Take control of your chronic back pain with Meri Sehat's guide to causes and treatment options. Our comprehensive resource provides you with an in-depth understanding

Chronic Back Pain

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Iqra Mazhar

Overview

Chronic back pain is an ongoing or recurring pain that lasts for 12 weeks or longer even after the underlying cause has been treated. The condition can significantly affect an individual&#39;s quality of life. 
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Chronic back pain is a common health problem that affects millions of people worldwide. The condition is often the result of a combination of biological and psychosocial factors, including structural abnormalities and emotional distress. 
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One of the primary mechanisms of chronic back pain is central sensitization &ndash; a process by which the nervous system becomes more sensitive to pain signals over time due to prolonged exposure to pain, injury, or inflammation in the affected area. As a result, the individual experiences increased pain perception and decreased pain tolerance. 
&nbsp;

However, the incidence and prevalence of chronic back pain vary depending on the population studied. According to a 2020 systematic review and meta-analysis, the global prevalence of chronic low back pain was estimated to be 18.3%<a href="#accordion">[2]</a>. Another study based on a national survey conducted in 2016 estimated the prevalence of chronic pain, including chronic back pain, in the United States to be 20.4%<a href="#accordion">[13]</a>. 
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Chronic back pain can be categorized into different types based on the location and underlying cause of the pain<a href="#accordion">[5]</a>:

<ol>
	<li>Axial Pain: Axial pain is the most common type of chronic back pain. It is typically felt in the lower back area and is often caused by muscle strain, ligament sprain, or <a href="https://merisehat.pk/disease/degenerative-disc-disease">disc degeneration</a>. 
	&nbsp;</li>
	<li>Radicular Pain: Radicular pain is caused by irritation or compression of a nerve root in the spinal column. It is typically felt as a sharp, shooting pain that radiates down the leg or arm and is caused by conditions such as <a href="https://merisehat.pk/disease/herniated-disc">herniated discs</a>, <a href="https://merisehat.pk/disease/spinal-stenosis">spinal stenosis</a>, or d<a href="http://merisehat.pk/disease/degenerative-disc-disease">egenerative disc disease.</a> 
	&nbsp;</li>
	<li>Referred Pain: Referred pain is pain felt in an area of the body other than the source of the pain. In the case of chronic back pain, the referred pain occurs in the buttocks, hips, or legs, and is typically caused by a problem in the spine or surrounding muscles. 
	&nbsp;</li>
	<li>Myofascial Pain: Myofascial pain is a type of chronic pain that is caused by trigger points or knots in the muscles or connective tissue. It can cause localized pain in the back or referred pain in other areas of the body. 
	&nbsp;</li>
</ol>

Signs and Symptoms

&nbsp;Here are some commonly recognized signs and symptoms of chronic back pain<a href="#accordion">[12]</a>: 
&nbsp;

<ol>
	<li>Dull or aching pain that lasts for more than 3 months</li>
	<li>Pain worsens with certain activities, such as sitting, standing, or lifting</li>
	<li>Stiffness or reduced flexibility</li>
	<li>Sciatica, i.e., pain or numbness radiating down one or both legs</li>
	<li>Muscle spasms or cramps</li>
	<li>Pain worsens with prolonged sitting or standing</li>
	<li>Trouble sleeping</li>
	<li>Fatigue or decreased energy levels 
	&nbsp;</li>
</ol>
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Causes

Here are some common causes of chronic back pain<a href="#accordion">[6]</a>: 
&nbsp;

<ol>
	<li>Musculoskeletal Conditions: Conditions that affect the muscles, bones, and joints in the back, such as osteoarthritis, degenerative disc disease, and spinal stenosis, can lead to chronic back pain. 
	&nbsp;</li>
	<li>Injuries: Injuries to the back, such as sprains, strains, or fractures, can cause chronic pain if they do not heal properly. 
	&nbsp;</li>
	<li>Herniated Discs: A herniated disc occurs when the soft, jelly-like center of the spinal disc bulges or ruptures through a weak spot in the disc wall, which can put pressure on the nerves and cause pain. 
	&nbsp;</li>
	<li>Poor Posture: Poor posture can cause chronic back pain by putting extra strain on the muscles and ligaments in the back. 
	&nbsp;</li>
	<li>Psychological Factors: Psychological factors, such as stress, anxiety, and depression, contribute to chronic back pain by altering the perception of pain and making it more difficult to cope with. 
	&nbsp;</li>
	<li>Medical Conditions: Certain medical conditions, such as fibromyalgia, scoliosis, and cancer, can also cause chronic back pain. 
	&nbsp;</li>
</ol>

