Chronic Lower Back Pain: A Complete Guide For Patients & Physicians

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Lower back pain is the second most common reason why people visit their doctor. Back pain that continues for at least three months is considered chronic (meaning it lasts longer than expected).

Chronic lower back pain can interfere with daily activities and be disabling.

It will affect a person’s mental health, social life, sleep, work performance, and overall quality of life.

Many factors affect a person’s risk for back pain, including age, body type, lifestyle habits, and genetic factors.

Living with back pain is the most frustrating thing for most people. First, sometimes the pain is unbearable. And second, back pain can be an obstacle in completing your everyday jobs.

Cleaning the house, playing with your kids, are both things that are much harder to do if you suffer from chronic back pain.

The back is made up of many different muscles that are constantly working to support you and maintain your posture. When one or more muscles are injured or strained, the result can be pain in the lower back.

According to its definition, chronic lower back pain usually lasts more than 3 months. This condition affects millions and millions of people throughout the whole world.

If we see for example the United States, more than 80 % of the population experiences chronic back pains in some period in their lives. Chronic back pain is one of the most common chronic pains.

Chronic back pain can range from a muscle ache to a shooting, burning, or stabbing sensation.

Approximately one out of five adults suffer from back pain. Studies have shown that chronic back pains are especially common in people who are obese, older people, people with low muscle mass, and tall people.

Apart from being so common, chronic back pain is also a very painful condition. Every person has a different experience with it, but overall, it sure affects our lives.

What is Chronic Low Back Pain?

Chronic low back pain is chronic pain in the lower back. It can last 3 months or longer and often interferes with daily life.

Chronic Low Back Pain is defined as a musculoskeletal disorder and it is a very common condition.  It is the second reason (after headaches) for people seeking medical help.

What Causes Chronic Low Back Pain?

The precise cause of lower back pains can’t be exactly defined, especially when it comes to chronic lower back pains.

However, several sources and conditions might cause lower back pains. The causes are usually different in younger versus older individuals.

Most Common Causes for Lower Back Pain in Younger People:

Most Common Causes for Lower Back Pain in Older People:

  • Osteoarthritis;
  • Spinal stenosis;
  • Fracture caused by compression.

Other possible causes:

  • Fibromyalgia.
  • Infection.
  • Spinal tumors.
  • Piriformis Syndrome.
  • Severe Depression.
  • Ankylosing spondylitis.

Why Does Chronic Low Back Pain occur?

Chronic low back pain occurs after an injury to the back or chronic stress on the muscles that surround your spine. This can be caused by many things such as accidents, injuries, and obesity. Some people just have chronic back pain with no apparent cause.

Sometimes chronic low back pain can lead to long-term disability, which interferes with a person’s ability to work.

Chronic Low Back Pain Symptoms

Low Back Pain. The first symptom that you suffer from chronic lower back pains is this.

Leg Pain. The most common symptom in people who suffer from chronic back pain is leg pain. The pain can start from your lower back and go all down your feet.

The pain may radiate down your leg or worsen with bending, twisting, lifting, standing, or walking.

Pain that reacts to certain movements or positions. If you notice that your pain is worse when you do a certain movement or sleep in a certain way, this can also be a symptom.

Stiffness. If you suffer from chronic lower back pains it is possible that you feel muscle stiffness throughout your body or in some parts.

Morning and Evening’s Pains. You may notice that your pains are worse in the morning or the evening when the body is calm.

How Do Doctors Diagnose Lower Back Pain?

A physician can use a variety of tests to locate any problems in the back or neck and help figure out the cause of lower back pain.

Because there may be more than one possible option, in-depth analyses and a complete medical history of the patient are necessary.

You will also have to do your best in explaining the pain to your doctor because that’s the most important factor in diagnosing your condition.

A medical history along with a physical examination is usually enough to diagnose a patient’s condition.

The physician will ask about what treatments have been tried in the past, how long the pain has been present if there was an injury or trauma that caused it and other related information.

A physical examination of the back and neck is necessary to look for signs of pain, tenderness, and any areas of decreased mobility.

A physician will also check whether a person can feel different sensations such as heat or cold or if they have any problems moving their arms and legs.

The following tests may be done on patients with chronic lower back pain to determine the cause of their symptoms:

X-rays will reveal any fractures or bone abnormalities.

An MRI (magnetic resonance imaging) can help in visualizing soft tissue injuries, infections, tumors, spinal cord compression, and damage to the nerves.

Computed tomography (CT) scan is another imaging test that provides information about any compression in the spinal cord or pinched nerve roots, tumors, aneurysm, infection, deformities, inflammation of facet joints, and any injury to the disc.

A CT myelogram reveals compression of nerve roots in places where there is a narrowing of the channel that carries blood to the spinal cord.

Ultrasound uses high-frequency sound waves to create detailed images of soft tissue and can help detect herniated discs, tumors, infections, and the extent of nerve compression from conditions such as spinal stenosis.

Based on a person’s medical history and physical examination findings, a doctor may order tests to determine the cause of lower back pain.

Many times the results of these tests are normal, which means additional testing is needed to find out what is causing the patient’s symptoms.

Blood tests can check for causes such as rheumatoid arthritis or any other autoimmune disorder that may cause inflammation in the joints and muscles normally found in or around the back.

What is the Best Treatment for Lower Back Pain?

