Chronic back pain

What is chronic back pain?

The term ‘chronic’ means something that has lasted for a long time. If you have experienced back pain that lasts for 3 months or more, it is referred to as chronic. Each of us feels pain in a different way, and back pain can be present anywhere along the spine. One of the most common sites is the lower back since it bears the weight of the rest of your spine and upper body, putting a lot of stress on the bones and soft tissues in the area. Around 80% of adults will experience lower back pain at some point during their lives.

Why does it happen?

To help understand chronic back pain, it is useful to know about the structures in your spine. The spine is made up of many bones, called vertebrae, which are ‘stacked’ on top of each other. These vertebrae are connected by tough bands of tissue, called ligaments, and a number of muscles attach to them as well. Soft rubbery discs separate the bones, cushioning them from impacts and allowing the spine to bend. Problems with these structures can cause them to function incorrectly and this will often lead to pain.

What causes chronic back pain?

The causes of chronic back pain can differ depending on the location of the pain. For example, neck pain is often caused by problems with the muscles of the shoulders, the bones in the neck, or nerves in that region.

If you have chronic pain in your upper (thoracic) spine – below the neck, between the shoulder blades – which has not been caused by an injury, you should speak to your doctor immediately as this can sometimes indicate something more serious.

Lower back pain has a wide range of causes and risk factors. Being of older age, being overweight, sustaining an injury to your back or being pregnant can all increase your risk of developing chronic lower back pain. Below are some of the commonest causes of chronic lower back pain:

• Cauda equina – The cauda equina is formed by nerve roots caudal to the level of spinal cord termination. Cauda equina syndrome is caused by compression of the nerves, causing one or more of the following: bladder and/or bowel dysfunction, reduced sensation in the saddle (perineal) area, and sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss, reflex change).
• Slipped disc – also called a prolapsed disc. Your spinal discs have two layers; usually, the inner layer is contained by the hard outer layer, but sometimes it can rupture through a weak area and put pressure on nearby nerves, causing pain. Men are twice as likely to suffer a slipped disc as women, and it commonly occurs between the ages of 30 and 50 years
• Spinal stenosis – the spinal cord runs down the length of the vertebral bones through a space called the spinal canal. This space can become narrowed due to wear and tear with age and this puts pressure on the spinal cord, leading to lower back pain. Spinal stenosis commonly affects people over 60 years old
• Sciatica – this occurs when the sciatic nerve becomes compressed as it leaves the spine. The sciatic nerve runs down from the lower back to the buttocks and back of the leg(s) so pain is mostly felt in these areas. Sciatica is often caused by a slipped disc or spinal stenosis
• Scoliosis – this is a sideways curve of the spine to the left or right, which puts extra strain on the bones, muscles and ligaments, leading to pain. Scoliosis usually develops during childhood growth, and the cause is not always known
• Non-specific back pain – this is a term used to describe back pain without any obvious cause. Often it is due to sprains and strains, or minor problems with the structures in the spine that are difficult to see with tests

How is chronic back pain diagnosed?

Your doctor will ask you some questions about your pain and other symptoms and perform a careful assessment to identify where the pain is coming from and how it is affecting you. Imaging such as x-rays, CT or MRI scans might be used by your doctor to help view the spine and confirm a diagnosis.

If you have any of the following symptoms, you should seek urgent medical attention as it may point to a more serious underlying cause:

• Loss of control of your bladder or bowels – this is called cauda equina syndrome, a medical emergency, and you should go straight to A&E
• Pain in the upper (thoracic) spine between the shoulder blades that spreads to the chest
• Pain that develops slowly over months and is gradually getting worse and worse
• Unexplained weight loss
• Weakness or numbness in the legs

How is chronic back pain managed?

There are a number of ways in which chronic back pain can be managed. The first line of management involves lifestyle modifications:

• Try to stay active and mobile but avoid activities that cause pain
• Physiotherapy and light exercise, such as walking, swimming or using an exercise bike can help. These focus on loosening up the spine and strengthening the muscles that support it. This helps to reduce pressure on your bones, nerves and soft tissues
• Take appropriate pain relief, which will enable you to stay mobile

Sometimes, spinal injections to provide pain relief directly to the affected area may be offered. The treatments above will often be successful at relieving your chronic back pain, but if you are still experiencing pain then additional treatments can be considered.

If treatment has not been effective after 6 months, then surgery is the next option. Depending on the cause of your back pain, different operations are available, but not all types of chronic lower back pain can be managed with surgery:

• Spinal fusion – this joins together two or more of your vertebral bones, reducing painful movement and stabilising the spine. It is often performed to treat scoliosis or a badly degenerated spinal disc
• Disc replacement – a damaged (herniated) spinal disc can be removed and replaced by an artificial one
• Decompression of the spine – commonly performed for spinal stenosis to reduce pressure on the spinal cord

Chronic back pain is an extremely common complaint, and it can range in severity. Pain in the lower back is very likely to affect you at some point in your life, and there are a number of treatments that can help to manage it, depending on the cause. If you're struggling to cope with chronic (long-term) pain, our pain management experts offer a wide range of treatments and therapies to improve your quality of life.