Chronic low back pain

Overview

Most back pain gets better in weeks. When it lasts longer than 3 months, it's called chronic. Often there's no single cause; wear and tear in the spine, tight or weak muscles, and changes in how nerves process pain all play a part.

Scans often show disc and joint changes that many people without pain also have, so they don't always explain the pain.

Symptoms

The pain may be dull, achy, or sharp and can come and go.

• Back pain lasting more than 3 months
• Stiffness
• Pain that's worse with sitting or bending

Less common

• Pain going down a leg
• Trouble sleeping
• Low mood from ongoing pain

Look up a symptom: Back pain · Back pain lasting more than 3 months

When to get medical care

Causes

Common causes include muscle and ligament strain, disc and joint wear, spinal stenosis, and sciatica. Stress, poor sleep, and inactivity can make pain last longer.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

• Older age
• Heavy lifting or physical work
• Extra weight
• Smoking
• Depression or stress

Possible complications

• Depression
• Living with chronic pain

Diagnosis

Diagnosis is mostly based on your history and an exam.

Questions you may be asked

• Where the pain is and whether it goes down a leg
• What makes it better or worse
• Warning signs like weakness or bladder problems

The exam

They'll check your back's movement, strength, reflexes, and feeling in your legs.

Tests

Tests are only needed for warning signs or before procedures:

• MRI: If there's nerve damage, a possible infection or cancer, or surgery is being considered.

Treatment

The best treatments help you move more and hurt less.

Self-care

• Stay active and keep doing daily activities
• Exercise regularly, like walking, yoga, or tai chi
• Use heat for short-term relief
• Keep a healthy weight
• Learn pain coping skills, like those taught in cognitive behavioral therapy

Medicines

Medicines play a smaller role than exercise.

OwieClear doesn't give doses: follow the label or your healthcare professional. Medicine names here are examples, not a full list.

Physical therapy, massage, acupuncture, and spinal manipulation help some people. Surgery is only for specific problems, like a pinched nerve that causes weakness.

How it compares

Prevention

To keep your back healthy:

• Stay active
• Lift with your legs
• Keep a healthy weight
• Don't smoke

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• A physical therapist can help with exercises to rebuild strength and motion.

Living with it

• Keep a simple diary of symptoms, triggers, and medicines to bring to visits.
• Bring a list of your medicines and questions to each visit.
• Stay active in ways that feel good to you.
• Get enough sleep and manage stress.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Older adults: Spinal stenosis and bone loss are more common.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Chronic back pain may not go away completely, but most people improve and stay active with exercise and a good plan.

Getting ready for your visit

Describe how pain affects your life.

What to bring

• Treatments you've tried

Questions to ask

• Would physical therapy help?
• Which exercises are safe for me?
• Do I need a scan?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Chronic low back pain