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Long-term back pain

For back pain lasting more than six weeks (known as 'chronic back pain'), your doctor will advise you on what painkillers to take and may recommend the following treatments:

  • Exercise programme – this should involve up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
  • Manual therapy – there are different types of manual therapy, including manipulation, mobilisation and massage, usually performed by chiropractors, osteopaths or physiotherapists. If you choose a course of manual therapy, this should include up to nine sessions over a period of up to 12 weeks.
  • Acupuncture – involves inserting fine, solid needles at different points in the body, has been shown to help reduce low back pain. If you choose a course of acupuncture, this should include up to 10 sessions over a period of up to 12 weeks.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

If the painkillers do not help, you may be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended for depression, but they are effective at treating some cases of persistent pain.

Some TCAs can have serious side effects, including suicidal thoughts, although this is rare. If this happens to you, contact your doctor or go to your nearest hospital immediately. You may want to tell someone close to you that you are on amitriptyline and ask them to let you know if they notice any changes in your behaviour.

Counselling

If the treatments listed above are ineffective, you may be offered some counselling to help you deal with your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse. Cognitive behavioural therapy (CBT) works by helping you to manage your back pain better by changing how you think about your condition.

Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.

Surgery

Surgery is usually only recommended as a treatment option when all else has failed.

One common procedure, called 'spinal fusion surgery', fuses the joint that is causing pain to prevent it moving.

Bone is a living tissue, which makes it possible to join two or more vertebrae together by placing an additional section of bone in the space between the vertebrae. This helps to prevent the damaged vertebrae from irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

However, spinal fusion is a complicated procedure and the results are not always satisfactory. You may still experience some degree of pain and loss of movement after surgery.

Other treatments

Other treatments that are sometimes used to treat long-term back pain include the following. There is, however, a lack of evidence about their effectiveness:

  • Low level laser therapy – low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair.
  • Interferential therapy (IFT) – a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body's natural painkillers).
  • Therapeutic ultrasound – ultrasound waves are directed at your back to accelerate healing and encourage tissue repair.
  • Transcutaneous electrical nerve stimulation (TENS) – a machine delivers small electrical pulses to the back through electrodes that are placed on the skin. The pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain.
  • Lumbar supports – cushions, pillows and braces are used to support your spine.
  • Traction – a pulling force is applied to your spine.
  • Injections – painkilling medication is injected directly into your back.

Not sure what to do next?

If you are still concerned about your back pain, why not use healthdirect’s online Symptom Checker to get advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self care, talking to a health professional, going to a hospital or calling triple zero (000).

Last reviewed: July 2015

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