Chronic back pain

When inflammation is suspected

Pain that begins at a young age, wakes you at night, comes with morning stiffness and is relieved by movement may call for investigation for spondyloarthritis. Psoriasis, eye inflammation or inflammatory bowel disease can support the suspicion. This pattern is not enough by itself for the diagnosis. Pain spreading into the leg with numbness may be related to nerve irritation (numbness and nerve pain) and must be assessed clinically.

Mechanical, inflammatory or of nerve origin

Mechanical pain often changes with load or position. Inflammatory pain may be more marked after rest and eased by movement. Irritation of a nerve root (sciatica) can cause pain that spreads into the leg, numbness or weakness in a particular distribution. These patterns help orientation but can overlap. A symptom that changes or a new neurological deficit requires reassessment.

How assessment is done and why imaging may not match the pain

The doctor reviews the duration, activity, nerve symptoms and the effect on daily life. He or she examines movement, strength and sensation. Magnetic resonance imaging is not automatically needed for every chronic pain: imaging is recommended when there are alarm signs or when the result may change treatment, at another center, and we interpret the result. Tests are chosen to clarify a particular suspicion.

Changes in the discs and joints become more common with age and may also be seen in people without pain. For this reason, a report with “degeneration” or “protrusion” does not automatically explain every symptom. The doctor looks for agreement between the site of pain, nerve signs and findings. On the other hand, the absence of major damage on imaging does not mean the pain is not real: long-lasting pain may come with changes in the processing of pain signals, physical deconditioning and sleep difficulty.

Movement, posture and sleep: what has the best evidence

For chronic back pain, regular exercise has some of the strongest evidence for improving pain and function. There is no single “best” exercise: walking, swimming, trunk stabilization exercises, adapted yoga or strength training give similar benefits, so choose the one you can do regularly. Start with a low load and increase gradually; it is normal to feel some pain during exercise, but not pain that markedly worsens you in the afternoon or the next day. Prolonged bed rest during acute episodes does not help: a quick return to light movement is associated with better recovery.

At work, changing position every 30–45 minutes matters more than a “perfect” chair. Lift loads with bent knees and the object close to the body. Sleep and pain affect each other: a regular schedule, a dark room and a pillow that keeps the neck aligned help; sedatives for sleep are not recommended as a long-term solution. Chronic stress and fear of movement increase pain; learning accurate explanations about the back, that pain does not necessarily mean damage, reduces anxiety and improves outcome. Local warmth can give short-term relief; braces used continuously weaken the muscles and are not recommended except in certain situations.

When a deeper assessment is needed and what to ask

Pain that wakes you at night and is not eased by changing position, unexplained weight loss, fever, pain after a fall or significant injury, a history of cancer or prolonged corticosteroid use call for faster assessment, because serious causes are rare but important. Numbness, weakness or a change in bladder control call for urgent assessment.

At the visit ask: what does the examination show and is imaging needed; which exercises should I do and how often; which activities should I avoid temporarily; when can I return to work or sport; which medicines are safe for me and for how long. Bring MRI or X-ray reports, if they exist, together with the images.

Treatment and long-term aims

Treatment is tailored to the cause and may include exercise, physiotherapy and pain management. If there is inflammatory disease, the relevant treatment is needed too. Keep moving as tolerated and avoid prolonged bed rest; increase activity gradually, with guidance when needed. Sleep, stress and the way you work can affect pain and are discussed in the care plan.

The aim is not limited to lowering a number on the pain scale: improving walking, sleep and ability to work is just as important. When there is fear of movement or significant emotional impact, psychological support for pain management may be included. Passive therapies can give relief in certain cases, but an active rehabilitation plan plays an important role. Do not use painkillers or anti-inflammatories continuously without review; medicines are assessed for benefit and risk, especially in patients with heart, kidney or stomach disease. Specialized interventions are considered when there is a clear indication and are not recommended on the strength of a wording in an MRI report alone. If there is numbness, weakness or significant limitation, seek reassessment.

Care at Tirana Polyclinic: we offer rheumatology consultation and coordination with physiotherapy, neurology or orthopedics as needed. We interpret imaging performed at other clinics and set the follow-up plan, with check-ups every 6 months to a year or sooner when the doctor considers it reasonable.