Chronic Back Pain
پرانا کمر دردChronic back pain is pain in the lower or middle back that has lasted more than about three months. This kind of pain usually comes from worn discs and joints or weak muscles, and only rarely needs an operation. Its assessment by Dr. Salman Falak finds the few patients with a surgical cause and guides the rest to non-surgical care.
What chronic back pain is
Almost everyone has a bout of back pain at some time, and most bouts settle within a few weeks. Pain becomes chronic when it lasts beyond about three months, or keeps returning so often that it shapes daily life. By then the original strain has healed, and the pain is being kept going by a mix of worn joints, stiff and weak muscles, poor sleep and sometimes low mood. That is why chronic back pain responds poorly to rest and well to the right kind of movement.
A neurosurgeon's part in this is specific. Dr. Salman Falak looks for the minority of patients whose pain has a structural cause that surgery can fix, such as a disc pressing on a nerve or a spine that has become unstable, and he says plainly when it does not. Most people who come to his OPD with long-standing back pain leave with a diagnosis and a plan that does not involve an operation.
Symptoms and red flags
Chronic mechanical back pain is usually a dull ache across the lower back that is worse after sitting or standing for long and better with a change of position. It may spread to the buttocks or the top of the thighs but rarely below the knee. Stiffness in the morning that loosens with movement is common. Pain that runs down one leg past the knee points to a nerve and is covered on the sciatica page.
A few warning signs mean the pain needs prompt assessment, whatever its duration:
- Numbness or weakness in a leg, or trouble with bladder or bowel control
- Pain that wakes you at night and does not ease in any position
- Fever or unexplained weight loss alongside the pain
- Pain after a fall or accident, or a history of cancer or weak bones
Causes and who gets it
The common causes are wear in the discs and the small facet joints, written as degenerative disc disease or spondylosis on reports, and back and core muscles that have become weak from years of sitting. Less common causes include a slipped disc, narrowing of the spinal canal, a slipped vertebra, an old fracture that has left the spine unstable, and infection or a tumour. These are not guesses. Each has its own pattern on examination and on MRI.
Chronic back pain is most common in middle age and beyond, in people who sit for long hours or lift heavily for work, and in those who carry extra weight or smoke. Women after the menopause and anyone on long-term steroid treatment can develop weak bones, and a painful back in that group is checked for a compression fracture. Low mood and poor sleep make any pain feel worse and are taken seriously in the assessment.
How it is diagnosed
The consultation begins with the story: when the pain started, what makes it better or worse, whether it travels, and whether any of the red flags above are present. Dr. Salman Falak then examines the back for tenderness and movement, and tests the power and the reflexes in the legs so that nerve involvement is not missed.
Scans are ordered when they will answer a question. An MRI is advised when there are leg symptoms or red flags, or when pain has not improved with proper treatment. X-rays taken standing and bending show whether a vertebra is slipping, and a bone density test is added when a fracture or weak bone is suspected. Many patients arrive with an MRI already done, and it is worth knowing that some wear on a scan is normal with age. The scan is read together with the examination before any treatment is suggested.
Treatment: non-surgical care first, then surgery where it helps
For most patients the plan is non-surgical. It starts with a clear explanation of what is and is not wrong with the spine, because fear of movement is one of the main reasons pain persists. Then comes a structured exercise programme through a physiotherapist, with medicine used for a limited time to make exercise possible. Losing weight and sleeping better help more than most people expect. Injections into a facet joint or around a nerve root are used for specific diagnoses, and they work best as a bridge to exercise.
Surgery has a clear role in a small group. When a disc is pressing on a nerve and causing leg pain or weakness, lumbar disc herniation surgery removes the pressure. When the spine has become unstable, from a fracture or a slipped vertebra, transpedicular screw fixation holds the bones steady while they fuse. Surgery for back pain alone, with a normal MRI and no instability, does not work well, and Dr. Salman Falak will not recommend it.
What recovery looks like
Recovery from chronic back pain is gradual and rarely a straight line. With regular exercise most patients notice that the good days begin to outnumber the bad within a few months, and flare-ups become shorter and less frightening. The aim is a back that works for daily life and work, even if an occasional ache remains.
After surgery, the course depends on the operation. A discectomy usually means a short stay and a return to desk work within weeks. A fixation is a bigger operation with a longer recovery, and the bone takes months to fuse, so lifting and bending are limited in that period. Follow-up for patients from other cities is done by video where possible, with X-rays taken locally and sent on WhatsApp.
When to see a neurosurgeon
See a neurosurgeon if back pain has lasted more than a few weeks despite proper treatment or has started to run down a leg, and at once if any red flag is present. A consultation does not commit you to surgery. Most patients are reassured and sent back to physiotherapy with a clearer plan. If you live far from Lahore, begin with a video consultation and send your scans on WhatsApp. If an examination is needed, it can be arranged at the Lahore OPDs or at the weekly clinics in Gujranwala and Phool Nagar.
Related conditions and procedures
If your pain follows a fall or your report mentions a fracture or a slipped vertebra, the page on spinal fracture and instability explains when the spine needs to be held with screws. Pain that travels into the leg is covered under sciatica, and a disc problem under slipped disc. The procedure pages linked above describe lumbar disc herniation surgery and transpedicular screw fixation in detail, from the hospital stay to recovery.
Procedures that treat it
Questions patients ask
How do I know if my back pain is neurological?
Back pain is called neurological when a nerve or the spinal cord is involved. The signs are pain that runs down a leg, numbness or pins and needles, weakness in the foot or leg, or trouble with bladder or bowel control. Pain that stays in the back and changes with position is usually mechanical, from the muscles and joints, and it is treated differently.
What can a neurosurgeon do for back pain?
A neurosurgeon finds out whether the pain has a cause that surgery can fix and then either operates or says clearly that it is not needed. For a trapped nerve the operation is a discectomy; for an unstable spine it is fixation with screws. For the larger group with wear-related pain, the neurosurgeon rules out anything serious and directs the patient to the right non-surgical care.
How do I know when back pain is serious?
Pain with leg weakness, numbness in the saddle area, loss of bladder or bowel control, fever, or unexplained weight loss is serious and needs a doctor the same day. So does pain after a significant fall, or pain that wakes you at night and does not ease. Ordinary back pain, however unpleasant, usually eases with movement and does not come with these warning signs.
How long should I let back pain go before seeing a doctor?
A simple bout with no leg symptoms can be given a few weeks with normal activity and simple painkillers. If it has not clearly improved by then or has spread into a leg, get it assessed. Do not wait at all if there is numbness or weakness, and treat any change in bladder or bowel habit as urgent.
Can chronic back pain be assessed by video consultation?
Yes, a first assessment works well by video. Dr. Salman Falak takes the history and looks at any scans you send on WhatsApp, then tells you whether you need an in-person examination or can start treatment locally. Many patients from Faisalabad and Sialkot save a journey this way.
What should I bring to the appointment?
Bring all your scans and reports. The actual MRI films or CD matter more than the written report, so bring those if you have them, along with a list of the medicines and treatments you have already tried. Wear clothes that make it easy to examine your back and legs.
Send your MRI. Get a clear answer before you travel.
WhatsApp your reports and your city, and you will be told whether surgery is likely, which tests to bring, and which OPD is nearest to you.