Chronic Low Back Pain
What is chronic low back pain?
What are the signs of chronic low back pain?
What causes chronic low back pain?
How does my doctor tell if I have chronic low back pain?
How is chronic low back pain treated?
Low back pain is a condition that affects 80% of the general United States population at some point in life, often to the point of missing work because of it. Chronic low back pain is long-lasting, lower back pain—it is defined as continuing for more than three months—and has many different causes, some of which are listed below.
- Mild to severe pain in the lower back that has lasted for more than three months
- Morning stiffness
- Sleep interruptions due to pain
- Tiredness and/or irritability
- Inability to sit or stand for long periods of time
There are many possible causes of chronic low back pain:
- An accident or physical trauma of some kind that affects your lower back
- Wrong movements at work or play
- Posture-related causes, for example, if you have developed a way of sitting or standing that is putting stress on your lower back
- A ruptured disc (protruding or herniated disc), when the discs between the bones in your back are under constant pressure. As discs degenerate and weaken, cartilage in your back (translucent elastic tissue) can bulge or be pushed into the space that contains the spinal cord or a nerve root, causing pain.
- Cauda equina syndrome—a disc pushed into the spinal canal—a serious complication of a ruptured disc.
- Sciatica, a condition which can be caused (among other processes) by a ruptured (or herniated) disc presses on the spinal root nerve, which passes through the spine down into the leg.
- Spinal degeneration from disc wear and tear can lead to a narrowing of the sciatica nerve and spinal canal. A person with spinal degeneration may experience stiffness in the back when they wake up or may feel pain after walking or standing for a long time.
- Spinal stenosis, a narrowing of the spinal column that causes pain by producing pressure on the nerve roots. Some people are born with a tendency to develop this condition.
- Osteoporosis is an age-related bone disease. It is the progressive decrease in bone density and strength. Breaking of brittle, porous bones in the spine and hips can happen when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop this condition. Irregularities of the skeleton can produce strain on the bones and supporting muscles, tendons, ligaments, and tissues supported by the spinal column. These irregularities include scoliosis, a curving of the spine to the side, and other conditions.
- Stiffness and tenderness of the connective tissue structures (fibromyalgia, fibromyositis), may cause pain, tiredness, and multiple tender points, particularly in the neck, spine, shoulders, and hips.
- Severe infection to or inflammation of the spinal joints (spondylitis), which is chronic back pain and stiffness. There are also other painful inflammations in the lower back, including osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints, the region between the sacrum and the ilium at the bottom of the back).
Your doctor may take some of the following steps to see what kind of chronic low back pain you have:
- Listen carefully to your description of what happened and what it feels like
- Arrange for a neurologic examination
- Take a medical history, including asking questions about your family's health, especially if a relative has had chronic low back pain
- Carry out a physical examination. Functional evaluation may include flexibility, lifting, and walking tests to see what you can do now compared to what you want to be able to to do
- Order X-rays to get a clear view of the bones in the back, if indicated
- Order an MRI (magnetic resonance image) to get a clearer view of the soft tissue, discs, and nerves in your spine, if indicated
The choice of treatment depends entirely on the cause of the low back pain. Some types may benefit from exercise, physical therapy, massage, and/or medications, whilst others may benefit from injections, bracing, or surgery. The treatment program will be discussed with your doctor. DHMC also has a special team of Spine Center professionals—in the Functional Restoration Program—responsible for treating, counseling, and educating patients when they are not going to have surgery.
See our suggestions for exercises that can help relieve low back pain on our Dartmouth-Hitchcock Healthwise® Health Encyclopedia website.
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