Does chronic back pain mean my spine is damaged?

Not usually. In most people seen with chronic low back pain in primary care, no underlying disease or condition is found. Changes such as disc wear and disc bulges are common on scans of people without pain and increase with age, so they may not explain your symptoms.

A Cochrane review of 249 trials found moderate-certainty evidence that exercise reduces pain compared with no treatment, usual care or placebo, although the improvement in day-to-day function was smaller. The type of exercise can be chosen to suit your needs, preferences and abilities.

Should I have an MRI scan?

Most people with back pain do not need one. NICE advises imaging in a specialist setting only if the result is likely to change your treatment.

Is surgery an option for chronic back pain?

For low back pain without a specific cause, NICE advises against spinal fusion except in research trials, and against disc replacement. Surgery is mainly considered for specific problems, such as a trapped nerve causing sciatica or spinal stenosis that affects walking and quality of life.

What is radiofrequency denervation?

It is a procedure to seal off some of the nerves in your back so they stop sending pain signals, used only for long-term lower back pain. NICE suggests it may be considered for selected people when other treatment has not worked, and only after a positive response to a diagnostic medial branch block. Not every hospital offers this procedure; if it may suit you, your doctor can discuss referral to a specialist pain or spine service.

Usually, yes. Staying at work or returning to normal activities is encouraged, with adjustments where needed.

Hunjan Hospital Ludhiana

Chronic Back Pain Treatment

Information on long-lasting (chronic) low back pain: assessment, exercise-based treatment, medicines, when procedures or surgery may help, and warning…

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Understanding chronic back pain Assessment and scans Treatment options When procedures or surgery may be considered A typical care pathway Risks and limitations Frequently asked questions Treatment Journey References

Understanding chronic back pain

Back pain is called chronic when it has lasted 3 months or longer; its intensity may rise and fall over time.^[1] In most people seen with chronic low back pain in primary care, the pain is not caused by an identifiable underlying disease or condition; this is called chronic primary low back pain.^[3]

Care focuses on understanding the pain, staying active and building strength, with medicines or procedures used selectively.^[1,3]

An assessment to look for specific causes that need different treatment^[1]
Advice and information to help you manage pain and continue normal activities^[1]
Exercise-based physiotherapy, with manual therapy only alongside exercise^[1]
Medicines, procedures or surgery only when they are likely to help

Your plan is reviewed as you progress. The aim is to improve what you can do day to day, not only to reduce the pain.

Assessment and scans

Your doctor will ask about your pain, check your movement, strength, reflexes and sensation, and look for signs of a specific cause such as a trapped nerve, infection, inflammatory disease, a fracture or, very rarely, cancer.^[1,2]

Scans are not needed for most people with back pain. NICE advises against routine imaging in non-specialist settings, and imaging in a specialist setting only if the result is likely to change treatment.^[1] Wear-and-tear changes such as disc degeneration and disc bulges are common on scans of people with no back pain at all and become more common with age, so scan findings must be interpreted alongside your symptoms.^[5]

Treatment options

Guidelines from NICE and the World Health Organization support non-surgical care for chronic low back pain.^[1,3]

Education and self-management: information about back pain and encouragement to continue normal activities and work^[1,3]
Exercise: exercise programmes probably reduce pain compared with no treatment or usual care; side effects are mostly minor, such as muscle soreness^[4]
Manual therapy: spinal manipulation, mobilisation or massage may be considered, but only as part of a treatment package that includes exercise^[1]
Psychological therapy: approaches such as cognitive behavioural therapy (CBT) can help you cope with long-lasting pain^[2,3]
Medicines: anti-inflammatory painkillers may be considered at the lowest effective dose for the shortest possible time^[1]

NICE advises against opioids for chronic low back pain, paracetamol on its own, and antidepressants or gabapentinoids for low back pain. It also advises against belts or corsets, traction, acupuncture, ultrasound and TENS.^[1]

When procedures or surgery may be considered

Most people with chronic back pain do not need an operation. In guidelines, procedures or surgery are discussed only in specific situations (some specialist procedures or operations may involve referral to another centre):

Radiofrequency denervation: when non-surgical treatment has not worked, the pain is thought to come from the small facet joints, it is moderate or severe, and a diagnostic nerve block has given a positive response^[1]
Decompression surgery: for sciatica (leg pain from a trapped nerve) that has not improved with non-surgical treatment, when scan findings match the symptoms^[1]
Spinal stenosis: when leg pain and weakness, including difficulty walking, cause poor quality of life; decompression may be done with or without fusion^[6]

A typical care pathway

A general outline. Chronic pain often improves gradually, with ups and downs along the way.

Step 1
Assessment

History, examination and a check for warning signs. Scans are arranged only if they are likely to change your treatment.^[1]
Step 2
Self-management and exercise

An exercise programme suited to your needs and preferences, with advice on staying active and at work.^[1,4]
Step 3
Review

Progress is reviewed. Medicines, manual therapy alongside exercise, or psychological support may be added.^[1,3]
Step 4
Specialist options

If pain remains moderate or severe despite these measures, specialist procedures or surgery for a trapped nerve or spinal stenosis may be discussed, including referral to another specialist centre where needed.^[1,6]

Risks and limitations

No single treatment works for everyone with chronic back pain, and improvements are often modest: for example, trials show exercise improves pain more clearly than day-to-day function.^[4] Knowing the limits helps you choose.

Exercise can cause temporary muscle soreness; build up gradually^[4]
Anti-inflammatory painkillers can affect the stomach, liver, kidneys and heart, so they are not suitable for everyone^[1]
Opioid painkillers are not recommended for chronic low back pain and can be associated with dependence and overdose^[1,3]
Radiofrequency denervation suits only a selected group of people and is done only after a positive diagnostic nerve block^[1]
Surgery for spinal stenosis tends to improve leg pain more than back pain, and its risks include a dural tear, nerve injury, failure to relieve symptoms and the need for further surgery^[6]

Go to the nearest emergency department, or call 112, if back pain comes with numbness, tingling or weakness in both legs, loss of feeling around the genitals or anus, new bladder or bowel problems, or chest pain, or if it started after a serious accident. Ask for an urgent appointment if you feel hot, cold or shivery or generally unwell, or the pain is severe and getting worse quickly. See a doctor if you have lost weight without trying, notice swelling in your back, or the pain is worse at night.^[2,7]

Frequently asked questions

Patient pathway