Managing Chronic Low Back Pain
If you have never suffered from low back pain, consider yourself one of the fortunate few. Back pain
is a common reason for Americans under the age of 45 to limit their activity. It is also a common reason for visits to the doctor and for surgery. There is some good news, though. Most people recover from an acute episode in a few days or weeks without much disruption to daily activities or medical treatment. For others however, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.
The back is a strong column that is made up of of bones, nerves, ligaments, and muscles. This combination of tissue allows for a large range of motion while remaining strong enough to keep you upright and stable. A number of individual bones, called the vertebrae, run from just under the skull through to the tailbone. These bones are separated by cushioned discs and are held in place by strong bands of tissue called ligaments and muscles. The bones create a tunnel that the spinal cord sits in. Nerves leave the spinal cord through several areas in the back to pass to the rest of the body. When all these structures are healthy, the back is in balance and works wells. Chronic pain is caused by strain or injury to one or all of these structures.
Chronic back pain is often due to wear and tear on the back from repetitive stress or strain. It can also develop or worsen because of weaknesses and imbalances in the back. Stress, strain, and imbalances can all place excess stress on supportive tissue like ligaments and muscles. When that tissue is irritated or inflamed it can put strain on nearby nerves. This can lead to a cycle of imbalance and injury that causes chronic pain. The low back is especially susceptible to chronic pain because it is involved in weight bearing of the upper body and lifting.
Common factors that can lead to chronic low back pain include:
- Being overweight or obese
- Occupational injuries, particularly if the work environment requires or allows use of improper body mechanics, such as bending or twisting when lifting
- Poor posture
- Poor ergonomics for sedentary workers
- Medical conditions, such as arthritis, spinal stenosis, tumors, infections, or fractures (with or without osteoporosis)—that result in damage to bones
- Spinal deformities, some of which may be present at birth
- Prior surgery or back injury
Many times, there is no absolutely clear cause of low back pain.
What is the best treatment for chronic low back pain?
According to evidence, what seems to matter is not which one, but how
treatments you use.
In other words, interventions that address not only the physical aspects of the pain, but also its psychological, social, and occupational influences seem to be the most effective. An effective rehabilitation program may encompass:
- Physical therapy
- Exercise and strength training
Cognitive-behavioral therapy—to help you adjust behaviors to better cope with back pain
Balneotherapy—the use of hot and cold baths and spas
- Heat and cold application
Alternative therapies use non-conventional methods to manage or relieve back pain. More often than not, alternative therapies are used in combination with standard medical treatment.
Below are among the most commonly used alternative therapies to treat chronic low back pain:
Chiropractic—may help to release muscles imbalances and get the spine in better alignment
Acupuncture—may help tight tissue relax
Massage therapy—may help relax tight muscles and improve blood flow to the area
There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of these therapies is superior to the others or to physical therapy, the standard conventional treatment. Furthermore, it is unclear that any of these approaches provides more than short-term benefit.
Complex Solutions for Complex Problems
This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy therefore, should be part of a multi-dimensional treatment strategy.
Chronic back pain can affect your ability to keep up with your normal activities. These treatments will help you slowly increase your activity level until over time.
Steps to Manage Chronic Pain
If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:
- Recognize that your condition is a complicated problem that cannot be treated in isolation. This is the first step to gaining control over your pain and your life.
- Determine which facets of your pain have not been adequately addressed—psychological, social, occupational, and/or physical. Tackling this problem from only one perspective is unlikely to work.
- Continue working with your doctor, and consider getting a referral to a doctor who specializes in physical medicine and rehabilitation, or chronic low back pain. These doctors may be in the best position to coordinate a comprehensive, multi-disciplinary treatment plan, whether or not it includes alternative therapies.
- Strive to restore your ability to function. Your goal should be to resume your normal activities, not only to reduce your pain. Although the two are closely linked, the evidence suggests that focusing on function is the key to recovery.
- Look both ways. Look ahead to visualize what it will be like to have no pain or disability. But also look back to measure your progress. It is easier to succeed when you see how far you have come.
American Academy of Physical Medicine and Rehabilitation
American Society of Exercise Physiologists
Canadian Society of Exercise Physiology
Acupuncture and related therapies for chronic low back pain. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T906249/Acupuncture-and-related-therapies-for-chronic-low-back-pain. Updated August 11, 2016. Accessed February 16, 2017.
Back pain information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Back-Pain-Information-Page. Accessed February 16, 2017.
Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-491.
Chronic low back pain. EBSCO DynaMed website. Available at: EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain. Updated January 8, 2017. Accessed February 16, 2017.
Complementary, alternative, or integrative health: What's in a name? National Center for Complementary and Integrative Health website. Available at: https://nccih.nih.gov/health/integrative-health. Updated June 2016. Accessed February 16, 2017.
Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79(12):1067-1074.
Low back pain. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/low-back-pain. Updated March 2014. Accessed February 16, 2017.
Manual therapies for chronic low back pain. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T910280/Manual-therapies-for-chronic-low-back-pain. Updated June 30, 2015. Accessed February 16, 2017.
Roelofs PD, Deyo RA. Non-steroidal anti-inflammatory drugs for low back pain.
Cochrane Database Syst Rev. 2008;(1):CD000396
1/15/2010 DynaMed's Systematic Literature Surveillance
EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain: Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-154.