Chronic Back Pain – Types and Treatment Options

Back pain is the most common type of chronic pain – out of the 2.5 million people in the UK affected by acute back pain, typically 20% develop into chronic back pain. In some cases, treatment successfully relieves the symptoms of the condition, but in other cases the pain persists despite medical and surgical treatment. The treatment of back pain costs the NHS almost 22% of the UK healthcare budget because of the vast number of people who suffer from this often debilitating condition.

There are a significant number of causes of chronic back pain, some of the most common include:

Herniated disc – this occurs when the connective tissue surrounding the disc breaks down, allowing the inner gel-like substance to leak out and put pressure the spinal cord or on a single nerve root.

Tumour – although this is relatively rare, a tumour located near the spine causes pain and reduced mobility.

Spinal stenosis – this is an abnormal narrowing (stenosis) of the spinal canal that can occur in any region of the spine.

Rheumatism – is an autoimmune disease in which the body’s own immune system attacks the body’s joints.

Osteoarthritis – this is caused by mechanical wear and tear on joints which can lead to compression fractures.

Sciatica – this is when the sciatic nerve is compressed or irritated. This can lead to pain in the back and lower down the legs.

Due to the unpredictable nature of chronic back pain which, in some cases may be continuous or intermittent and range from mild to severe, it can be a difficult condition to treat. A range of treatments are available including:

Epidural injections – this is a regional anaesthesia that blocks pain in a specific area of the body. The goal of an epidural is to provide pain relief rather than anaesthesia.

Spinal cord stimulators (SCS) – SCS are an implant that reduces abnormal pain signals reaching the brain and restores the normal pain-inhibition pathways by stimulating the body’s natural chemical neurotransmitters. Neurotransmitters are used by the nervous system to communicate with each other.

Facet joint injections – these are used as a diagnostic tool to isolate and confirm the specific source of back pain. They have a therapeutic effect by numbing the source of pain and soothing inflammation.

Antidepressants– such as tricyclics and serotonin-norepinephrine reuptake inhibitors have been commonly prescribed for chronic back pain. They can help reduce pain and muscle tension, regain healthy sleeping patterns and address the mental and emotional toll of pain.

Opioids – act by attaching to and activating opioid receptor proteins in certain organs. When these drugs attach to their receptors, they inhibit the transmission of pain signals.

Complementary therapies – these include chiropractic treatments and osteopathy which include manual manipulations to realign and balance the spine.

There is no definitive method of treatment for chronic back pain because symptoms can vary considerably between each individual. If the methods of treatment suggested by the medical practitioner are unsuccessful, a last resort is spinal surgery. Success rates for spinal surgery can reach as high as 90% but each individual case needs careful consideration of any risks incolved in the procedure versus the potential benefits.

Watch our expert Dr Christopher A. Jenner explain the benefits and risks of spinal injections in this short video: