John Hopkins physician recommends natural ways to ease chronic back pain(and when is a surgery necessary)

Back pain is among the most common medical complaints in the world, and for many people it doesn’t just fade away. Instead, it lingers, reshaping daily life and leading to questions about whether anything short of surgery can offer relief.

The World Health Organization estimates that more than 600 million people are affected globally, making low back pain the single leading cause of disability. But that does not mean that everyone needs a surgery. Sure chronic back pain is complex, but it doesn’t always demand the operating room.Back pain rehabilitation specialist Dr. Stephanie Van, M.D., cautions against rushing into invasive procedures. “People with back pain should not feel rushed into settling for an invasive, irreversible surgical procedure,” she says.

“Surgery can be helpful for many people, but it is usually considered a last resort after more conservative options have been exhausted. Surgery can correct structural abnormalities contributing to back pain, but it does not guarantee pain relief, and it may even worsen the pain.

”

Why back pain becomes Chronic

Common culprits include arthritis of the spine, where cartilage thins over time, spinal stenosis, which narrows the canal around the spinal cord, herniated or bulging disks that press on nerves, and myofascial pain syndrome, a condition marked by muscle pain without a clear source.

These conditions overlap with lifestyle factors — posture, smoking, weight, inactivity — creating a cycle of pain that, if untreated, easily becomes long term.

The first line of defense: Physical therapy

Van explains that movement is one of the earliest tools prescribed for patients living with chronic pain. Exercises need to be tailored to individual needs, often combining core strengthening, stretching, posture retraining, gradual pain-threshold work, and low-impact aerobic conditioning.Studies consistently back this approach. A 2021 review concluded that exercise therapy leads to clinically meaningful improvements in pain and function for chronic low back pain. Long-term follow-ups show benefits lasting well beyond the initial therapy period. Physical therapy isn’t about avoiding pain altogether, but about building resilience, retraining the body so the spine can function with less irritation.

Training the mind alongside the body

Physical pain rarely travels alone. It often brings depression, irritability, and frustration. Rehabilitation psychologists who introduce practices such as meditation, yoga, tai chi, or mindfulness-based stress reduction come in handy. These aren’t just soft add-ons — they have neurological effects.

A Johns Hopkins-led review published in JAMA Internal Medicine found that mindfulness meditation produced measurable improvements in anxiety and depression, with benefits comparable to standard medications. More recently, a 2024 study in the North American Spine Society Journal reported that tai chi and qigong reduced back pain while improving sleep, mood, and balance.

The science suggests these mind-body practices help calm the nervous system, reducing the brain’s perception of pain.

Rethinking diet’s role in pain

Inflammation often runs in the background of chronic pain. Diets high in processed foods, refined sugars, and trans fats can amplify inflammation, while nutrient-rich, plant-forward patterns may reduce it. Dr. Van encourages patients to evaluate what they eat and, where possible, maintain a healthy weight to lessen the physical load on the spine.

Everyday choices that matter

Lifestyle adjustments can be deceptively powerful. “Listen to your body and learn to pace yourself,” says Dr. Van. That means recognizing activities that worsen pain and learning to step back when necessary. It is often stressed practical measures, taking breaks during chores, asking for help with heavy lifting, and avoiding habits like smoking, which is known to slow healing and intensify pain. These seemingly small shifts add up to better management of long-term symptoms.

Injections as temporary tools

For patients whose pain stems from a clear source, injection-based therapies may help. Options include trigger point injections, epidural steroids, nerve blocks, and nerve ablations. These can relieve symptoms for weeks or months, but they are not intended as long-term cures. Their true value often lies in buying time for patients to reengage in physical therapy. Johns Hopkins research also suggests that the act of injection itself may matter as much as the medication.

The cautious use of medications

When other measures are insufficient, medications can provide relief, ranging from anti-inflammatories and muscle relaxants to nerve pain agents and antidepressants. Physicians emphasize the lowest effective dose for the shortest necessary time, since all drugs carry risks.Dr. Van stresses one boundary clearly. “Opioid medications are not recommended as a first-line strategy for chronic back pain,” she explains.

“They are most helpful in the short term for acute pain, like after a traumatic accident or surgery. Prolonged use of opioids is so stigmatized because it inevitably leads to medication tolerance, escalating to higher and riskier doses, physical dependence and habit formation.

”

When surgery becomes an option

Despite best efforts, some cases demand more. Alarming symptoms, such as sudden bladder or bowel issues, groin numbness, limb weakness, or balance problems, can point to urgent surgical needs.

Imaging that confirms a structural cause may also justify surgery, but only after conservative therapies fail.As Dr. Van puts it: “Surgery is the most invasive, high risk strategy for chronic back pain. It is irreversible, and it does not guarantee complete relief of back pain. The best spine surgeons will offer surgery only after the patient has tried and has not had success with conservative treatments.”