How can I manage my chronic back condition to minimize its impact on my daily life and occupation?

Managing Chronic Low Back Pain in a 72-Year-Old with Multilevel Degenerative Disc Disease

You should modify your work activities and adopt a comprehensive biopsychosocial approach to manage your chronic back condition, including appropriate pain management, physical therapy, and ergonomic adjustments to minimize its impact on your daily life and occupation.

Assessment of Your Condition

Your imaging shows:

• Stable subtle levoscoliosis
• Slight retrolisthesis of L4 relative to L5 (unchanged)
• Diffuse lumbar facet osteoarthropathy
• Stable multilevel degenerative disc disease throughout the lumbar spine

These findings represent chronic degenerative changes that are likely contributing to your increasing back pain and work limitations.

Work Modification Recommendations

Since your kitchen work appears to be exacerbating your condition:

1. Request workplace accommodations rather than immediately changing jobs 1

   • Anti-fatigue mats if standing for long periods
   • Adjustable height work surfaces
   • Proper lifting techniques training

2. Consider a "fit note" from your healthcare provider 2

   • This can help manage your return to modified work
   • Work is often the area of people's lives most disrupted by pain

3. Modify specific activities:

   • Avoid prolonged standing in one position
   • Take regular short breaks to change positions
   • Limit heavy lifting or repetitive bending

Self-Management Strategies

1. Stay active rather than resting 2, 1

   • Bed rest is not recommended and may worsen your condition
   • Maintain daily activities with modifications as needed

2. Implement a structured exercise program focusing on:

   • Core strengthening exercises
   • Aerobic fitness (walking, swimming)
   • Not just stretching alone 1

3. Weight management if applicable 1

   • Consider a structured weight loss program if you have elevated BMI
   • This should include dietary modification, exercise, and behavioral support

Pain Management Approach

1. First-line medications:

   • NSAIDs if not contraindicated 3
   • Consider topical analgesics for localized pain

2. Second-line options if first-line treatments are insufficient:

   • Duloxetine may be beneficial 3
   • Avoid long-term opioid use due to limited evidence for efficacy 3

3. Non-pharmacological pain management:

   • Heat therapy for pain relief
   • Transcutaneous electrical nerve stimulation (TENS)
   • Massage therapy

Specialist Referral Considerations

1. Physical therapy referral:

   • For individualized exercise program
   • Manual therapy techniques
   • Ergonomic education specific to kitchen work

2. Pain specialist evaluation if pain remains uncontrolled:

   • For comprehensive biopsychosocial assessment 2
   • Consider referral to a specialist pain center if no improvement after 12 weeks of treatment

3. Psychological support if needed:

   • Cognitive behavioral therapy can help with pain coping strategies
   • Particularly important if pain is causing significant distress or disability

Monitoring Progress

1. Regular follow-up with your healthcare provider:

   • Assess response to interventions
   • Adjust treatment plan as needed

2. Use of validated tools:

   • The STarT Back tool can help predict risk of developing persistent disabling pain 2
   • This helps guide appropriate resource allocation and referrals

Common Pitfalls to Avoid

1. Relying solely on imaging findings:

   • Disc protrusions seen on imaging rarely correlate directly with pain 4
   • Focus on functional improvement rather than imaging changes

2. Expecting complete pain resolution:

   • Set realistic goals for pain reduction and functional improvement
   • Chronic back pain often requires ongoing management

3. Overreliance on passive treatments:

   • Active self-management strategies are essential for long-term improvement
   • Avoid becoming dependent on treatments that don't promote self-efficacy

Remember that chronic back pain is best managed with a multimodal approach that addresses both physical and psychosocial factors 5. With appropriate workplace modifications, active self-management, and targeted interventions, you can minimize the impact of your back condition on your daily life and occupation.