Chronic low back pain—or chronic back pain—is defined as pain that continues for 12 weeks or longer, even after an initial injury or an episode of acute low back pain that has been treated. About 20 percent of people with acute low back pain develop chronic low back pain with persistent symptoms within one year. Even if the pain persists, this does not always mean that there is a medically serious underlying cause or an easily identifiable and treatable reason. In some cases, treatment successfully relieves chronic low back pain, but in other cases the pain continues despite medical and surgical treatment.
Common Causes of Chronic Low Back Pain
Chronic low back pain is usually associated with advanced age. However, it may also result from a previous injury. The most common causes include:
- Facet joint arthritis, meaning the gradual destruction of the cartilage between the joints of the spine.
- Spinal stenosis, meaning the narrowing of a part of the spinal canal that may cause pain due to pressure on the nerves.
- Damage to intervertebral discs (disc herniation, degenerative disc disease).
- Myofascial pain syndrome.
In some cases, it is difficult to identify the cause of chronic low back pain. If the source of the pain is not known or cannot be treated, the best option is close collaboration between the patient and the doctor in order to reduce pain flare-ups and manage the condition through non-surgical treatments.
Non-Surgical Treatments for Chronic Back Pain
1. Injection Treatments
These are used when the source of pain is known, and sometimes they help exclude specific causes of low back pain if the treatment does not work. Minimally invasive options include epidural steroid injections, transforaminal steroid injections, and percutaneous neurolysis using radiofrequency.
Steroid injectables are synthetic medications similar to cortisol, a natural hormone produced by the adrenal glands and the brain. Steroids help reduce pain and inflammation and are used to treat various inflammatory conditions and painful disorders, including herniated discs.
The epidural steroid injection is a small dose of anti-inflammatory and analgesic medication injected into the lower back (lumbar area) to relieve pain in the legs or back. The medication is injected into an area called the epidural space. By reducing inflammation, an epidural steroid injection can significantly help reduce pain. It may serve as a treatment on its own or as a diagnostic tool to identify the pain source when there is uncertainty.
The transforaminal steroid injection is the direct injection of the same substances into the neural foramen—the exit point of the nerve root from the spine.
Additionally, an effective treatment method is percutaneous neurolysis with radiofrequency. Many modern studies support the reduction or even disappearance of low back pain after radiofrequency ablation (RFA) of the small sensory nerves located near the spinal joints.
It is a minimally invasive method that destroys nerve cells by applying an electric field to the tissue. This achieves denervation (through heat or pulsed field), resulting in pain relief. Radiofrequency neurolysis has advanced significantly in recent years.
Injection therapy may lead to remission or even elimination of pain for a certain period but is not a permanent solution and is used in combination with other therapies.
2. Pharmacological Treatments
Analgesics, anti-inflammatory drugs, muscle relaxants, and other medications may be used to control chronic low back pain. However, most of them come with side effects and are not intended for long-term use. Opioids are generally not recommended as monotherapy or as a first-line treatment before other medications are tested.
They are also not advised for long-term management. Many opioids cause dependence and do not address the underlying cause of low back pain. They should be prescribed only after detailed evaluation by a specialist and only if other medications have failed.
In recent years, many clinical studies have supported the benefits of natural anti-inflammatory supplements, and it is important for healthcare professionals—especially those managing chronic pain—to stay informed so they can properly advise patients using supplements alone or in combination with conventional treatments.
3. Physical Therapy
Exercise is a cornerstone in the treatment of chronic low back pain. It is one of the first therapies a patient should try under the guidance of a doctor and a physical therapist experienced in spinal conditions. Not all exercises are suitable for all patients—exercise must be individualized and adjusted based on symptoms and condition. Maintaining a home exercise routine also seems to be crucial for treatment success.
Physical therapy for chronic low back pain may include:
- Training in proper posture
- Pain tolerance training
- Stretching and flexibility exercises
- Aerobic exercise
- Core strengthening
4. Alternative Therapies
Acupuncture, massage, biofeedback, laser therapy, electrical nerve stimulation, and other non-surgical spinal treatments may also help manage chronic low back pain.
5. Nutrition
Certain diets promote inflammatory processes, especially those high in fats, refined carbohydrates, and processed foods. Consult your doctor to determine whether your diet contributes to chronic low back pain and how it can be modified. Maintaining a healthy weight may also help reduce pain by lowering the burden on the spine.
6. Lifestyle Changes
A patient with chronic low back pain must accept certain limitations and adapt accordingly. They must learn to “listen” to their body and adjust their pace in daily activities. It is helpful to identify activities that worsen pain and avoid them when possible. This can reduce pain flare-ups and help prevent the progression of underlying conditions related to pain.
Another important lifestyle change is quitting smoking. Nicotine has been shown to increase pain and delay healing.
When Is Surgery Recommended for Low Back Pain?
Warning signs that may indicate the need for surgery—if proven to be related to the condition of the spine—include:
- New or worsening bowel or bladder dysfunction
- Limb weakness
- Gait and balance disturbances
- Signs of increased reflexes
Surgery may also be indicated for chronic low back pain when the cause of pain is known and confirmed through imaging, or when other treatments have failed.