What are some of the main medical treatments for chronic 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.^[1] However, non-drug treatments — such as education, physical/exercise therapy, and cognitive behavioral therapy — are generally sought out as a first line of therapy.^[2] It is recommended that people with chronic low back pain should avoid strict bed rest and continue to stay active.^[3] Severe pain may be treated with opioid pain medications when necessary.^[1] Additional treatments include tricyclic antidepressants, which may be used alongside analgesic (pain-relieving) therapy,^[4] or the drug gabapentin, which is used to treat pain, numbness, or tingling that can arise from nerve root damage or irritation.^[5] 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.^[3] 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.^[1]