If your back pain persists for three months or longer, it’s considered chronic. This kind of pain tends to be on-and-off, providing temporary relief followed by frustration. Managing chronic back pain can be particularly challenging, especially when the cause is unclear.
Chronic back pain is often linked to aging, but it can also result from an injury. The main culprits include arthritis of the spine (gradual thinning of spinal cartilage), spinal stenosis (narrowing of the spinal canal leading to nerve pain), disk problems like herniated or bulging disks, and myofascial pain syndrome (muscle pain without a clear cause).
Sometimes, pinpointing the cause of chronic back pain is tricky.
People with back pain shouldn’t feel pressured into opting for invasive, irreversible surgery right away. While surgery can help correct structural abnormalities contributing to back pain, it’s usually considered a last resort after trying less drastic measures.
If the source of your pain is unknown or can’t be treated, collaborating with your doctor on a pain management plan is recommended. This plan should aim to reduce the severity and frequency of flare-ups, focusing on improving function and quality of life. The key is to approach treatment with a comprehensive understanding of your pain and explore various options before considering surgery.
Non-Surgical Ways to Treat Chronic Back Pain
Physical Therapy and Home Exercise Program
Exercise is a fundamental part of treating chronic back pain, and it’s one of the initial approaches recommended by your doctor and spine physical therapist. However, there isn’t a one-size-fits-all solution. Dr. Van emphasizes that prescribed exercises should be tailored to your specific symptoms, condition, and comfort level.
Consistently following your exercise routine at home is crucial for maintaining the strength and stability of your spine. Physical therapy for chronic back pain may involve core strengthening, stretching, posture retraining, testing pain limits, and aerobic exercises at a comfortable pace.
Mindfulness and Meditation
Chronic back pain takes both a physical and emotional toll. To address the emotional aspects, such as frustration, irritability, and depression, you might be referred to a rehabilitation psychologist.
This specialist may suggest mindfulness techniques, meditation, yoga, tai chi, and other cognitive and relaxation strategies. These methods aim to enhance your conscious control over your nervous system and its response to activity.
Diet Change
Certain diets, especially those high in trans fats, refined sugars, and processed foods, can be highly inflammatory and may contribute to chronic back pain. Consult with your doctor to assess if your diet could be a factor in your pain, and discuss potential changes.
Maintaining a healthy weight can also help alleviate back pain by reducing pressure on your spine. For personalized advice on adopting a more balanced diet and developing eating habits that support your health goals, a referral to a nutrition specialist is recommended.
Lifestyle Modifications
Before turning to medications or procedures, there are practical changes you can make to significantly improve chronic back pain through your daily activities.
Dr. Van recommends listening to your body and pacing yourself. Take breaks during strenuous tasks, and if you’re carrying heavy items, make multiple trips or ask for assistance. Identify activities that worsen your pain and try to avoid them, focusing more on comfortable and enjoyable activities.
This not only helps your back feel better but can also prevent the underlying condition from worsening. Additionally, consider minimizing harmful habits like smoking, which is known to increase pain and hinder healing. Set one realistic goal at a time before tackling another lifestyle change.
Injection-Based Treatments
Certain injection-based procedures like trigger point injections, epidural steroid injections, nerve blocks, and nerve ablations are available for chronic back pain. These treatments are considered when the source of pain is known and can help rule out certain causes if they prove ineffective.
While injections may temporarily relieve or reduce pain, they aren’t long-term solutions and should be complemented with regular, gentle activities like physical therapy and home exercises.
Alternative Treatments
Alternative treatments such as acupuncture, massage, biofeedback therapy, laser therapy, and electrical nerve stimulation can be beneficial for chronic back pain.
The potential benefits of these approaches generally outweigh the risks, making them worth exploring. Consult with your spine specialist to discuss alternative treatments that might work for you.
Pharmacologic Treatments
Various medications, including topical, oral, and injectable options, can help manage chronic back pain. These may include anti-inflammatories, muscle relaxants, nerve pain medications, and even antidepressants.
However, medications can have side effects. Collaborate with your doctor to find a strategy that directly addresses the cause of your pain, if known. Use the lowest effective dose to minimize side effects and only take medications as long as they are helpful and well-tolerated.
When is Surgery a Good Idea for Back Pain?
If you notice any of the following “red flag” symptoms that are found to be related to your spine condition, surgery might be considered:
- Weakness in limbs
- Gait and balance problems
- Evidence of increased (brisk) reflexes
Additionally, surgery can be an option for chronic back pain if a specific cause is confirmed through imaging, and other treatments have proven ineffective.
