Chronic Spine and Back Pain

The expert doctors at UT Southwestern Medical Center specialize in comprehensively evaluating and delivering proven therapies to patients suffering from chronic pain, including neuropathic pain and back pain.

At the Spine Center, our multidisciplinary approach provides patients access – with one call – to physiatrists, pain management specialists, neurosurgeons, and orthopaedic surgeons. We offer interventional pain procedures, such as injections and minimally invasive techniques, and noninterventional treatments, such as biofeedback and physical therapy.

Spine Center

Comprehensive Spine Care to Reclaim Quality of Life

The specialized spine doctors at UT Southwestern Spine Center are dedicated to helping patients overcome spine problems, providing comprehensive care and access to the latest and most effective treatments.

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Why Choose UT Southwestern for Chronic Back Pain?

Chronic back pain can be a constant burden, but with the right treatment, patients can experience the relief and freedom to enjoy their daily activities again.

At the Spine Center, we don’t believe in the one-size-fits-all concept. Each patient's treatment plan is as unique as their pain. Our multimodal approach aims to eliminate pain and restore normal function – without unnecessary surgery.

Unlike other clinics that may offer only specific treatments, UT Southwestern provides a full range of therapeutic options to meet our patients’ needs.

Healing is a journey best taken together. We build strong partnerships with our patients, encouraging them to be active participants in their care.

When Is Back Pain Chronic?

Spine and back pain that lasts longer than six months is called chronic pain. The pain can range from annoying to debilitating.

Chronic back pain can interfere with a person’s daily activities, disrupt their sleep, and affect their emotional well-being.

What Are the Common Causes of Chronic Back Pain?

Chronic back pain often involves complex interactions among physical, lifestyle, and psychological factors, such as:

Degenerative disc disease: As people age, the spinal discs that cushion the vertebrae can deteriorate, leading to pain. This condition is often the result of wear and tear over time.
Herniated or bulging discs: When the soft material inside a spinal disc pushes out through a crack in the tougher exterior, it can press on nearby nerves, causing pain.
Spinal stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the spinal cord and nerves, leading to pain, numbness, and weakness.
Spondylolisthesis: This occurs when a vertebra slips out of place onto the vertebra below it, which can cause nerve compression and chronic pain.
Osteoarthritis: The breakdown of cartilage in the joints of the spine can lead to pain and stiffness, particularly in older adults.
Injuries: Acute injuries from accidents, falls, or sports can lead to long-term back pain if not properly treated.
Lifestyle factors: Poor posture, lack of exercise, and obesity can contribute to the development and persistence of chronic back pain.
Psychological factors: Stress, anxiety, and depression can worsen the perception of pain and contribute to chronic pain conditions.

Risk Factors

Certain factors increase the likelihood of developing chronic back pain, including:

Age: While back pain can occur at any age, it becomes more common as people get older.
Sedentary lifestyle: A lack of physical activity and exercise can lead to weak back muscles.
Excess weight: Being overweight or obese puts additional stress on the back, which can contribute to chronic pain.
Arthritis: This condition can cause inflammation and pain in the back.
Improper lifting: Lifting objects without using proper body mechanics can strain the back.
Smoking: Smoking can lead to bone damage and pain, and it also slows down the healing process.
Mental health concerns: Excessive stress, anxiety, and depression can increase the risk of back pain.
Pregnancy: The weight gain and postural changes associated with pregnancy can lead to chronic back pain.
Occupational hazards: Jobs that require heavy lifting, bending, twisting, or exposure to whole-body vibration (such as truck driving) can increase the risk of chronic back pain.

How Is Chronic Back Pain Diagnosed?

If a patient has chronic back pain, we’ll conduct a physical examination and order additional testing if needed. This thorough evaluation helps us create a treatment plan tailored for each patient.

Tests, procedures, and spine imaging studies used to diagnose chronic pain can include:

X-ray: Uses radiation to produce images of bones and joints
Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to produce detailed images of soft tissues, including muscles and nerves
Computed tomography (CT): Uses specialized X-ray equipment to create images of the body that can help detect bone abnormalities in particular
Myelography: Involves injecting a contrast dye into the spinal canal to highlight the spinal cord and nerve roots on X-rays or CT scans
Electromyography (EMG): Used to evaluate the health of muscles and the nerve cells that control them (motor neurons)

How Is Chronic Back Pain Treated?

After diagnosis, we’ll discuss our recommendations with the patient and create a comprehensive treatment plan that aims to relieve pain, improve physical function, and reduce pain-associated psychological distress.

Nonsurgical Treatments for Chronic Back Pain

Chronic back pain can often be managed effectively with nonsurgical treatments. These therapies aim to reduce pain and improve function, so patients can get back to doing the things they enjoy.

Nonsurgical treatments include:

Spinal injections

Injections deliver medication directly to the source of the pain, providing relief and helping to reduce inflammation.

Epidural steroid injection: Delivers corticosteroids into the epidural space around the spinal cord to reduce inflammation and pain
Facet joint injection: Targets the facet joints, which are located between each vertebra
Selective nerve root block: Delivers medication directly to the nerve root that is causing pain

Biofeedback

This technique teaches patients to control physiological processes such as muscle tension, heart rate, and pain perception through the use of electronic monitoring devices. This method can help manage chronic pain by promoting relaxation and reducing stress-related symptoms.

Medications

Doctors may prescribe medications to help manage chronic back pain, including:

Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen or naproxen, help reduce inflammation and relieve pain.
Muscle relaxants: These can help alleviate muscle spasms and improve pain relief.
Antidepressants: Certain types of antidepressants, particularly tricyclic medications, can help with chronic pain management.

Physical Therapy

Physical therapy is a key component of chronic back pain management. A physical therapist can develop an exercise program tailored to the patient's specific needs. This may include:

Strengthening exercises to target the muscles that support the spine, helping to improve stability and reduce pain
Stretching, which can increase flexibility and reduce tension in the back muscles
Aerobic conditioning through low-impact aerobic exercises, such as walking or swimming, which can enhance overall fitness without straining the back
Manual therapy, such as massage or spinal manipulation, to help relieve pain and improve function

Other Nonsurgical Treatments

Our doctors may recommend other therapies for chronic back pain, including:

Acupuncture: This holistic health practice uses thin needles to target particular areas of the body to reduce pain and enhance overall wellness.
Cognitive behavioral therapy (CBT): This type of psychotherapy can help patients manage pain by changing negative thought patterns and behaviors related to their pain.
TENS (transcutaneous electrical nerve stimulation): This therapy uses low-voltage electrical currents to provide pain relief by stimulating nerves and muscles.
Lifestyle modifications: Changes in diet, posture, and activity levels can significantly impact chronic back pain management. Losing weight, practicing proper ergonomics, and quitting smoking are essential strategies.

Surgical Treatments for Chronic Back Pain

If nonsurgical treatments don’t provide a patient with sufficient relief, we may recommend surgical options. Our goal is to address the root cause of the back pain and deliver long-term relief, reducing the likelihood of future issues.

Surgeries we perform for chronic back pain include:

Discectomy: This surgery involves removing the portion of the herniated disc that is pressing on the nerve root. It can be performed as an open surgery or through a minimally invasive approach (microdiscectomy), which involves smaller incisions and typically results in a quicker recovery.
Laminectomy: This procedure involves removing part of the vertebra (the lamina) to relieve pressure on the spinal cord or nerves. It's often performed in conjunction with a discectomy.
Spinal fusion: In cases where multiple discs are herniated or there is spinal instability, spinal fusion may be performed. This surgery involves fusing two or more vertebrae together to stabilize the spine.