Chronic Low Back Pain

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:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.