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Low back pain - chronic

Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.

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Low back pain that is long-term is called chronic low back pain.

Alternative Names

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low

Causes

A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.

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Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:

  • Heavy use from work or sports
  • Injuries or fractures
  • Surgery

You may have had a herniated disk , in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.

If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis . These problems are called degenerative joint or spine disease.

Spinal stenosis

Other possible causes of chronic low back pain include:

You are at greater risk for low back pain if you:

  • Are over age 30
  • Are overweight
  • Are pregnant
  • Do not exercise
  • Feel stressed or depressed
  • Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
  • Smoke

Symptoms

  • Dull aching
  • Sharp pain
  • Tingling or burning sensation
  • Weakness in your legs or feet

Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or on the bottom of your foot.

Exams and Tests

During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.

Other tests you have depend on your medical history and symptoms.

Tests may include:

Treatment

Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.

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Your doctor may recommend measures to reduce your pain, including:

  • A back brace to support your back
  • Cold packs and heat therapy
  • Traction
  • Physical therapy, involving stretching and strengthening exercises
  • Counseling, to learn ways to understand and manage your pain

These health care providers can also help:

  • Massage therapist
  • Someone who performs acupuncture
  • Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

If needed, your doctor may prescribe medicines to help with your back pain:

  • Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
  • Low doses of prescription medicines
  • Narcotics or opioids when the pain is severe
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If your pain does not improve with medicine, physical therapy, and other treatments, your doctor may recommend an epidural injection.

Spinal surgery is considered only if you have nerve damage or the cause of the back pain does not heal after a long time.

In some patients, a spinal cord stimulator can help reduce back pain.

Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:

  • Epidural injection
  • Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
  • Spinal cord stimulation, in which a small device sends electric current to the spine to block pain signals 

Some people with low back pain may also need:

  • Job changes
  • Job counseling
  • Job retraining
  • Occupational therapy

Outlook (Prognosis)

Most back problems get better on their own. Follow your health care provider's advice on treatment and self-care measures.

When to Contact a Medical Professional

Call your health care provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.

References

Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2010;(5):CD003010.

Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7):CD002014.

Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505-514.

Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492-504.

Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, et al., eds. Kelly's Textbook of Rheumotology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 47.

Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(2 Suppl):S49-283.

Updated: 5/28/2013

Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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