What is chronic low back pain?

How it is defined

The World Health Organization (WHO) 2023 guideline defines chronic primary low back pain as a persistent or recurrent pain experience of more than three months that is not reliably attributed to an underlying disease process or structural lesion. "Primary" means no clear underlying cause has been identified. The same guideline notes that most episodes of acute (short-term) low back pain are time-limited and have a favorable course, while a smaller number of people have symptoms that persist past three months.

Other bodies use slightly different wording. NICE defines chronic pain as lasting 3 months or longer and says its intensity may fluctuate over time. NIAMS, a US research institute, describes chronic back pain as pain that lasts longer than 12 weeks and occurs daily. A Cochrane review adds pain that goes away but returns more than twice in a year. The cut-offs are close but not identical, and a clinician decides how they apply to a person.

How common it is and why it persists

The WHO estimates that about one in 13 people globally had low back pain in 2020, around 619 million people, and calls it the leading cause of disability worldwide. It says chronic low back pain is often linked with a reduced ability to take part in family, social and work roles.

NIAMS notes that several factors may be present at once and interact. These can include mechanical or structural problems in the spine, inflammatory conditions and other medical conditions, and it adds that sometimes no specific cause can be found. It also lists poor sleep, depression and anxiety as factors linked with more frequent and severe back pain. For the shorter-term picture, see how long back pain usually lasts and what causes most low back pain.

Approaches the guidelines describe

The WHO guideline considered non-surgical care in primary and community settings and made conditional recommendations, based mostly on low or very low certainty evidence. Options it says may be offered include structured education, a structured exercise program, spinal manipulative therapy, massage, needling therapies such as acupuncture, cognitive behavioral therapy, anti-inflammatory medicines (NSAIDs, with moderate-certainty evidence) and multidisciplinary biopsychosocial care, which looks at physical, psychological and social factors together. It recommends against routine use of opioids, traction, therapeutic ultrasound and TENS (a device that sends weak electrical pulses through the skin).

The NICE low back pain guideline (NG59) points the same way in several respects. It recommends self-management advice that encourages normal activities, and says to consider an exercise program, manual therapy only alongside exercise, and oral NSAIDs. It advises against opioids for chronic low back pain. For chronic pain where non-surgical treatment has not worked, it says clinicians may consider referral for radiofrequency denervation, a procedure that targets certain pain-carrying nerves, under specific conditions. It does not recommend spinal fusion for low back pain except within a randomized trial. The two guidelines differ in places, such as acupuncture, so even expert bodies do not agree on every treatment.

The NHS adds that cognitive behavioral therapy can help with coping, and that a procedure to seal off nerves may be offered for long-term lower back pain. For more on movement and rehabilitation, see whether exercise helps back pain, what physiotherapy involves and the recovery and daily life set.

When to get help

The NHS says to see a GP if back pain does not improve after treating it at home for a few weeks, stops you doing day-to-day activities, or if you are worried or struggling to cope. NIAMS lists numbness and tingling, back pain after a fall or injury, and back pain with trouble urinating, leg weakness, fever or unintended weight loss as reasons to see a doctor. The NHS says to call 999 or go to A&E for pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, bladder or bowel changes, or pain that began after a serious accident.

Definitions and care pathways differ between countries and clinicians. This page explains terms and does not diagnose or advise on treatment.