There is no doubt that the most effective treatment is to see your healthcare professional and get a proper diagnostic of what causes your chronic lower back pain.

The treatment of chronic lower back pains depends a lot on the cause of it. In general, no matter what the cause is, there are 4 possible options: self-care, medications, surgeries, and other alternative therapies.


Self-care is the most important thing no matter what condition is the problem. Self-care can serve as prevention or as a treatment for the already painful back.

Eating healthy, losing weight if you are obese, exercising, sleeping well and comfortably, having a good posture, watching out for sudden movements, trying not to lift too heavy things… all these are important for good self-care.

The pain of the lower back is mainly because most people have weak core muscles, they have poor posture which leads to the appearance of spinal muscle injuries. If you use too heavyweights in exercises for your back, it can lead to injury as well.

There are many things that you can do to treat your lower back pain. The most important thing is not to wait for the pain to go away but take action immediately.

If you wait too long, your muscle injuries may worsen and degenerate into chronic lower back pain.

 Lower Back Pain Medications

If your pains are not too big, you should start with some easier pain killers. Over-the-counter pills can be a good solution.

If you can’t find relief in those medications, your doctor can prescribe some stronger options. Antidepressants or some anti-inflammatory medications can also be an option.

The list below is from the most commonly used to the less commonly used.

  • Tylenol
  • Aspirin, or products that contain aspirin.
  • Ibuprofen (Advil). Lower doses of ibuprofen can be used in combination with Tylenol to improve the efficacy.
  • Naproxen (Aleve). Higher doses are needed in comparison to ibuprofen, especially if the pain is caused by inflammation.
  • Celebrex to reduce inflammation. They are generally used in combination with other medications, due to their high price.
  • Voltaren or diclofenac for an increased effect on pain and inflammation.
  • Mobic may be prescribed if Celebrex is ineffective.
  • Nabumetone (Relafen) to relieve severe pain caused by inflammation.

The list above is commonly prescribed over-the-counter medications to treat symptoms of low back pain.

If these medications don’t improve your symptoms, some stronger prescription drugs can be prescribed.

However, if you are on any of the following medications you need to consult with your doctor before taking any medication for lower back pain.

Surgeries for Lower Back Pain

This is only for extreme conditions. There are several types of surgeries available depending on the condition. Consult your doctor and see what’s good for you.

  • Laminectomy
  • Discectomy
  • Spinal fusion
  • Foraminotomy
  • Disk replacement
  • Interlaminar implant surgery (ILIS)
  • Transforaminal lumbar interbody fusion or TLIF
  • Posterior motion device surgery
  • Artificial disc replacement

Alternative Treatments for Lower Back Pain

Physical therapy or some other activity, like yoga or meditation, can also be good for you.

Here is one of the most effective alternative treatments for lower back pain.

For some people, lower back pain can be debilitating. Research has found that over time, exercise is more helpful than staying in bed or taking medication for relief from this type of discomfort.

One of the most effective exercises to relieve pain and increase flexibility for those with back trouble is swimming.

Swimming is easy on the joints, as it is a weight-bearing exercise that causes less stress than running or jogging.

The water supports your body as you move through it, making swimming easier on the spine and lower body. Swimming actually can help build muscle tone as well as increase endurance.

Yoga, meditation, and other exercises that focus on breathing also are helpful in relieving lower back pain.

Practicing yoga can be very beneficial for your physical well-being. When you feel stress or tension, taking a few minutes to practice deep breathing can help relieve muscle stiffness or discomfort. It may take time to become accustomed to this type of exercise, but it is worth it.

In some cases, physical therapy may be helpful in alleviating the pain associated with lower back problems.

Tips to Relieve Lower Back Pain

If you have acute lower back pain, it’s best not to remain in bed, Dr. McAlister said. Instead, get up and walk around to help the back heal.

When you feel like sitting or lying down, use a firm mattress with pillows supporting your spine (you may need extra pillows behind your back), he said. Don’t lean against the headboard; support your lower back instead.

If you can’t change your mattress, use a thick pillow between your knees to support your spine while sitting or lying on your back.

If you’re overweight, losing just 10 pounds can reduce lower back pressure and help relieve pain, Dr. McAlister said. And if you have chronic lower back pain, there are simple exercises that can help.

If you have lower back pain and stiffness, Dr. McAlister suggests these exercises:

1. Stand with your feet shoulder-width apart and arms relaxed at your sides. Put your chin down, push out your chest and slowly arch backward as if trying to touch the ceiling with your head. Hold for one second, then slowly roll your back up to the starting position. Repeat 10 times, then do three sets of 10 daily.

2. Stand with your arms at your sides and feet hip-width apart. Put your right hand on a sturdy chair or table for support, and slowly bend forward from the hips as if bowing with straight legs. Touch the floor with your palms if you can. Hold the stretch for 30 seconds, then relax. Repeat with your left hand on the chair and repeat three times daily.

3. Lie facedown with each arm resting at your side on a table or desk, elbows bent to 90 degrees so that your upper arms are parallel to the floor and your forearms are perpendicular. Push with your forearms against the desk or table for one minute, then relax. Repeat 10 times, 3 times a day.

Do not do exercises that push you into pain; if you experience sharp pain during any exercise, stop. Also avoid these aggravators: sitting on soft seats (such as couches), doing repeated twisting motions, and doing heavy lifting without good form and strengthening exercises.