Chronic Back Pain: Causes and Seeking Effective Treatment

Severe chronic back pain?

Hello Doctor: My husband has been suffering from chronic back pain (pain on both sides of the spine and soreness in both legs).
We live in Tainan and would like to come to your hospital for a thorough examination.
We want to understand the underlying issue—whether it is related to bones, muscles, nerves, or meridians.
This condition has persisted for three years, and he has to take six pain-relieving medications daily; otherwise, the pain will flare up.
When the pain occurs, he cannot get out of bed and sweats profusely.
Previous doctors have attributed it to stress, but it has been so long, and he has even lost his previous job without any improvement.
Recently, we visited Chi Mei Hospital, where the doctor performed an electromyography (EMG) and indicated that there is nerve compression at the last lumbar vertebra.
The doctor recommended muscle relaxants and painkillers again.
We really want to know if there are other causes for such severe pain.
The responses from previous doctors have been too superficial and vague, with no thorough examinations conducted—at most, just X-rays.
The EMG was something I insisted on, as the doctor initially said it was unnecessary, but it turned out there was indeed compression.

jolin, 30~39 year old female. Ask Date: 2010/07/05

Dr. Shi Guozheng reply Orthopedics

Chronic lower back pain has several causes, particularly in young individuals, which are often related to work and poor posture.
Sciatica is also one of the causes, but it presents with neurological symptoms such as numbness, weakness, shooting pain, or difficulty walking.
In some cases, there may even be urinary incontinence.
Other potential causes include spinal osteophytes or spondylolisthesis.
It is recommended that you visit a medical center to consult with a spine specialist for a thorough examination.

Reply Date: 2010/07/05

More Info

Chronic back pain can be a debilitating condition that significantly impacts daily life, as you've described regarding your husband's situation. Given that he has been suffering from this pain for three years and has been reliant on pain medications, it is crucial to approach this issue comprehensively to identify the underlying causes and develop an effective treatment plan.

Understanding Chronic Back Pain
Chronic back pain can arise from various sources, including musculoskeletal issues, nerve compression, and even psychological factors such as stress and anxiety. In your husband's case, the recent diagnosis of nerve compression at the lumbar spine level suggests that there may be a structural issue contributing to his pain. This could be due to a herniated disc, spinal stenosis, or other degenerative changes in the spine.

1. Musculoskeletal Factors: These include issues with the bones, muscles, ligaments, and tendons. Conditions such as osteoarthritis, muscle strains, or ligament sprains can lead to chronic pain. A thorough physical examination and imaging studies like MRI can help identify these issues.

2. Nerve Compression: As indicated by the electromyography (EMG) results, nerve compression can cause significant pain and discomfort. This occurs when a herniated disc or bone spurs press on the spinal nerves, leading to pain that may radiate down the legs (sciatica). Treatment may involve physical therapy, medications, or even surgical options if conservative measures fail.

3. Psychological Factors: Chronic pain can also be exacerbated by stress and anxiety. The mind-body connection is powerful, and emotional stress can lead to muscle tension and increased pain perception. Addressing these psychological aspects through counseling or stress management techniques can be beneficial.

Diagnostic Approach
Given the complexity of your husband's condition, a comprehensive diagnostic approach is essential. Here are some recommended steps:
- MRI Scan: An MRI provides detailed images of the spine and surrounding tissues, allowing for a better understanding of any structural abnormalities, such as herniated discs or spinal stenosis.

- Physical Examination: A thorough physical examination by a specialist, such as an orthopedic surgeon or a neurologist, can help assess the range of motion, strength, and reflexes, which can provide further insight into the source of pain.

- Additional Tests: Depending on the findings, additional tests such as CT scans or X-rays may be warranted to evaluate bone structure and alignment.

Treatment Options
Once the underlying cause of the pain is identified, treatment can be tailored accordingly. Here are some common approaches:
1. Physical Therapy: A structured physical therapy program can help strengthen the muscles supporting the spine, improve flexibility, and reduce pain. Techniques may include stretching, strengthening exercises, and modalities such as ultrasound or electrical stimulation.

2. Medications: While your husband is currently taking pain medications, it may be worth discussing with a physician the possibility of adjusting the medication regimen. Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or even nerve pain medications like gabapentin may be appropriate.

3. Injections: In some cases, corticosteroid injections can provide temporary relief by reducing inflammation around the affected nerves.

4. Surgery: If conservative treatments fail and the pain is significantly affecting quality of life, surgical options may be considered to relieve nerve compression or stabilize the spine.

5. Alternative Therapies: Complementary therapies such as acupuncture, chiropractic care, or massage therapy may provide additional relief and should be considered as part of a holistic approach to pain management.

Conclusion
Chronic back pain is a multifaceted issue that requires a thorough evaluation to determine its cause. Given your husband's long-standing pain and the recent findings of nerve compression, it is crucial to pursue further diagnostic testing and explore a comprehensive treatment plan. Seeking care from a specialized pain management clinic or a multidisciplinary team may provide the best outcomes. It is essential to remain proactive in managing this condition and to advocate for thorough evaluations and personalized treatment options.

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