Nonsurgical and Postsurgical Management of Low Back Pain

Chronic low back pain (LBP) is defined as pain lasting longer than 3 months. Over 600 million individuals are afflicted with chronic pain. Chronic LBP is the leading cause of years lived with disability worldwide. Management of chronic nonspecific LBP may be challenging to the clinician and must include an assessment of all tissues in the region, including muscles and ligaments. Different sources of LBP may have similar presentations, requiring careful diagnostic skills and supportive imaging studies. On occasion, there may be more than one source for the LBP. Interventions may be divided into steroid injection, thermal ablations, release techniques, or neuromodulation. A broad range of medications are available for the management of LBP, each associated with unique therapeutic and toxic profiles. Treatment consists of a combination of exercise, cognitive behavior therapy, pharmacotherapy, interventional procedures, and interdisciplinary rehabilitation. When correctly selected, nonoperative therapies for chronic LBP may offer patients a high degree of relief through repeated intervention. Postsurgical pain is significantly different from chronic pain and should be treated differently. Unmanaged acute pain may result in chronic pain. It is possible for patients to have both chronic and acute pain at the same time. Opioids should be viewed as the last option for chronic pain.