Chronic Back Pain

Chronic back pain is pain lasting more than twelve weeks. In the large majority of cases no specific pain generator can be identified, and this is not a failure of investigation: disc bulges, degenerative changes and facet arthritis appear on scans of large numbers of people with no pain at all. Early imaging in the absence of red flags is associated with worse outcomes, partly because incidental findings drive fear and avoidance. The best-supported management is movement based. Graded exercise of almost any type helps, with the effect coming from consistency rather than the specific programme, and combining it with cognitive approaches that reduce fear of movement outperforms either alone. Sleep quality, psychological distress and smoking all predict persistence. Passive treatments including prolonged rest, long-term opioids and repeated imaging carry more risk than benefit. Supplement evidence is limited: curcumin has small trials showing modest analgesic effect in osteoarthritic pain, and correcting genuine vitamin D deficiency helps people whose musculoskeletal pain stems from that deficiency. Neither replaces loading the tissue and regaining confidence in movement.

• •Persistent ache or stiffness in the lower back
• •Pain that worsens with prolonged sitting or standing
• •Morning stiffness easing with movement
• •Referred pain into the buttock or thigh
• •Reduced tolerance for lifting or bending

• •Non-specific mechanical pain with no single identifiable source
• •Deconditioning and reduced trunk endurance
• •Central sensitisation in long-standing cases
• •Disc herniation with nerve root compression in a minority
• •Facet joint arthritis
• •Spinal stenosis in older adults
• •Poor sleep and psychological distress

In most cases pain persists because of a combination of deconditioning, altered movement patterns driven by fear, disturbed sleep and sensitised pain processing, rather than a fixed structural lesion.