[Chronic back pain-pharmacological and nonpharmacological treatment approaches]

Chronic back pain is a global health problem with significant impacts on physical and mental health, work ability, and quality of life. Back pain has an increased risk of becoming chronic, especially in patients with other chronic conditions. Treatment primarily focuses on nonpharmacological approaches. Regular exercise is strongly recommended for pain relief and improved function. Physical therapy can provide guidance and education on appropriate exercises. Acupuncture may offer some pain relief, but the evidence is inconclusive. Pharmacological treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioids. While NSAIDs can provide short-term relief, long-term use is associated with side effects. Muscle relaxants are not recommended for chronic pain. Opioids can be effective for severe pain but carry a risk of addiction and should be used with caution. Facet joint injections can provide temporary relief for some patients. Surgery may be considered when there is a clear correlation between structural abnormalities and symptoms. However, the relationship between degenerative changes and pain is complex and not fully understood. The management of chronic back pain often requires a multidisciplinary approach. Nonpharmacological interventions should be the first line of treatment. Pharmacological agents can provide temporary relief. Regular follow-up by healthcare professionals is crucial for optimal management.