Chronic Low Back Pain: Causes, Diagnosis and Solutions
Chronic low back pain is one of the most frequent health problems in the world.
It affects millions of people and can become a real physical, emotional and social burden. We speak of chronic low back pain when the pain in the lower back persists for more than three months, either continuously or intermittently, or when it is associated with a chronic disease that will make this pain recurrent.
Although many people consider it a “normal” part of getting older or having an active life, the truth is that it should not be accepted as inevitable. With proper diagnosis and treatment, most cases can improve.
Most common causes of chronic low back pain
In the case of low back pain, the age of the patient and the anatomical conditions of the patient will have a great influence on the name and surname of the pain suffered by the patient.
In the young patient, the most frequent cause of low back pain is discogenic pain, which means that the source of the pain is in the lumbar intervertebral disc.
Muscle or ligament problems are another common cause, especially in young patients. It may be due to overexertion, bad postural habits, repetitive movements for example at work or lack of exercise that causes the absence of a musculature prepared to “hold” the spine upright.
This discogenic pain may develop into low back pain accompanied by “radicular” pain or, as it is commonly known, “sciatica”. The intervertebral discs act as shock absorbers between the vertebrae. When one becomes displaced or ruptures, it can press on a nerve and cause this type of pain.
Pain of arthritic origin of the spine is more typical of older patients because over the years the joints of the spine (called facet joints or zygapophyseal joints) may deteriorate, causing inflammation and stiffness.
Another very prevalent condition is spinal stenosis or canal stenosis which may appear earlier or later depending on the anatomical characteristics of the patient’s spine. This is a narrowing of the canal through which the nerves pass in the spine. This can compress the nerves and cause low back pain accompanied by tingling or weakness in the legs.
The first step in treating chronic low back pain is to understand what is causing it. For this, a good medical diagnosis is fundamental, which will be made with a clinical interview, physical examination of the patient and the performance of complementary tests such as X-rays, magnetic resonance or computerized tomography. These tests help to see if there are problems but they are not diagnostic “per se”. What matters above all is the patient’s clinical condition. There is not always a “visible lesion” on the tests, and that does not mean that the pain is not real. Many times, the pain
chronic is maintained by a combination of physical, emotional and lifestyle factors.
life.
What solutions exist?
The treatment of chronic low back pain should be personalized, comprehensive and multidisciplinary.
There is no single solution that works for all patients, but these should include:
Patient education: In relation to understanding pain, understanding where the limitations are according to their pathology, how they can do to improve or minimize the number of episodes of low back pain with personal habits encouraging physical exercise adapted to their situation and even adaptations of jobs with high physical load.
Medications: Anti-inflammatory drugs, analgesics or muscle relaxants can be used, always under medical control when the pain is not chronic and we are talking about acute low back pain. If this process becomes chronic, multidisciplinary evaluation and treatment is mandatory.
Psychological therapy: Psychological support (such as cognitive-behavioral therapy) helps manage the stress, anxiety and depression that often accompany chronic pain.
Interventional techniques: When pain does not improve with conventional treatments, infiltrations, nerve blocks, neuromodulation and, in very specific cases, surgery can be used.
Chronic low back pain can seriously affect quality of life, but it does not have to become a permanent condemnation. With the right diagnosis, a comprehensive approach and patient commitment, it is possible to reduce pain, regain movement and get back to enjoying daily activities.
Do not ignore pain or resign yourself to living with it. Consult professionals specialized in pain or rehabilitation, ask questions, get information and actively participate in your treatment. Your health and well-being deserve complete and personalized attention.
Dr. Enrique del Cojo
Medical Director MIVI Cáceres