Stephanie Pham Van, M.D.
Back pain is considered chronic if it lasts three months or longer. It can come and go, often bringing temporary relief followed by frustration. Dealing with chronic back pain can be especially trying if you don’t know the cause.
Back pain rehabilitation specialist Stephanie Van, M.D., offers insights into common chronic back pain causes and nonsurgical treatment options — and she advises not to give up hope.
Common Causes of Chronic Back Pain
Chronic back pain is usually age-related, but it can also result from an injury. The most common causes include:
- Arthritis of the spine — the gradual thinning of the cartilage inside the spine
- Spinal stenosis — narrowing of the spinal canal that may lead to nerve pain
- Disk problems, such as a herniated or bulging disk
- Myofascial pain syndrome — muscle pain and tenderness without clear cause
In some cases, it is difficult to pinpoint the cause of chronic back pain.
“If your doctor has explored all diagnostic and treatment options they are comfortable with, consider seeking a second opinion from a back pain specialist,” Van recommends.
It is important to understand the source of your pain as much as possible, and to consider every available, reasonable option. People with back pain should not feel rushed into settling for an invasive, irreversible surgical procedure. Surgery can be helpful for many people, but it is usually considered a last resort after more conservative options have been exhausted. Surgery can correct structural abnormalities contributing to back pain, but it does not guarantee pain relief, and it may even worsen the pain, Van warns. If the source of the pain is not known or can’t be treated, the best strategy is to collaborate with your doctor on a pain management plan that reduces the severity and frequency of flare-ups and focuses on goals for function and quality of life.
Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try, under the guidance of your physician and spine physical therapist.
Physical therapy for chronic back pain may include:
- Core strengthening
- Stretching and flexibility exercises
- Retraining posture
- Testing the limits of pain tolerance
- Aerobic exercises at a comfortable pace
- Diet Change
- Some diets are highly inflammatory, especially those high in trans fats, refined sugars and processed foods.
There are many ways to adapt and adjust your behavior and activity that can significantly improve chronic back pain before even considering medications or procedures.
Trigger point injections, epidural steroid injections, nerve blocks, nerve ablations and other types of injection-based procedures are available for chronic back pain.
Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can make a difference for chronic back pain. Pharmacologic Treatments
All kinds of medicines (topical, oral, injectable) are used to help manage chronic back pain, including anti-inflammatories, muscle relaxants, nerve pain medications and even antidepressants. However, any medication can have unwanted side effects. Work with your doctor to explore medication strategies that directly address the cause of your pain (if it is known).
When is surgery a good idea for back pain?
If you suddenly start experiencing any of the following “red flag” symptoms, it might be time for surgery, if the symptoms found to be related to your spine condition:
- New or worsening bowel/bladder issues (incontinence, groin numbness)
- Weakness in limbs
- Gait and balance problems
- Evidence of increased (brisk) reflexes
Surgery can also be an option for chronic back pain if a cause is confirmed by imaging and if other treatments have not helped.
“Surgery is the most invasive, high risk strategy for chronic back pain,” Van says. “It is irreversible, and it does not guarantee complete relief of back pain.