What is chronic low back pain?
Low back pain is considered to be chronic if it has been present for greater than three months. Chronic low back pain may originate from an injury, disease or stresses on different structures of the body. The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achy, burning, stabbing or tingling, sharp or dull, and well-defined or vague. The intensity may range from mild to severe. Chronic low back pain may be the result by many different conditions. It may start from diseases, injuries or stresses to a number of different anatomic structures including bones, muscles, ligaments, joints, nerves or the spinal cord. A number of different theories have developed to try to explain chronic pain but the exact mechanism is not completely understood. In general, it is believed that the nerve pathways that carry the pain signals from the nerve endings through the spinal cord and to the brain may become sensitized. Sensitization of these pathways may increase the frequency or intensity with which pain is perceived. Imagine an old television set or computer screen in which the same image is projected continuously. This image is eventually “burned” into the screen. In the same manner, after the original source of pain is healed or no longer present, chronic pain patients may continue to feel pain.
How is chronic low back pain diagnosed?
During the evaluation of chronic back pain, the goal is to rule out any injuries or disease processes that place the patient at risk of further injury if not treated or addressed. Additional testing may include blood tests, X-ray films, bone scans, CT scans, MRI, diagnostic injections, and EMG/NCV. Often, the exact cause of the pain is still not well defined at the end of the evaluation. Nevertheless an evaluation is successful if it has ruled out those processes that place the patient at risk if they are not treated.
What treatments are available?
The goals of the treatment are to reduce pain, improve quality of life and increase function. There are several different general categories of treatment that are usually recommended for chronic back pain. These categories include physical therapy, medications, coping skills, procedures and alternative medicine treatments. Involvement of a physician with special training in chronic pain management may be advisable in some cases. Physical therapy includes patient education, and patient training in a variety of stretching and strengthening exercises, manual therapies, and modalities. Medications fall into several different categories. Both nonnarcotic and, rarely, narcotic pain medications may be used in the treatment of chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful with pain control and may help reduce inflammation. Muscle relaxants can also help with chronic pain and may enhance the effects of other pain medications. Nerve stabilizing drugs (neuropathic pain, antidepressants and tricyclic medications) are used to treat nerve-mediated pain. Coping skills are extremely important in the management of chronic back pain. Chronic pain directly affects all areas of a patient’s life. For this reason, teaching patients appropriate coping skills for dealing with anxiety, depression, irritability and frustration can be invaluable. Procedures ranging from minimally invasive injections to surgery may be used to manage chronic pain. Sometimes, implantable devices, such as a spinal cord stimulator, are beneficial in managing chronic pain.