Chronic Low Back Pain

The vast majority of cases of back pain are those of lower back pain lasting less than two months time. Lower back pain lasting less than two months time is classified as acute lower back pain. Pain lasting longer than that may be classified as subacute or chronic. The amount of time that a person has been suffering from symptoms varies between two to six months for the condition to be considered chronic.

Chronic pain is pain that lasts longer than three to six months or beyond the point when the tissue has healed. Chronic pain is very vexing for doctors who have been trained to treat tissue injuries. Either the tissues have healed on their own or with the aid of medical treatments such as non-steroidal anti-inflammatories, steroidal anti-inflammatories, physical therapy, or surgery.

When a patient first presents with back pain, the doctor will first want to assess whether the patient has a condition that requires emergency treatment. Once a serious condition is ruled out, the doctor will want to find out which tissues have become injured to cause the symptoms. The doctor will conduct his/her own physical examination to test for weakness, nerve compromise, reflex testing, and muscle balance. If the doctor hasn't received the information that he/she needs, other testing may be ordered, such as X-Ray, CT, MRI, Ultrasound, and EMG (electromyography). Once the doctors have received enough information to make a diagnosis, they will decide whether the condition will heal on its own, without treatment, or whether medical intervention will be necessary. Medical treatments may include heat/cold therapy, analgesic (pain-relieving) medications, muscle relaxant medications, Acupressure, or physical therapy. All of these medications are considered conservative because they don't involve either needle punctures or back surgery.

If one or more of these treatments aren't effective at healing the injury or significantly reducing the pain levels, then surgery may be considered an option towards improving the quality of the patient's life. Back surgery may be considered an option for some chronic low back pain patients suffering from:
  • Compression fractures
  • Moderate to severe scoliosis
  • Degenerative disc disease or lumbar disc herniation
  • Spondylolisthesis
  • Degenerative Joint Disease
  • Lumbar Spinal Stenosis

Together, patients and their doctors will measure the possible benefits against the possible risks for the particular back surgery option being considered. In a fairly high percentage of cases, the patient has what appears to be a successful surgery, though the patient continues to experience back pain. The two possible reasons for this may be:
  1. The surgery repaired or removed the damaged tissue causing the pain, but post-surgical complications occurred.
  2. The area being operated on was not the main page generator. The pain generator is the area of the body where the pain originates.
Chronic lower back pain can be either somatic or neuropathic. Somatic pain is pain that can be traced back to a particular tissue outside the nervous system, such as the muscles, bones, and connective tissues (i.e. joint tissues, tendons, and ligaments). Neuropathic pain is pain in which the nerves send pain signals to the pain in the absence of a tissue injury. Neuropathic pain is also called neuropathy or nerve pain.

As the weeks and months go by, chronic pain may take a toll on you, physically and emotionally. The way you think and the way you move your body may begin to change as the pain continues with you and you try to adjust to your new reality. One major concern is that chronic pain can, and often does, cause long-term changes in your body. For example, as you work and exercise, you may change your posture and the way you move to take some of the pressure on your lower back. These changes in the way you hold your body may cause muscle imbalances in your middle and upper back, as well as your arms and legs.