An Ongoing Ache

Diagnosis and treatment strategies for chronic back pain

Matthew Solan
Harvard Health Publishing

At some point, almost everyone experiences back pain. You may have strained a muscle while working out, lifting a heavy object or simply bending over. Acute back pain (meaning a short-term episode) typically results from this kind of injury. It often resolves on its own with rest and the use of hot or cold compresses. You might be advised to take over-the-counter topical remedies and medication for pain and inflammation.

However, chronic back pain — lasting more than 12 weeks — can be more challenging to diagnose and treat.

“Finding the exact cause of chronic back pain can be tricky, as it could be related to many factors,” says Christopher Morin, a physical therapist with Harvard-affiliated Spaulding Rehabilitation Hospital.

Here’s how the process works for diagnosing and treating chronic back pain.

Getting evaluated

The first step is a medical evaluation. Your doctor will ask about your symptoms and your medical history. They will examine your back muscles and spine and move you in specific ways to check for pain, muscle tenderness, weakness, stiff ness, numbness or abnormal reflexes.

Your doctor also may suggest additional testing, especially if they suspect a problem involving your spinal bones or nerves. Tests might include x-rays, a spinal MRI, a CT scan or a PET scan, urine and blood tests, electromyography or nerve conduction studies.

Common causes of chronic back pain, besides an injury, include fi bromyalgia, degenerative disc disease, spondylitis (infl ammatory arthritis of the spine), vertebral compression fractures caused by osteoporosis and spinal stenosis.

Your treatment path for these conditions can vary. For all of them, however, you’ll most likely begin with conservative approaches to address the pain, typically over-the-counter pain relievers and physical therapy. Many people also use complementary treatments, such as acupuncture, chiropractic care, yoga and massage therapy. Making lifestyle changes related to exercise, loss of excess weight and diet also is benefi cial.

Depending on your diagnosis, your doctor may refer you to an orthopedic surgeon, a rheumatologist or a pain specialist.

“People may incorporate a combination of treatments to help manage their pain,” Morin says. “It’s often a trial-and-error approach, and you may have to experiment with it until you fi nd something that works.”

Advanced treatments

If these approaches don’t work, the next steps involve stronger prescription medication, corticosteroid injections to temporarily reduce inflammation and relieve pain, specialized therapy, and, if necessary, surgery. Here’s a look at how these advanced treatments are used for specific conditions.

Fibromyalgia

This condition causes widespread pain and fatigue. In addition to the back, affected areas may include the trunk, neck, shoulders, knees and elbows. Specific points on the body may be painful to the touch.

Treatment: The drugs duloxetine (Cymbalta), pregabalin (Lyrica) and milnacipran (Savella) are FDA-approved for fibromyalgia. Though low-dose amitriptyline (Elavil) is not specifically approved for this condition, doctors often prescribe it to reduce pain and improve sleep.

Degenerative disc disease

A natural part of aging, degenerative disc disease aff ects the discs between the bones in your spine. When a disc deteriorates, the inner part can push out and press on the spinal cord or a nearby nerve. This is known as a herniated or “slipped” disc. The disc also can become so worn out that the vertebrae begin to rub together. Bending and twisting often triggers back pain.

Treatment: Your doctor will likely prescribe one or more of a variety of medications. These include acetaminophen, an NSAID, duloxetine or another nerve pain medication or muscle relaxants. They also might recommend a limited number of targeted corticosteroid injections. If symptoms interfere with daily activities, surgery can take pressure off the affected nerve roots. People tend to have the quickest recovery with minimally invasive approaches, such as a discectomy to remove the damaged portion of the disc pressing on the nerve.

Spondylitis

Spondylitis is a form of arthritis that causes inflammation and damage in the spine. In addition to back pain, spondylitis can cause pelvic and hip pain.

Treatment: If NSAIDs aren’t enough, the usual next step for addressing persistent inflammation is a biological agent to help control the disease, such as adalimumab (Humira, others) or infliximab (Remicade, others).

Osteoporosis

Weak bones due to osteoporosis do not cause pain. However, the condition increases the risk of a vertebral compression fracture, in which a bone in the spine collapses, leading to back pain.

Treatment: Besides pain medications, other potential therapies include temporary back bracing and calcitonin nasal spray or injections. To reduce the risk of future fractures, people with osteoporosis need to get enough vitamin D and dietary calcium and take steps to avoid falls. Several medications can help maintain bone density and even build bone.

Spinal stenosis

This condition involves narrowing of the spinal canal, which can compress the nerves and trigger pain, numbness and weakness in the back and legs. Symptoms tend to worsen when you’re standing or walking but improve when you’re sitting or leaning forward.

Treatment: Doctors encourage people with spinal stenosis to remain active. Your doctor might prescribe stronger pain relievers and a muscle relaxant. Surgery is often reserved for people who have persistent or worsening symptoms or develop leg weakness.

MT Hospitals ranked in top 100 critical access list

Carly Graf
Montana State News Bureau

Two Montana hospitals have earned national recognition for their eff orts to provide health care in rural communities.

Bitterroot Health’s Daly Hospital in Hamilton and Central Montana Medical Center in Lewistown are among the best 100 critical access hospitals in the country, according to a national health care industry organization that recognizes high performers every year.

The Chartis Group, based out of Chicago, determines winners based on health outcomes, patient satisfaction, financial sustainability and other factors.

“The delivery of care within rural communities is perhaps more complex today than at any point in recent memory,” Michael Topchik, the executive director of Chartis’ rural health arm, said in a statement “This year’s Top 100 Critical Access Hospitals have emerged as true leaders – committed to their mission through a powerful combination of resilience, dedication and innovation.”

Lewistown’s Central Montana Medical Center has earned this designation 11 out of the last 12 years.

“This is a huge honor, and one that could not have been accomplished without the hard work and dedication of our entire staff to provide quality care to our community,” said CEO Cody Langbehn.

The 25-bed critical access hospital is a lifeline for the region, offering a primary care clinic and emergency room as well as an array of surgical and outpatient services. Last year, it unveiled a new cancer center, saving patients regular trips to Billings and Great Falls for life-saving treatments.

“We have to be everything for everybody,” Langbehn said in an interview last September.

Bitterroot Health’s Daly Hospital in Hamilton boasts 24 acute care beds and is the primary touchpoint with the medical system for residents of the rapidly growing Ravalli County.

The facility made the top 100 list in 2024 and 2025 and, last fall, added a dialysis unit to round out its suite of services that include outpatient treatment, preventative programs, surgery, cardiology, midwifery and orthopedics, among others.

”Our focus is always on our patients — as it should be — but moments like this give us the opportunity to recognize the extraordinary people behind the care,” said Christina Voyles, a spokesperson for Bitterroot Health. “Our team members not only serve this community, but they’re also part of it. They know their patients. They care deeply about them, and they’re genuinely invested in the health and well-being of the Bitterroot Valley.”

Fewer Montana hospitals made the list this year than in recent cycles. In 2024 and 2025, for example, there were four facilities that earned the designation.

There are 50 critical access hospitals in Montana. They are tasked with providing health care in the state’s most remote communities, and are often the only medical facility for miles.

But low patient volumes and persistent challenges recruiting providers to live and work in small towns can make it hard for a rural hospital to survive, much less thrive.

Those headwinds appear likely to intensify in the wake of last year’s federal budget that slashed Medicaid funding, a key source of revenue for most rural providers. Though most critical access hospitals in Montana have expressed confidence that they will be able to outlast the coming changes, few doubt they’re poised to enter a trying stretch.

Carly Graf has worked for the Montana State News Bureau since 2023.

Southwest Montana Health Care Directory