There are various screening tests used to help diagnose and assess chronic back pain. Here are some commonly used tests<a href="#accordion">[7]</a>:

<ol>
	<li>Straight Leg Raise Test: This test assesses radicular pain. The patient is asked to lie down on their back with their legs straight. The examiner lifts each leg separately to see if it triggers pain. 
	&nbsp;</li>
	<li>Spinal Range Of Motion Test: This test assesses the patient&#39;s ability to move their spine through different ranges of motion. It also helps identify specific areas that are stiff or restricted. 
	&nbsp;</li>
	<li>X-Rays: X-rays can point out structural abnormalities in the spine, such as fractures or degenerative changes. 
	&nbsp;</li>
	<li>Blood Tests: Blood tests can help identify underlying medical conditions, such as infections or autoimmune disorders, which. may be contributing to chronic back pain. 
	&nbsp;</li>
</ol>
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Diagnosis

Here are some commonly used diagnostic tests to help identify the underlying cause of chronic back pain: 
&nbsp;

<ol>
	<li>Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic field and radio waves to produce detailed images of the spine. It can help identify structural abnormalities, such as herniated discs, spinal stenosis, or tumors. 
	&nbsp;</li>
	<li>Computed Tomography (CT) Scan: CT scans use X-rays to produce detailed images of the spine. They can help assess the bony structures of the spine and, thus, identify fractures, degenerative changes, or tumors. 
	&nbsp;</li>
	<li>Electromyography (EMG): EMG measures the electrical activity of muscles and nerves in the back. It can help identify nerve damage or dysfunction that may be causing chronic back pain. 
	&nbsp;</li>
	<li>Discography: Discography involves injecting a dye into the spinal discs to assess their structure and function. It can help identify herniated discs or other disc-related problems that may be causing chronic back pain. 
	&nbsp;</li>
	<li>Bone Scan: A bone scan uses a small amount of radioactive material to identify areas of increased bone activity. It can help identify bone fractures or tumors that may be causing chronic back pain. 
	&nbsp;</li>
</ol>
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Treatment

The treatment of chronic back pain depends on the underlying cause and the severity of the pain<a href="#accordion">[6]</a>: 
&nbsp;

<ol>
	<li>Medications: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation. Prescription medications, such as muscle relaxants or opioids, are also prescribed for severe pain. 
	&nbsp;</li>
	<li>Physical Therapy: Physical therapy, including exercises or electrical stimulation, helps improve strength, flexibility, and range of motion in the back. 
	&nbsp;</li>
	<li>Surgery: Surgery is usually reserved as a last resort for certain underlying causes of chronic back pain such as herniated discs or spinal stenosis when other treatments have not had any positive effect. 
	&nbsp;</li>
	<li>Chiropractic Care: Chiropractic care involves spinal adjustments and other manipulations to help improve alignment and reduce pain. 
	&nbsp;</li>
	<li>Mind-Body Therapies: Mind-body therapies, such as relaxation techniques, meditation, or biofeedback, not only reduce stress but also improve coping skills to help deal with chronic pain. 
	&nbsp;</li>
	<li>Acupuncture: Acupuncture involves the insertion of needles into specific points of the body to reduce pain and promote healing. 
	&nbsp;</li>
</ol>

Chronic back pain can lead to several complications that can affect a person&#39;s quality of life<a href="#accordion">[6]</a>. 
&nbsp;

<ol>
	<li>Limited Mobility: Chronic back pain can make it difficult to perform everyday activities, such as bending, lifting, or walking, leading to limited mobility. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression </a>And <a href="https://merisehat.pk/disease/anxiety">Anxiety</a>: Chronic pain can cause depression, anxiety, and other mood disorders, which can further reduce a person&#39;s quality of life. 
	&nbsp;</li>
	<li>Sleep Disturbances: Chronic pain interferes with sleep, leading to fatigue and decreased energy levels. 
	&nbsp;</li>
	<li>Disability: Chronic back pain can lead to disability and prevent a person from working or participating in everyday activities. 
	&nbsp;</li>
	<li>Medication Side Effects: Long-term use of pain medications can have side effects, such as constipation, nausea, or addiction. 
	&nbsp;</li>
</ol>

Here are some commonly recognized risk factors for the development of chronic back pain<a href="#accordion">[8]</a>: 
&nbsp;

