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by Dr. David Borenstein M.D. updated 8/2021

The therapy for chronic low back pain is more complicated. The goal of therapy is maximizing function despite some continued pain. Pain may be exacerbated at times, but this is not necessarily indicative of past or present disease-associated damage.

Chronic back pain can be treated with basic therapy for acute low back pain. Other therapies are added to this basic regimen. Tricyclic antidepressants are sometimes used to increase tone in the pain inhibitory pathway. These drugs also help with the depression that accompanies chronic pain.

If you continue to experience pain, try counterirritant therapy such as TENS, massage, or acupuncture. The relaxation response may decrease the stress associated with chronic pain. Therapies that can result in a relaxation response include yoga, biofeedback, and hypnosis. You and your physician need to meet on a regular basis to modify your therapies to obtain the best outcome.

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Some of you reading this article might believe curing a problem is better than controlling it. In all honesty, a cure in human biology is very difficult to achieve. Except for bacterial infections, most human diseases are controlled, not cured. This applies to back pain, too. You may have no pain and function normally. You may think you are cured. However, you are at much greater risk for a second episode of back pain within the next year. That suggests that your back problem has not been cured.

The constant monitoring that comes with controlling a medical problem is a better way to deal with low back pain. Control suggests that you will need to continue to exercise in an appropriate manner to maintain the strength of your back. Although it takes more work on your part, controlling your condition will make you ready to remedy any hint of back pain as soon as it appears.

Despite the best efforts of the human body to heal, many of you will not be better at two, three, or four weeks after the start of an attack of low back pain. Your pain has persisted in the area of the low back, with radiation no farther than the buttock or back of the upper leg. In those circumstances, a visit to a physician is important for an evaluation and additional therapy. As opposed to other health care professionals, a physician is the appropriate practitioner to go to for evaluation and therapy first. Physicians have access to all the diagnostic tools to determine what is wrong with your back. They also have the ability to prescribe all the conventional and complementary therapies that can help acute low back pain. You can read about all of these therapies in the following chapters.

  • Rest in bed only if you have leg pain. Otherwise, limit bed rest and walk as much as you can tolerate.
  • Try over-the-counter analgesics and nonsteroidal antiinflammatory drugs (NSAIDs).
  • As your back pain begins to resolve, do low-impact aerobic exercise such as walking or swimming.
  • Do not exercise your back too soon after the beginning of a back pain episode. Certain back exercises can increase pain if you do them too early in the healing process. Expand your “comfort zone” gradually.
  • Maintain a positive attitude and educate yourself about your back. This positive attitude has a beneficial effect on your healing. Remember most back pain resolves in two months. Don’t assume you will be the exception.

From Back in Control by Dr. David Borenstein