Chronic Back PainChronic pain is defined as a pain that has been present for more than three months. Commonly patients describe a pain that has been there for years and tends to fluctuate. Commonly it is thought to have resulted from an injury and unlike an acute event does not settle and persist but does tend to vary in intensity. Causes for chronic pain include degenerative disc disease, facet arthritis and persistent nerve root compression. In many cases, the exact cause of the pain cannot be identified and can be ongoing due to a change in the functioning of the nervous system.
Chronic back pain can involve any area of the spine from the neck radiating to the arms down to the lower back radiating to the legs and again can be associated with tingling/numbness.
The diagnosis of chronic back pain involves a thorough history and examination in order to identify any obvious causative factors. Previous treatments will need to be assessed with regards to any obvious improvement in symptoms. This includes injections or previous surgery. Assessment of previous imaging will be performed and further imaging including x-rays, MRI or CT scan may be required. Further tests including discography, EMG or injections may also be suggested. Treatment options will be based upon symptoms and diagnostic imaging. This may involve repeating previous interventions as treatments from one centre to another may offer different delivery techniques. This may also involve physical therapy.
Patients are usually managed with medications, chiropractic care, physical therapy, education, injections and/or surgery. Chronic pain management programs are available but require the patient to participate in courses lasting several hours per day over a number of weeks.
Surgery involving fusion or decompression may be suggested if there is a structural and surgical target for the pain. All of these options will be discussed in the clinic setting.
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