<ol>
	<li>Age: The structures in the spine degenerate with age, increasing the risk of chronic back pain.</li>
	<li>Poor Posture: Poor posture places excessive stress on the spine which can result in chronic back pain.</li>
	<li>Obesity: Excess weight, too, puts extra strain on the spine.</li>
	<li>Smoking: Smoking impairs blood flow to the spine, which can slow down the healing process.</li>
	<li>Sedentary Lifestyle: Lack of regular physical activity leads to weak muscles and poor flexibility, which can be painful and frustrating to experience.</li>
	<li>Previous Injury: A previous injury to the spine, such as a fracture or herniated disc, is another factor. 
	&nbsp;</li>
</ol>

Prevention of chronic back pain is important, and several factors can help reduce the risk of developing chronic back pain<a href="#accordion">[9]</a>: 
&nbsp;

<ol>
	<li>Regular Exercise: Regular exercise can improve muscle strength, flexibility, and endurance.</li>
	<li>Good Posture: Maintaining a good posture while sitting, standing, and lifting can reduce the strain on the back.</li>
	<li>Healthy Weight: Maintaining a healthy weight is also imperative to reduce strain on the spine.</li>
	<li>Ergonomic Workplace: Ensuring proper ergonomics at the workplace, such as using an ergonomic chair and desk, can help</li>
	<li>Safe Lifting: Using proper lifting techniques can help reduce the risk of back injury.</li>
	<li>Stress Management: Managing stress through relaxation techniques is useful in preventing muscle tension. 
	&nbsp;</li>
</ol>
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One innovative research on chronic back pain is the use of virtual reality (VR) technology to manage chronic back pain. A study published in the Journal of Medical Internet Research in 2021 investigated the feasibility and efficacy of a VR-based intervention for chronic low back pain. The study found that participants who used the VR intervention reported significant improvements in pain intensity, disability, and depression compared to those who did not use the intervention<a href="#accordion">[10]</a>. 
&nbsp;

Another recent study published in the Journal of Pain Research in 2021 investigated the use of a smartwatch-based biofeedback intervention to reduce chronic low back pain. The study found that participants who used the biofeedback intervention had significant reductions in pain severity and pain interference compared to those who did not use the intervention<a href="#accordion">[11]</a>. 
&nbsp;

Key Points

<ul>
	<li>Chronic back pain is an ongoing or recurring pain that lasts for 12 weeks or longer even after the underlying cause has been treated.</li>
	<li>One of the primary mechanisms of chronic back pain is central sensitization, which is a process by which the nervous system becomes more sensitive to pain signals over time, leading to increased pain perception and decreased pain tolerance.</li>
	<li>Referred pain is pain felt in an area of the body other than the source of the pain.</li>
	<li>The signs and symptoms of chronic back pain can vary from person to person. However, it&rsquo;s generally characterized by dull persistent pain, muscle spasms, and difficulty sleeping.</li>
	<li>Surgery is usually reserved as a last resort for certain underlying causes of chronic back pain such as herniated discs or spinal stenosis. 
	&nbsp;</li>
</ul>
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[1] American Chronic Pain Association. (2021). Understanding Chronic Pain.

[2] Hoy, D., Bain, C., Williams, G., et al. (2020). A Systematic Review of the Global Prevalence of Low Back Pain. Spine, 45(2), E67-E81.

[3] Nahin, R. L. (2018). Prevalence and Pharmaceutical Treatment of Pain in Older Americans: United States, 2013. Journal of Pain, 19(10), 1100-1106.

[4] Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 157(8), 1587–1590.

[5] Manchikanti L, Singh V, Falco FJ, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007;10(3):425-440.

[6] National Institute of Neurological Disorders and Stroke. (2020). Low Back Pain Fact Sheet

[7] Chou, R., Fu, R., Carrino, J. A., Deyo, R. A., & Johnston, R. B. (2009). Imaging strategies for low-back pain: systematic review and meta-analysis. The Lancet, 373(9662), 463-472.

[8] Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic Clinics, 25(2), 353-371

[9] American Association of Neurological Surgeons. (2016). Preventing Back Pain: Tips for a Healthier Spine

[10] Garcia-Palacios, A., Cervera, J. F., Molinari, G., Botella, C., & Banos, R. M. (2021). A Virtual Reality-Based Intervention for the Management of Chronic Low Back Pain: A Pilot Study. Journal of Medical Internet Research, 23(2), e20648

[11] Lee, Y. H., Ko, Y. J., Lee, H. Y., & Yoon, S. H. (2021). Effects of a smartwatch-based biofeedback intervention on pain and function in patients with chronic low back pain: A randomized controlled trial. Journal of Pain Research, 14, 2253-2262.