Low back pain is one of the main causes of absence from work and functional limitations in adults. In most cases, it is related to muscle contractures, poor posture or physical overload and improves with rest, physiotherapy and routine adjustments. However, when pain persists for weeks or months, reappears frequently or gets progressively worse, it is a sign that the problem may go beyond the muscles.
When low back pain stops being simple
Chronic low back pain is considered to be pain that lasts more than three months. In these cases, it is essential to investigate structural causes of the spine, such as herniated disc, spinal canal stenosis, osteoarthritis of the spinal joints or compression of nerve roots. Unlike muscle pain, these conditions tend to cause continuous discomfort, morning stiffness and limited movement.
Another point of attention is pain that radiates to the legs, especially when accompanied by tingling, numbness or a sensation of shock. These symptoms suggest neurological impairment and indicate that nerves may be being compressed, which requires further evaluation.
Warning signs that deserve investigation
Some signs help to differentiate common low back pain from situations that require specialized attention. Pain that worsens at night or at rest, loss of strength in the legs, difficulty walking, changes in sensitivity or urinary and bowel control are examples of important warning signs.
Furthermore, patients over 60 years of age, people with a history of cancer, recent trauma or inflammatory diseases should be evaluated more carefully. In these cases, imaging tests, such as MRI, help identify the source of the pain and define the best treatment strategy. Ignoring these signs can lead to the progression of the condition and loss of quality of life.
Individualized treatment and role of neurosurgery
The treatment of chronic low back pain must be individualized and, in most cases, begins conservatively. Physiotherapy, muscle strengthening, weight control, postural adjustments and specific medications usually bring good results. Regular practice of guided physical activity is also an essential part of care.
Neurosurgery comes into play when clinical treatment fails or when there are progressive neurological deficits. In well-indicated situations, surgical procedures can relieve nerve compression, reduce pain and restore functionality to the patient. With current techniques, many spine surgeries are less invasive, with faster recovery and lower risk.
Persistent low back pain should not be seen as normal or inevitable. Correctly identifying the cause is the first step towards effective treatment. When assessed at the right time, pain can be controlled and, in many cases, resolved, allowing the patient to resume their activities with more comfort and safety.
Dr. Cesar Cimonari de Almeida – CRM/SP 150620 | EQR 66640
Neurosurgeon
Membro da Brazil Health
