Chronic Back Pain Needs Special Attention and Targeted Treatment

Treatment for ongoing (chronic) low back pain
Chronic low back pain is pain that has lasted longer than 3 months. As low back pain continues beyond 3 months, it becomes vitally important that you develop skills for managing and coping with chronic pain so you can avoid getting into a cycle of sleeplessness, inactivity, irritability, depression, and more pain.

Chronic pain often requires both psychological counseling and medical treatment, because pain has a wearing effect on both the mind and the body. Seek out a cognitive-behavioral therapist who can teach you stress management and pain control skills. Look for a "back school" program and at least one type of health professional who specializes in spinal care. The most successful programs are usually those that combine exercise, activities to increase your function, and techniques to help you manage pain. Depending on your condition, you can start taking charge of pain by continuing with home treatment measures and using one or more of the following treatments:

• Daily exercises to strengthen your trunk and back. See a physical therapist for specific exercises. For more information, see:
  • Fitness: Increasing core stability.
  • One
  • study
  • suggests
  • that
  • this
  • type
  • of
  • exercise
  • may
  • be
  • more
  • effective
  • than
  • either
  • manual
  • therapy
  • or
  • education
  • as
  • a
  • part
  • of
  • physical
  • therapy
  • for
  • chronic
  • low
  • back
  • pain.
  • Low back pain: Exercises to reduce pain.
• Medicine if needed. They are not effective for all people, but medicines that doctors sometimes suggest for low back pain include:
  • Acetaminophen to reduce pain and/or medicines that reduce pain, swelling, and irritation, including ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn), and ketoprofen. These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
  • Prescription pain medicine or muscle relaxants for a short time, to help break the pain cycle.
  • Antidepressants, to treat chronic pain. This type of medicine not only treats depression but may have an additional effect on chronic pain.
  • Anesthetic or corticosteroid injections, to block pain sensation or reduce inflammation.
• Other therapies. These may include:
  • Heat and/or ice, depending on which seems to help you more. You may want to try switching between heat and cold.
  • Therapeutic massage, to ease muscle spasm.
  • Spine adjustment (manipulation), by an osteopath, chiropractor, physiatrist, or a physical therapy spine specialist. People who benefit from this usually notice improvement after one visit, and additional manipulation is not needed.
  • Cognitive-behavioral therapy or biofeedback, for controlling pain and pain triggers. See a psychologist, licensed counselor, or clinical social worker who specializes in pain management skills.
  • Acupuncture, which may help decrease pain and increase activity. Some studies show that acupuncture reduced pain and disability related to back problems more than usual treatment. In contrast, a summary of several studies showed that acupuncture reduced pain and increased the ability to be active, but not any more than other treatments.

Several experimental treatments are controversial and not widely used. These include:

• A traction-like treatment called vertebral axial decompression.
• Percutaneous disc decompression such as intradiscal electrothermic therapy (IDET).
• Radiofrequency ablationfor facet joint pain.
• Botulinum (Botox) injection.
• Prolotherapy.

Facet joint injections and spinal traction are not considered to be safe and effective treatments for chronic low back pain.

Treatment if low back pain gets worse or comes back
See your doctor if you have moderate to severe low back pain that lasts more than a couple of days; if you have back or leg symptoms that have gotten worse; if your symptoms have not gone away after 2 weeks of home treatment; or if improved symptoms flare up again. A physical exam and possibly an imaging test may produce new information about your condition and help direct your treatment decisions.

• If no serious cause of mild to moderate low back pain is apparent (as in 85% of cases), your health professional will probably advise you to continue with home treatment. Consider seeing a physical therapist for back-healthy exercises to use every day, as long as they don't make your symptoms worse. A medicine to reduce pain, moist heat application, massage, cognitive-behavioral therapy, learning how to best use your back in a "back school" program, chiropractic therapy (also called spinal manipulation), or biofeedback may also help prevent your symptoms from becoming chronic.
• If your pain is severe, your doctor may recommend short-term use of an opiate painkiller, epidural steroid injection, or muscle relaxant. These medications have potential harms and side effects, but these may be balanced out if the medicines help you. Epidural steroid injections are usually used only for people with symptoms from a herniated disc, such as pain in the buttocks and down into the leg. Talk with your doctor about the expected benefits and side effects of any medicine.
• If your pain is caused by another health problem, such as a herniated disc, spinal stenosis, ankylosing spondylitis, osteoarthritis, cancer, or infection, your doctor will make specific treatment recommendations.

If you have a herniated disc, your doctor may recommend surgery. Most doctors will wait to consider surgery until after you have tried nonsurgical treatment for 1 to 3 months without improvement (but usually before more than 6 months have gone by). Surgery is eventually considered for about 1 out of 10 people who have a herniated disc.

At one time, traction was a common treatment for low back pain. Traction was thought to stretch the spine and reduce pressure on the spinal discs. Recent research does not prove that traction will reduce acute low back pain.