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Chronic back pain is defined as pain that persists for 12 weeks or more, even after an initial injury or acute back pain has been treated. About 20 percent of people with acute back pain develop chronic back pain with persistent symptoms within a year. Even if the pain persists, it does not always mean a medically underlying severe cause or a cause that can be easily identified and treated. In some cases, treatment successfully relieves chronic back pain. Still, in other cases, the pain persists despite medical and surgical treatment.

Common causes of chronic back pain

Chronic back pain is usually associated with advanced age. However, it may also be due to a previous injury. The most common causes of chronic back pain are:

  • vertebral arthritis, i.e., the gradual destruction of cartilage between the joints of the spine.
  • spinal stenosis, i.e., the narrowing of a part of the spinal canal that can cause pain due to pressure on the nerves in the area.
  • damage to the intervertebral discs (disc herniation, intervertebral disc degeneration).
  • myoperitoneal pain syndrome.

In some cases, it is difficult to identify the cause of chronic back pain. Suppose the source of the pain is not known or cannot be treated. In that case, the best option is for the patient to work with the doctor to reduce the pain’s exacerbations and treat it with non-surgical treatments.

Non-surgical treatments for chronic back pain

  1. Injectable treatments

They are used when the source of the pain is known and sometimes help rule out specific causes of back pain if the treatment does not work. Minimally invasive treatments include epidural steroid infusion, intrathecal steroid infusion, and transdermal neurolysis using radiofrequency ablation.

Injectable steroids are artificial synthetic drugs similar to cortisol, a natural hormone produced in the adrenal glands and brain. Steroids help reduce pain and inflammation and are used to treat various inflammatory diseases and painful conditions, including intervertebral disc herniation.

Epidural steroid infusion is a low-dose injection of anti-inflammatory drugs and analgesics into the lower back (waist) to relieve pain in the legs or abdomen. The drug is injected into an area called the epidural space. By reducing inflammation, epidural steroid injections can significantly help reduce pain. Epidural steroid infusion can be a treatment and a way of differentially diagnosing the source of pain in the lumbar structures when in doubt.

On the other hand, intrathecal injection of steroids is the direct injection of the same substances into the nerve foramen, i.e., at the point of exit of the nerve root from the spine.

Also, transdermal neurolysis using radiofrequency is an effective method of treatment. Many modern studies support reducing or even disappearing back pain after radiofrequency ablation (RFA) of the tiny sensory nerves located near the vertebral joints. It is a minimally invasive method aimed at destroying nerve cells by applying an electric field on a tissue. In this way, denervation is achieved (by cauterization or cold field), with consequent pain relief. Transdermal neurolysis using radio frequencies has evolved dramatically in recent years.

Injectable treatment can lead to remission or even elimination of pain for some time. Still, it is not a permanent solution and is used in combination with other therapies.

  1. Pharmacological treatments

Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to control chronic back pain. However, most are accompanied by side effects and are not intended for long-term use. Opioid analgesics are generally not recommended as monotherapy or as the first treatment for a patient before trying other medicines. It is also not recommended to be used as a long-term treatment. Many of them are addictive and do not address the underlying cause of back pain. They should only be prescribed after a thorough examination by a specialist and if other medicines have not been shown to be effective for the patient. In recent years there have been many clinical studies on the beneficial effects of natural anti-inflammatory drugs. It is essential that health professionals, especially those involved in the treatment and management of chronic pain, be fully informed on the various dietary supplements available to form a successful treatment plan with or without conventional medicine.

  1. Physiotherapy

Exercise is the foundation for treating chronic back pain. It is one of the first treatments that the patient should try under the guidance of a doctor and physiotherapist with experience in the spine. However, the same exercises are not suitable for all patients. The exercises should be individualized and adapted according to the patient’s symptoms and condition. It also seems important to maintain an exercise routine at home for the success of the treatment.

Physiotherapy for chronic back pain may include:

  • training to maintain proper posture
  • testing of pain tolerance limits
  • Stretching exercises and flexibility exercises
  • Aerobic Exercise
  • trunk strengthening
  1. Alternative therapies

Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other non-surgical treatments for the spine can also help treat chronic back pain.

  1. Nutrition

Some diets favor inflammatory processes in the body, especially those high in fat, processed carbohydrates and processed foods. Consult your doctor to see if your diet contributes to chronic back pain and how you can change it. Maintaining a healthy weight could also help reduce back pain by reducing the strain on the spine.

  1. Lifestyle change

The patient with chronic back pain must accept certain limitations in their daily life and adapt. He must learn to “listen” to their body and adjust the rhythm accordingly to daily activities. It is also good to observe which activities may aggravate the pain and to avoid them as much as possible. This can help reduce pain but also prevent the progression of the underlying pain-related condition. Another necessary lifestyle change is smoking cessation. Nicotine has been shown to aggravate pain and delay its healing.

When is surgery for low back pain indicated?

The following are warning signs that surgery is needed if they are found to be related to the condition of the spine:

  • new or worsening bowel or bladder disorder
  • weakness of the limbs
  • gait and balance disorders
  • signs of increased reflexes

Surgery may also be a good option in treating chronic back pain if the cause of pain is known and confirmed by imaging techniques or if other treatments have not helped.

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