Chronic Back Pain - Common Causes and Treatment

Introduction

If back pain persists for three months or longer, the disease is considered chronic. The pain is often intermittent, bringing episodes of temporary relief followed by excruciating pain. Management of chronic back pain can be challenging if the underlying cause remains obscure.

What Are the Common Causes Behind Back Pain Being Chronic?

Chronic back pain usually occurs as a manifestation of the aging process. However, it can also result from prior injuries caused by trauma or repetitive strain. The common causes behind chronic back pain are enlisted as follows;

• Arthritis of the Spine: Arthritis occurs due to the gradual wearing away of the cartilage discs present within the spine between the vertebrae.

• Disc Disease: Disc conditions such as herniated or bulging disc could result in severe back pain. Due to chronic wear and tear the disc dehydrates and it results in the peripheral layer of the disc bulging outwards also known as bulging disc. Progressively a bulging disc may result in a herniated disc where the internal gelatinous material of the disc extrudes out completely.

• Myofascial Pain Syndrome: This type of pain of unexplained origin occurs in the muscle.

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The underlying cause behind some cases of the chronic back is difficult to pinpoint. If all other diagnostic options have been exhausted with no definitive diagnosis or treatment plan, a second opinion from a back pain specialist should be sought. Rushed decisions to undergo extensive medical and surgical procedures without identifying the origin of the pain are inadvisable. This could fail to address the symptoms and cause them to aggravate. If the source of the pain is obscure or treatment is not possible, the best option is to reduce the intermittent flare-ups and pain management with non-surgical treatment modalities.

What Are the Non-Surgical Treatment Modalities for Chronic Back Pain?

1) Physiotherapy: Exercise is one of the key treatment modalities for chronic back pain. It is the first line of treatment that should be opted under the guidance of a physician and spine physical therapist or occupational therapist. However, the same set of exercises does not yield similar results in all cases. The activities need to be tailored to the patient's specific needs depending upon the symptoms and the underlying conditions. Maintaining a proper exercise regimen at home is also a big part of success.

Physical therapy for chronic back pain includes the following;

• Retraining the patient's posture while sitting, walking, or performing other tasks.

• Testing the pain tolerance of the patient.

• Stretching and flexibility exercises as directed by the physician or therapist.

• Aerobic exercises.

• Core strengthening to improve muscle strength.

2) Mindfulness and Meditation: Chronic back pain causes both physical and emotional torment to an individual. To manage frustration, irritability, depression, and other psychological aspects of chronic pain, a rehabilitation psychologist must be consulted to address the psychological manifestations stemming from the condition. In addition, the specialist may recommend alternative treatments such as meditation, yoga, tai chi, and other cognitive and relaxation strategies to divert the mind from focusing on the pain and overall improve the quality of life.

3) Diet: Studies show that some diets are highly inflammatory, especially those high in trans fats, refined sugars, and processed foods. Therefore, a doctor should be consulted to identify if the patient's diet could contribute to chronic back pain, and modifications must be suggested to it accordingly. A healthy weight could also help lessen back pain by reducing the pressure on the spine.

4) Lifestyle Modifications: Chronic pain cases necessitate patients to identify their limitations and adapt their activities accordingly. Taking a break while performing daily menial tasks is advisable. Making a note of the activities that aggravate the pain and avoiding them could also alleviate the pain. This could result in subsiding the pain and prevent the underlying condition from advancing. Quitting smoking may also help as nicotine is scientifically known to accentuate and aggravate pain and cause a delay in the healing process.

5) Injection-based Treatments: Injection-based treatments for chronic back pain may be viable; treatment modalities such as nerve blocks, epidural steroid injections, nerve ablations, and other procedures. These procedures may be used when the source of the pain is known or when to rule out specific other causes if the patient does not respond to treatment. Injection-based therapy may cease or alleviate pain for a limited period but is not intended as a long-term solution. Therefore, these treatments should never be used in isolation and only as adjuncts in severe cases for pain management.

6) Alternative Treatment Modalities: Alternative therapies such as acupuncture, massage, biofeedback, laser, electrical nerve stimulation, and other non-surgical spine treatments can also help alleviate chronic back pain. A spine specialist should be consulted to know about alternative treatment modalities that could benefit the patient.

7) Pharmacotherapy or Drug-based Treatment Modalities:

• Analgesics or painkillers, anti-inflammatory drugs such as Ibuprofen and Naproxen, skeletal muscle relaxants, and in extreme cases, opioid-based medications can be used for chronic back pain management. However, the adverse effects of the drugs, as mentioned before, should be considered, and prolonged use should be avoided.

• Opioid-based medications are not used as the first line of treatment and should be considered only for a long-term line of treatment. Most opioids are addictive and do not address the underlying cause of pain, and the body may build up a tolerance over time. A thorough examination by a specialist and only if other drugs have failed to provide relief should opioid therapy be considered.

What Are the Surgical Treatments for Chronic Back Pain?

When non-surgical and drug-based therapies fail, surgical options must be sought. The surgical treatments for chronic back pain are enlisted as follows;

1) Spinal Fusion: Spinal fusion is performed under general anesthesia. During the procedure, the blood pressure and heart rates are constantly monitored using a pressure cuff and lead on the chest, which allows the surgeon and anesthesiologist to monitor the vital signs during surgery which may take several hours.

A bone graft is prepared to fuse the two vertebrae, which may be derived from the patient's pelvic bone. Synthetic bone grafts or allografts may be obtained from a bone bank or a consenting donor.

2) Laminectomy

• Bilateral Laminectomy: In this procedure, both sides of the lamina are removed with or without widening the intervertebral foramina or adjacent tissue and bone removal.

• Unilateral Laminotomy: In this procedure, a part of the entire lamina of the affected vertebra is removed with or without adjacent tissues only on one side.

It may also be endoscope-guided, which is minimally invasive. It requires a smaller incision than open surgery, preserving more tissue and bone and reducing the time needed for healing.

Conclusion

Chronic back pain usually occurs as a manifestation of the aging process. However, it can also result from prior injuries caused by trauma or repetitive strain. The underlying cause behind some cases of the chronic back is difficult to pinpoint. If the source of the pain is obscure or treatment is not possible, the best option is to reduce the intermittent flare-ups and pain management with non-surgical treatment modalities. When non-surgical and drug-based therapies fail, a surgical option must be sought.