Low back pain is incredibly common, affecting 70-90% of people at some point in their lives. For most people, a back pain episode (even an extremely painful one) is short-lived and goes away completely within a few weeks. However, 5-10% of people will go on to develop chronic low back pain.
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What is chronic low back pain?
Chronic low back pain (CLBP), also sometimes known as chronic non-specific low back pain, is defined as back pain that lasts longer than three months. You may also be diagnosed with CLBP if you have ongoing, repeated back pain episodes. Some people experience CLBP due to a medical condition, such as osteoporosis. However, many people experience persistent pain for which no underlying physical cause can be found.
While we still don’t fully understand why some people develop CLBP, it seems to involve a complex interplay of biological, psychological and social factors, including changes to the way the nervous system processes pain information.
What does a low back pain assessment involve?
If you’re experiencing CLBP, your healthcare professional will do an assessment to find out more about what’s happening. They will ask you some questions about your pain, such as how and when it started, whether it follows a pattern, and how pain is impacting your daily life. They might also ask about what treatments you’ve had and whether they helped.
They will also conduct a physical assessment, looking at things like your movement, sensation and response to touching your back. They will also screen for things which healthcare professionals call ‘red flags’. These are signs which may indicate a more serious cause for your pain, which is rare but important to rule out.
These include:
- Known cancer (past or present)
- Unexplained weight loss
- Night pain
- Fevers or recent infection
- IV drug use
- Immune suppression
- Numbness in the area between your legs (known as ‘saddle numbness’)
- Retention of urine or incontinence
- Progressive numbness, weakness or loss of reflexes in the legs.
If you have severe symptoms, any red flags or are experiencing pain that radiates into your legs, you might be referred to have imaging tests such as a CT or MRI scan of your lower back.
It’s also important for your healthcare professional to screen for what’s known as ‘yellow flags’. These are the psychological and social factors which can lead to a higher risk of developing long-term distress. They include certain beliefs, emotions, and behaviours, as well as workplace and family factors.
In CLBP, yellow flags include:
- Unhelpful beliefs about back pain (such as that pain always means something serious must be wrong or that pain is uncontrollable)
- Unhelpful pain behaviour (such as resting too much and avoiding movement for fear it will lead to damage)
- Dissatisfaction at work or a worker’s compensation claim
- Emotional or psychological problems, such as depression or anxiety
- A passive approach to healthcare, such as low involvement in rehabilitation.
These assessments help to build up a picture of your condition, guide treatment decisions, and provide a better understanding of likely progress.
What are my treatment options?
Most people with CLBP can function in daily life, with self-management being the cornerstone of treatment. This includes things like:
- Lifestyle changes such as weight loss, stopping smoking and eating a healthy diet
- Self-directed light aerobic exercise, core muscle strengthening/Pilates, stretching/yoga
- Environmental modifications such as a sit-to-stand desk at work.
If you are experiencing any psychological issues such as anxiety or depression, cognitive behavioural therapy with a psychologist is recommended.
In rare cases, surgery may be advised. Your doctor can talk to you about suitable treatment options for managing your condition.
Written by A/Prof Laurence McEntee, Orthopaedic Spine Surgeon at Gold Coast Private Hospital.
