Low back pain is considered chronic when it doesn’t resolve within 12 weeks.^[1] Unlike acute back pain, which tends to go away on its own, chronic low back pain often requires medical intervention. Chronic low back pain is a common condition, affecting 15%–20% of people in the U.S as of 2020.^[2] Moreover, an estimated 8.2% of people in the U.S. have severe chronic low back pain, causing nearly 75% of affected people to have difficulties in their social and work lives, while also affecting their body mobility and the ability to perform self-care.^[3]

The presence of any of the following symptoms potentially require immediate attention and emergency care:

• Loss of bowel or bladder function

• Fever
  The symptoms of chronic low back pain can vary based on the underlying cause, and sometimes pain or injury in the low back region can cause pain in other areas of the body. The types of pain experienced can range from constant, dull aching to severe, stabbing pain that all but prevents movement and severely impairs mobility and quality of life.
  People with chronic low back pain may experience any of the following symptoms:^{[4][5] [6]}

• Pain in the low back region, particularly when twisting, bending, or sitting.

• Pain in any of the muscles or joints in the lower back region or spine.

The following symptoms are specific to lumbosacral radiculopathy, a common cause of low back pain that can be acute or chronic:^[7]

• Numbness, pain, or tingling in the upper glute/hip region, which may be more localized to the high-glute region, or extend down the back of the leg, sometimes all the way to the toes.
• Weakness in the legs or feet.

To diagnose chronic lower back pain and create an effective treatment plan, a healthcare provider will perform a medical history evaluation and thorough physical and neuromuscular exams.^[8] The following tests may also be performed to diagnose chronic low back pain: Imaging exams such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) can be used to check the spine for specific injuries. However, in the absence of red flags that indicate neurological problems, such as problems with bowel or bladder function, imaging is not recommended within the first 6 weeks of developing back pain. This is because imaging tests are often inconclusive. People without back pain can have abnormal imaging findings, and people with severe back pain may have nonspecific imaging results.^[8] Early imaging can potentially increase the likelihood of surgery that does not improve patient outcomes, as noted in one study that found patients undergoing early MRI imaging were twice as likely to have surgery compared to those who did not.^[9] In cases of suspected lumbar radiculopathy, electromyography (EMG) may also be performed to rule out other other neurological conditions with similar symptoms.^[10] Blood tests for inflammatory biomarkers such as blood cell counts, erythrocyte sedimentation rate, and C-reactive protein levels may also be performed to check for infections that may be causing the low back pain.

It is important to emphasize that chronic low back pain is a symptom, rather than a diagnosis. Specific causes of chronic low back pain, if they can be identified, can vary widely, requiring specific types of treatment, often under the care of specialists ranging from neurosurgeons to rheumatologists to psychologists. However, chronic low back pain in many cases is “nonspecific”, meaning that the cause is not known. The typical treatment for nonspecific chronic low back pain typically begins with a primary care physician, who may ultimately recommend nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen to manage pain.^[8] However, non-drug treatments — such as education, physical/exercise therapy, and cognitive behavioral therapy — are generally sought out as a first line of therapy.^[11] It is recommended that people with chronic low back pain should avoid strict bed rest and continue to stay active.^[12] Severe pain may be treated with opioid pain medications when necessary.^[8] Additional treatments include tricyclic antidepressants, which may be used alongside analgesic (pain-relieving) therapy,^[13] or the drug gabapentin, which is used to treat pain, numbness, or tingling that can arise from nerve root damage or irritation.^[14] People with chronic low back pain are often referred to a physical therapist for treatment. Physical therapy involves exercises to correct muscle imbalances, postural deficiencies, or impaired mobility, possibly alongside soft tissue mobilization and/or spinal traction. Education about the nature of low back pain, addressing any fears surrounding low back pain, and exercises that gradually increase physical function and independence may all be included.^[12] People with more severe pain and disability may be referred to a specialist for evaluation for surgery or epidural steroid injections. In this procedure, medicine is injected into the epidural area, a fat-filled compartment that contains the spinal cord.^[8]

The following supplements have been studied for low back pain:

• Vitamin D^[15]
• Amino acids^[16]
• Vitamin B12^[17]
• Alkaline minerals^[18]
• Collagen peptides, when tested alongside vitamin C and other supplements^[19]

Various herbal remedies have also been studied, including:^[20]

• Harpagophytum procumbens (devil’s claw)
• Salix alba (white willow bark)
• Symphytum officinale L. (comfrey root extract, studied for acute, non-specific low back pain)
• Lavender essential oils (applied by acupressure)
• Capsicum frutescens (cayenne)
• Solidago chilensis

Diet may have an effect on chronic low back pain, although more research is needed to conclusively establish a link, as well as determine the extent to which different people may be affected. Unhealthy diets and smoking are known to have a negative effect on chronic pain,^[21] and different dietary patterns are known to affect the amount of inflammation in the body, suggesting that dietary interventions could have potential mitigating effects on back pain.^[22]

However, there is currently a lack of high-quality studies testing the effects of different dietary interventions for chronic low back pain. A 2022 observational study did find associations between higher protein intake and reduced chronic low back pain, and energy-dense diets and increased chronic low back pain.^[23] More research is needed to determine whether diets can affect chronic low back pain, however.

Chronic low back pain can be stubborn and difficult to treat. Numerous alternative treatments have been tested in randomized controlled trials, with varying degrees of success. Additional treatments include:

• Spinal cord stimulation^[24]
• Cerebral or peripheral electrical brain stimulation^[25][26]
• Interferential current electrotherapy, a type of electrical muscle stimulation used to treat chronic pain^[27]
• Botulinum toxin^[28]

Various complementary health, mind, and body interventions are also sometimes used to treat chronic low back pain, including:

• Acupuncture^[29]
• Tai chi^[30][31]
• Yoga ^[32]
• TENS (transcutaneous electrical nerve stimulation)^[33]
• Massage therapy^[34]
• Biofeedback^[35]
• Dry needling^[36]
• Cupping^[37]
• Low-level laser therapy^[38]
• Mindfulness-based stress reduction^[39]
• Spinal manipulation^[40][32]
• Prolotherapy^[41]
• Myofascial release^[42]

Chronic low back pain can often be nonspecific in nature, making it difficult to identify the root cause.^[43] In many people, the specific cause of pain is never identified.^[44] However, chronic low back pain has many specific causes as well. The following conditions are known to cause chronic low back pain:

• Irritation of the spinal cord or nerve roots, commonly from herniated discs or spinal stenosis.
  • Vertebral fractures or trauma to the spine.
• Inflammatory disorders of the spine, such as axial spondyloarthritis, a type of arthritis that causes pain and swelling in the spine and the joints connecting the spine to the pelvis.
• Spinal infections.
• Cancerous growths in or around the spine or nerve roots.
• Poor joint mobility, particularly in the lower lumbar or hip regions.^[45][46]
• Facet osteoarthritis.
• Degeneration of the spinal disc.