Brief Overview: Chronic low back pain is pain, stiffness, or discomfort in the lower back lasting longer than 3 months. It may be mechanical (related to muscles, ligaments, discs, or joints), neuropathic (nerve compression/irritation), or nonspecific. It is one of the leading causes of disability worldwide and often impacts function, mood, and quality of life.
Prevalence:
Etiology:
- Degenerative spine disease: osteoarthritis, degenerative disc disease, spinal stenosis.
- Musculoskeletal strain: repetitive lifting, poor posture, deconditioning.
- Nerve-related: herniated disc, sciatica, radiculopathy.
- Structural: scoliosis, spondylolisthesis.
- Other contributors: osteoporosis fractures, inflammatory conditions, prior trauma or surgery.
Risk Factors:
- Age
- Overweight, obese
- Sedentary lifestyle
- Stress, depression
- Physically demanding job
- Tobacco use
Commonly Associated Conditions:
- Osteoarthritis, spinal stenosis, degenerative disc disease
- Sciatica and radiculopathy
- Osteoporosis and vertebral fractures
- Depression, anxiety, and sleep disorders
- Chronic pain syndrome
Common Medications:
- acetaminophen, topical NSAIDs (diclofenac gel)
- NSAIDs (oral): ibuprofen, naproxen (caution in some)
- Duloxetine, TCAs
- Muscle relaxants: short-term only; avoid chronic use in seniors
- Opioids: avoid long-term; may be used in refractory cases under specialist oversight
- Topical treatments: lidocaine patches, capsaicin cream
- Adjuncts: antidepressants for mood/pain modulation
Common Labs, Imaging, and Tests:
- X-ray, MRI, CT
- Additional tests may be ordered if indicated
Common Symptoms:
- Dull, aching, or sharp pain in the lower back (≥3 months)
- Stiffness
- Pain radiating into buttocks or legs (sciatica)
- Muscle spasms or tightness
- Reduced flexibility, difficulty standing/walking long periods
- Sleep disturbance, fatigue, mood changes
Common Treatments:
- Non-Pharmacologic (cornerstone):
- Physical therapy: strengthening, stretching, posture training.
- Exercise: low-impact (walking, swimming, yoga, tai chi).
- Heat therapy for stiffness, ice for acute flare-ups.
- Ergonomic adjustments: chairs, mattresses, lifting techniques.
- Weight management to reduce strain.
- Cognitive-behavioral therapy (CBT) for chronic pain coping.
- Pharmacologic:
- Stepwise use of acetaminophen, NSAIDs, neuropathic agents, topical therapies
- Typically avoid long-term opioids or muscle relaxants
- Interventional:
- Epidural steroid injections, nerve blocks
- Radiofrequency ablation (for facet joint pain)
- Surgery (rare)
Physical Findings:
- Local tenderness or stiffness in lumbar region
- Limited range of motion
- Abnormal posture or gait
- Neurological findings if nerve involvement: weakness, numbness, reflex changes
- Muscle tightness in paraspinal or hamstring muscles
Potential Complications and Contraindications:
- Complications:
- Functional decline, disability, falls
- Chronic opioid or NSAID overuse
- Depression, anxiety, sleep problems
- Progression to spinal stenosis or deformity
- Contraindications:
- NSAIDs: avoid in renal disease, GI ulcers, heart failure
- Muscle relaxants: avoid long-term use in some (sedation, fall risk)
- Opioids: high risk of dependence, confusion, falls
- Benzodiazepines, antiepileptics, systemic corticosteroids, glucosamine, herbal preparations, cannabis are generally not recommended for chronic low back pain
General Health and Lifestyle Guidance:
- Stay active — ask your healthcare provider what exercises are recommended for you
- Daily stretching and strengthening, especially core and back muscles
- Use proper posture when sitting/standing
- Maintain a healthy weight
- Supportive sleep environment (firm mattress, correct pillows)
- Manage stress with relaxation, mindfulness, or counseling
- Avoid smoking
Suggested Questions to Ask Patients:
- How long have you had back pain, and how does it affect your daily life?
- Does pain radiate into your legs or cause numbness/tingling?
- What activities worsen or improve your pain?
- Do you use pain medications? How often? Do they help?
- Have you tried physical therapy or exercise programs?
- Do you have sleep disturbance or low mood due to pain?
- Have you noticed red flag symptoms (weight loss, fever, bowel/bladder changes, leg weakness)?
Suggested Talking Points:
- The best results often come from combining exercise, posture changes, and safe medication use
- Staying active is important — gentle movement usually helps more than prolonged rest.
- Physical therapy and lifestyle changes can reduce pain and improve independence.
- If you develop new weakness, loss of bladder/bowel control, or severe pain, that’s a red flag — call your doctor right away. Ask your healthcare provider for any other warning symptoms and advice on when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/subacute-and-chronic-low-back-pain-management?search=chronic%20low%20back%20pain&source=search_result&selectedTitle=1~61&usage_type=default&display_rank=1
- https://medlineplus.gov/ency/article/007422.htm
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.