Why Does Your Back Hurt?

So What Can Be Done?

"If the cause can't be identified, does that mean nothing can help?" — No. Far from it.

In fact, because chronic low back pain usually involves multiple factors, approaches that address several of them at once tend to be the ones that help.

Approaches Supported by Evidence

1. Appropriate exercise therapy — Exercises matched to the type of pain have been reported to improve outcomes (Long 2008)
2. Pain education — Understanding how pain works has been reported to reduce pain intensity on its own
3. Psychological approaches — Cognitive behavioral therapy and mindfulness have been shown to help (Cherkin 2016, JAMA)
4. Medication management — Not a cure-all, but certain medications can provide relief as part of a broader plan
5. Spinal cord stimulation (SCS) — An option for patients who have not responded to conservative treatment. Like any surgical procedure, SCS carries risks including infection, lead migration, and the possibility that it may not provide adequate relief. When appropriate, it has been reported to help reduce pain in selected patients.

The Key Takeaway

An MRI finding alone is not a reason for surgery.

A large clinical trial with 11 years of follow-up found that spinal fusion for non-specific chronic low back pain did not produce a clinically meaningful difference compared to structured rehabilitation (Mannion 2013).