Managing Chronic Back Pain

Intro

Chronic back pain (lasting >12 weeks) is common and usually not caused by something dangerous. Most people improve with time, movement, and targeted self-care. The goal is to reduce pain, improve function, and prevent flares.

Key Points

Keep moving within comfort; bed rest makes pain worse long-term.
Look for red flags (below) that need medical assessment.
Combine exercise + education + pacing; add meds or procedures only if needed.
Mood, sleep, and stress strongly influence pain—treat the whole picture.

Common Causes

Non-specific mechanical pain (most cases).
Degenerative changes (disc, facet joints).
Radicular pain / sciatica (nerve irritation).
Less common: spinal stenosis, inflammatory arthritis, vertebral fracture.

Red Flags — Seek Medical Review

Recent major trauma; unexplained weight loss; fever; history of cancer; IV drug use; night pain not eased by rest.
Neurologic deficits: new weakness, numbness in the saddle area, loss of bladder/bowel control → urgent care (possible cauda equina).

Self-Care & Rehab

Activity: Walk daily; avoid prolonged sitting. Gradually resume normal tasks.
Exercise therapy: Core strengthening, hip mobility, and graded aerobic work (physio program or reputable app).
Pacing: Break tasks into chunks; avoid boom-bust cycles.
Heat/ice: Short sessions can ease symptoms.
Sleep: Aim for consistent schedule; supportive mattress/pillow.
Weight, smoking, stress: Address contributors that sensitize pain pathways.

Medications (use judiciously)

First line: Paracetamol/acetaminophen can help some; short courses of NSAIDs if appropriate.
Avoid routine opioids; consider only short-term in select cases under clinician guidance.
Neuropathic agents (e.g., duloxetine) may help specific patterns; discuss risks/benefits.

When to Consider Imaging or Procedures

Imaging (MRI) not needed initially unless red flags or persistent disabling pain after conservative care.
Injections (e.g., epidural) may help short-term in radicular pain; benefit is often temporary.
Surgery is reserved for specific conditions (severe stenosis, persistent sciatica with deficits) after non-surgical options fail.

Flare Plan

Dial back intensity, not to zero—keep gentle movement.
Use heat/ice and short course NSAIDs if suitable.
Resume rehab exercises as pain settles.
If not improving after 1–2 weeks or red flags appear, seek review.

FAQ

Do I need an MRI?
Usually no. Imaging often shows “abnormalities” that are normal with age and don’t change treatment.

Is bed rest good for flares?
No—brief rest is okay, but extended rest slows recovery.

Can stress really worsen back pain?
Yes. Stress, low mood, and poor sleep amplify pain signals; managing them helps pain control.