Daily life
Chronic low back pain lasts longer than three months and has many contributing causes
Chronic low back pain is pain in the lower back that lasts longer than three months [1]. Most back pain improves within weeks, but some does not, and treatment usually focuses on managing pain [2][1].
Key points
- Back pain that lasts longer than three months is generally called chronic [1][3].
- Several factors can act together, and sometimes no specific cause is found [4].
- Exercise is a first-line treatment, though no single type has been shown to be best [5].
- Medicines often do not fully resolve chronic pain, so care tends to aim at pain management [1].
- Numbness or weakness in both legs or bladder or bowel changes with back pain need emergency care [2], and fever with back pain is a reason to call your doctor [4].
Chronic back pain means pain that lasts longer than three months
Pain in the lower back counts as chronic when it lasts longer than three months [1]. Another source describes pain lasting more than 12 weeks and occurring daily as chronic [4]. Most back pain is not like this. It usually improves within a few weeks [2][6].
Chronic back pain is common. It is the most widespread pain syndrome in the United States and a leading cause of years lived with disability [1].
Pain can be a dull, constant ache or a sudden, sharp pain that may shoot down the leg [4]. People with chronic low back pain also commonly describe numbness, muscle spasms, and stiffness [1].
Chronic back pain can have several causes at once
Many factors can be present together, and sometimes no specific cause is found [4].
- Mechanical or structural problems in the discs, muscles, ligaments, or tendons, or a squeezed nerve [4].
- Wearing down of the cushioning discs between the vertebrae with age [6][4].
- A herniated disc, where the soft center of a disc pushes out and presses on a nerve [6].
- Narrowing of the spinal canal, which puts pressure on the spinal cord and nerves [4].
- Inflammatory arthritis of the spine and other medical conditions [4].
Aging changes in the spine do not keep most people from living generally pain-free lives [6]. Some people with disc tears have no pain at all, and it is not clear why others do [6].
Changes in the nervous system may help keep pain going
Growing evidence suggests that changes in the central nervous system may contribute to the persistence of chronic low back pain [3]. Researchers have linked it to changes in brain regions involved in sensing and managing pain [3].
Life factors matter too. Poor sleep, depression, or anxiety can make back pain more frequent and more severe [4]. People with chronic back pain often have anxiety and depression, which may worsen pain in turn [3].
Risk also rises with being less physically fit, with obesity, with physically demanding or sitting-heavy jobs, and with age, especially after 45 [4].
Exercise and medicines both have limits as treatments for chronic back pain
| Approach | What the sources say |
|---|---|
| Exercise | A first-line, cost-effective treatment, but no single type has proven best [5]. |
| Staying active | Continuing daily activities is advised, and long bed rest is not [2]. |
| Walking, swimming, yoga, pilates | May help ease back pain [2]. |
| Manual therapy | A trained therapist massages and moves the muscles, bones, and joints [2]. |
| Medicines | Muscle relaxants, pain relievers, and steroid injections often do not resolve chronic pain [1]. |
| Brain stimulation (tDCS) | May reduce pain and slightly improve disability, but evidence is low to moderate in certainty [3]. |
| Surgery | May be an option if a condition like a slipped disc is the cause and other treatments have not helped [2]. |
Guidelines describe a stepped approach. It starts with treatments that do not use medicine, then moves to non-opioid medicines. Opioids come last, and only when the likely benefits clearly outweigh the risks [3].
For a procedure that seals off certain nerves so they stop sending pain signals, one source says it is only for long-term lower back pain [2].
Chronic pain affects more than the back
Chronic low back pain can affect physical and emotional functioning, sleep, social life, household chores, and work or school [1]. It is also linked with lower work productivity and higher healthcare costs [1].
Because of this, researchers argue for treatment that aims to reduce disability as well as pain [1]. Current clinical goals focus on pain management, since available medicines often do not fully resolve the pain [1].
Exercise research is still unsettled. A review of 223 trials found 150 different performance measures and little agreement on how exercise might work [5].
When to get care
Certain back pain signs need emergency care or prompt medical attention
Very rarely, back pain signals a serious problem such as a broken bone, cancer, or an infection [2]. These signs need emergency care:
- Pain, tingling, weakness, or numbness in both legs [2].
- Loss of feeling around the genitals or anus [2].
- Changes in bladder or bowel control, such as trouble urinating or losing control of urine or stool [2].
- Pain that started after a serious accident, such as a car crash [2].
These signs need prompt medical attention [2]:
- Feeling hot, cold, shivery, or generally unwell with back pain [2].
- Severe pain that starts suddenly or quickly gets worse [2].
Fever, chills, or unexpected weight loss with back pain are also reasons to call your doctor [6].
If you think you may have a medical emergency in the United States, call 911 or go to the nearest emergency room.
A primary care doctor can check your back when pain lingers or has warning features
See a doctor if your pain does not improve after a few weeks [6][4]. The same applies if it stops you from doing daily activities, or is worse at night or when you cough or sneeze [2].
- A lump or swelling in your back, or a change in its shape [2].
- Pain at the top of the back between the shoulders rather than the lower back [2].
- Severe pain that does not improve with medication [4].
- Pain that is always present regardless of activity or position, or a history of cancer [6].
A doctor will usually ask about your history and examine your back. This can include bending tests and checking reflexes, strength, and sensation in your legs [6].
Sources
- Patient Experiences of Chronic Low Back Pain: Development of a Conceptual Model Based on a Targeted Literature Review and Qualitative Patient Interviews Musculoskeletal care
- Back pain nhs.uk
- Effects of transcranial direct current stimulation on patient-reported outcomes in chronic low back pain: a systematic review and three-level meta-analysis Frontiers in medicine
- Back Pain Symptoms, Types, & Causes niams.nih.gov
- Selection and justification of performance-related measures in exercise trials for people with chronic low back pain: A scoping review and content analysis Musculoskeletal science & practice
- Low Back Pain orthoinfo.org
Not medical advice. This page is general education written from the sources above. It cannot diagnose a condition or replace a licensed clinician who knows your history. If you may be having an emergency, call your local emergency number or go to the nearest emergency department.