Chronic Lower Back Pain: Seeking Answers After Two Years of Suffering

Lower back pain has persisted for two years?

Hello, Doctor.
I have been experiencing lower back pain for almost two years now.
At its worst, I was unable to bend over to get out of bed and had to roll onto my side and push myself up with my hands.
Currently, the pain persists whether I am moving or at rest, and at times it radiates down to the outer side of my calf, affecting my ability to walk.
I have consulted several doctors, but their opinions vary significantly.
Some suggest ankylosing spondylitis (though my blood tests are normal), myofascial pain syndrome, and incomplete development of the fifth lumbar vertebra with adjacent joint adhesions (which is the most common diagnosis).
Other doctors have mentioned lumbar-sacralization combined with far-out syndrome and sciatica.
I have taken many medications without any improvement.
My question is: if the pain is caused by muscles or tendons, can it really last this long? Most doctors say that my symptoms will not improve and have recommended physical therapy.
However, I am now experiencing pain even when I am not moving, and the symptoms are getting worse.
Is there any way to treat this? Thank you, Doctor.

A-Zhi, 20~29 year old female. Ask Date: 2005/05/14

Dr. Shi Guozheng reply Orthopedics

Lower back pain can be quite bothersome and may persist for a long time.
Its diagnosis is often uncertain, but rehabilitation typically leads to some improvement.
Treatment may require a multifaceted approach, including medication, physical therapy, and correcting poor posture and habits.
This is worth trying.

Reply Date: 2005/05/14

More Info

Chronic lower back pain can be a debilitating condition, and it sounds like you have been through a challenging journey over the past two years. Your symptoms, including severe pain when bending, pain radiating to the outer calf, and difficulty walking, indicate that there may be multiple factors contributing to your discomfort.
From your description, it seems that you have received various diagnoses, including ankylosing spondylitis, myofascial pain syndrome, and issues related to the fifth lumbar vertebra. Each of these conditions can cause significant pain, but they also require different approaches to treatment.
1. Muscle and Tendon Issues: If your pain is primarily due to muscle or tendon problems, it is indeed possible for these issues to persist for an extended period, especially if they are not adequately addressed. Myofascial pain syndrome, for example, can lead to chronic pain due to trigger points in the muscles. These trigger points can remain active and painful for months or even years if not treated properly. Physical therapy, including stretching, strengthening exercises, and manual therapy, can be beneficial in managing this type of pain.

2. Structural Issues: The mention of developmental issues with the L5 vertebra and adjacent joint adhesions suggests that there may be structural problems contributing to your pain. Conditions like spondylolisthesis or degenerative disc disease can lead to nerve root compression, which may explain the pain radiating down your leg. Imaging studies, such as MRI, can help clarify these structural issues and guide treatment.

3. Inflammatory Conditions: Although your blood tests for ankylosing spondylitis were normal, it is essential to consider that some inflammatory conditions may not always show up in standard blood tests. If there is a suspicion of an inflammatory process, further evaluation by a rheumatologist may be warranted.

4. Treatment Options: Given the complexity of your symptoms, a multidisciplinary approach may be the most effective. This could include:
- Physical Therapy: A tailored rehabilitation program focusing on strengthening the core and back muscles, improving flexibility, and addressing any postural issues.

- Pain Management: Medications such as NSAIDs, muscle relaxants, or even nerve blocks may provide relief. In some cases, corticosteroid injections can help reduce inflammation.

- Alternative Therapies: Techniques such as acupuncture, chiropractic care, or massage therapy may offer additional relief.

- Surgical Options: If conservative treatments fail and structural issues are identified that could be corrected surgically, consulting with an orthopedic or neurosurgeon may be necessary.

5. Ongoing Monitoring: Chronic pain can be a dynamic condition, and it is crucial to continue monitoring your symptoms and adjusting your treatment plan as needed. Keeping a pain diary can help you and your healthcare providers identify patterns and triggers, which can inform your treatment strategy.

In conclusion, while it can be discouraging to hear that some doctors believe your symptoms may not improve, it is essential to remain proactive in seeking treatment. Engaging with a team of healthcare professionals, including physical therapists, pain specialists, and possibly a rheumatologist, can provide you with a comprehensive approach to managing your chronic lower back pain. Remember, recovery is often a gradual process, and persistence in seeking the right treatment can lead to improvements over time.

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