can aid in keeping the pain under control and preventing it from coming back.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Book an appointment with Thomson Medical today.