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Low Back Pain
Low back pain is considered chronic if it persists for more than three months. Pain can be shooting, stabbing, localized in nature, or referred from another part of the body. Whatever its degree and nature, chronic low back pain should always be evaluated by a physician to rule out any serious problems.

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Low Back Pain
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Who Suffers from Chronic Low Back Pain?
What Are the Symptoms?
The Causes of Chronic Low Back Pain and How It Can Be Diagnosed
Treatments for Chronic Low Back Pain
Low Back Pain Websites
More Information on Low Back Pain

      Low Back Pain: Basics       Low Back Pain: Treatment [Algorithm]
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Who Suffers from Chronic Low Back Pain?

Chronic low back pain is among the most common chronic pain syndromes, affecting men and women equally. If left untreated, it can cause unnecessary suffering and upset a person's life at home and on the job. The good news is that a wide range of treatment options are readily available to successfully reduce or manage this type of pain.

Chronic low back pain frequently affects people in their prime working years and, as a result, it is the single largest cause of lost work days and lost income. It also accounts for more than 25 percent of all workers' compensation claims, with a great cost to society. Additionally, while studies show that many sufferers do not seek medical attention, chronic low back pain remains a primary reason for hospital and physician office visits.

What Are the Symptoms?

The symptoms of chronic low back pain are varied, making a precise diagnosis often difficult. Low back pain is considered chronic if it persists for more than three months. Many people have a limited range of motion or tender areas. In addition to the actual back pain, some people may experience fever or weight loss, which can indicate illness or infection. Psychological symptoms also may occur.

Depression has been shown to be three to four times as prevalent in patients with chronic back pain as in the general population.

Chronic low back pain can be shooting, stabbing, localized in nature, or referred from another part of the body. In some cases, people with chronic low back pain are found to have distinct pain syndromes, including arthritis, myofascial pain with muscle spasm, degenerative joint disease and radiculopathic pain (pinched nerve). They may experience this pain only when walking, sitting or standing, each action suggesting a specific root cause. Whatever its degree and nature, chronic low back pain should always be evaluated by a physician to rule out any serious problems.

The Causes of Chronic Low Back Pain and How It Can Be Diagnosed

The Causes of Back Pain
There are many pain-sensitive structures in the back. Injuries, infection or inflammation affecting these structures are often the origin of chronic low back pain. Most cases result from simple sprains or strains of the muscles and ligaments. Others may be related to bruises and disk herniations.

How Is Chronic Low Back Pain Diagnosed?
Diagnosis of chronic low back pain, as well as of its many related syndromes, relies heavily on a thorough physical examination and blood work-up, a complete medical and psychosocial history, and a description of the pain, including its location and how it started. While a good physical exam focuses on obvious deformities, tender areas, range of motion and neurologic function, it also can shed light on problems not easily diagnosed that involve the muscles, connective tissue, nerves and spine. There are special maneuvers that should be performed so that the physician can correctly assess and distinguish the many possible causes of chronic low back pain.

Imaging techniques may be necessary if there is tenderness over the spine or the patient's history indicates the possibility of a tumor or infection. Magnetic resonance imaging (MRI) is used to evaluate tissue, bone, muscles and nerves; computed tomography (CT) provides three-dimensional images of internal structures such as organs; and myelography and electromyelography inject contrast dyes into the spine to produce pictures of the spinal cord. Simple X-rays can be very useful in determining such conditions as osteoporosis and spondylolisthesis.

Other more advanced diagnostics -- thermography, diskography and electrophysiologic studies among them -- also are sometimes necessary.

Thermography converts measurements of body heat, increased by inflammation or infection, into visual signals that can be photographically recorded.

Diskography takes pictures of vertebrae in the spine following the injection of radiopaque chemicals that can withstand radiation and X-rays to identify areas producing pain.

Electrophysiologic studies examine the electrical aspects of body functions.

When no physical reason for the pain can be identified, treatment can be difficult to determine, necessitating a multidisciplinary approach to care. In addition, depression, stress or other psychological dysfunction should be treated at the same time.

Low Back Pain: Treatment [Algorithm]

Treatments for Chronic Low Back Pain

Treatment for chronic low back pain may last from a few weeks to several months, and usually takes a multimodality approach, in which several different therapies (drug, physical, interventional, complementary, psychological) are used in combination with one another. View the Flash presentation to learn more. click to view

Drug Therapy. Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvant analgesics (like antidepressants and anticonvulsants), and opioids. Long-term opioid therapy may be appropriate for carefully selected patients who can be monitored by their physicians and who can appropriately manage their medication.

Physical Therapy. Walking, swimming or cycling on a stationary bike can provide general conditioning and help strengthen weakened muscles while minimizing the stress on the spine. Therapy is tailored to the patient, with gradual increases in duration.

Interventional Therapy. One way to alleviate chronic low back pain is to block or numb pain pathways. This is accomplished through a variety of invasive treatments, including epidural steroids, injections, joint and nerve blocks and analgesic pump devices.

Complementary Therapy. Used in combination with analgesic treatments, complementary therapy incorporates a wide range of practices that are thought to prompt the body's release of pain-relieving substances. They include acupuncture, massage, meditation, herbal remedies, chiropractics and hot and cold packs. Visit our Low Back Pain pages on to learn more about state-of-the-art therapies.

Psychological Therapy. Some patients can benefit from counseling (single or group). Employee assistance programs, located at the job site, and often free of charge, can also help.

Some patients with chronic lower back pain may require surgery as a final alternative. And, for some patients who are particularly disabled, a formal program administered by a multidisciplinary pain center may be best.

Low Back Pain Websites

Diagnosis and Treatment of Low Back Pain: Clinical Guidelines - Annals of Internal Medicine (.pdf)

Diagnosis and Treatment of Low Back Pain: Patient Summary - Annals of Internal Medicine (.pdf)

Low Back Pain Fact Sheet - National Institute of Neurological Disorders and Stroke (NINDS)

Medline Plus: Back Pain - National Institutes of Health

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