Chronic Low Back Pain

Chronic low back pain is pain in the lumbar or lumbosacral region that persists or recurs for more than three months. It is one of the most common reasons patients seek care for chronic pain and can affect people of all ages and occupations. Symptoms range from a persistent ache to sharper, activity-limiting pain and may affect sleep, work, exercise and everyday function.

The causes are varied and often overlap. Disc-related changes, facet joint osteoarthritis, spinal stenosis, previous injury and other musculoskeletal or neurological conditions can contribute, but imaging abnormalities are also common in people without pain. Symptoms may include localised back pain, stiffness and, in some patients, pain referred into the buttock or leg. Clinical assessment is the starting point, with imaging generally reserved for red flags, suspected serious pathology, significant neurological findings, or situations in which the result is likely to change management.

Management is individualised and usually emphasises education, staying active, targeted exercise and physiotherapy, with medication used selectively. In appropriately selected patients with suspected facet-mediated pain, diagnostic medial branch blocks may help determine whether radiofrequency denervation is likely to be beneficial. Epidural injections may be considered in selected patients with radicular pain, and surgery or neuromodulation may be appropriate for carefully selected refractory cases. Multidisciplinary pain rehabilitation can help restore function and reduce the impact of persistent pain.