Summary
Chronic back pain — pain lasting three months or longer — isn’t a life sentence, but it does require a different approach than acute pain. It persists because the underlying structural causes (degenerated discs, arthritic joints, weakened postural muscles) remain unaddressed, often compounded by mechanical habits that continue to stress the spine. At MAPS Centers for Pain Control in Chicago, a team-based approach combines physical therapy, targeted injections, advanced interventional procedures, and newer restorative treatments to deliver lasting relief — not just temporary symptom management. Recovery takes commitment and time, but a clear path forward exists for every patient.
There’s a particular kind of discouragement that comes with chronic back pain. It’s not just the pain itself — it’s the waiting for it to finally go away, the treatments that helped for a while before the pain came back, the creeping suspicion that this is just how life is going to be now. For millions of Americans — and a significant number of patients across Chicagoland — chronic back pain has become the background noise of daily existence.
But here’s what chronic pain patients deserve to hear clearly: persistent back pain almost always has an identifiable cause, and in the vast majority of cases, effective treatment exists. The challenge isn’t that chronic back pain is untreatable. The challenge is understanding why it became chronic in the first place — and building a plan that addresses that reason rather than just quieting the symptoms for a few weeks at a time.
“I would tell anybody living with back pain, anybody suffering from back pain — you do not need to just suffer in back pain,” says Adarsh Shukla, MD, LCP-C a double-board-certified pain management specialist at MAPS Centers for Pain Control. “And you don’t need to think that there’s no hope or there’s no recovery for you. There is so much that we can offer.”
Related: Back Pain Relief in Chicago: Causes, Symptoms, and Non-Surgical Treatment Options | What Causes Back Pain? Common Triggers You Shouldn’t Ignore
What Makes Back Pain “Chronic”?
Clinically, back pain is considered chronic when it persists for three months or longer. But that definition, while useful for classification, doesn’t capture the full picture of what chronic pain actually means for the person living with it.
Chronic back pain is rarely a single, static problem. It tends to evolve — starting perhaps as an acute injury or a period of intensified degeneration, then settling into a persistent state where pain fluctuates between manageable and debilitating but never fully resolves. Patients develop compensatory movement patterns to avoid pain, which creates new mechanical stresses. Muscles that aren’t used normally begin to weaken and atrophy. Sleep is disrupted, activity levels drop, and the physical deconditioning that follows makes everything worse.
Understanding this cycle — and where to interrupt it — is at the heart of effective chronic back pain management.
Why Does Back Pain Become Chronic? The Real Reasons Pain Persists
The Underlying Cause Was Never Fully Addressed
The most common reason back pain becomes chronic is straightforward: the physical condition causing it was never properly diagnosed and treated. Pain may have been managed — with rest, over-the-counter medications, or even short courses of physical therapy — but the structural issue driving it remained in place.
Dr. Shukla is direct with every new patient about this reality. “I know this pain may have just presented in the past week, maybe month, maybe a couple months, but likely the processes inside your body that were happening that led to this were happening long before that. It could be years of either improper mechanics or years of degeneration that was happening in your body.”
When degenerated discs, arthritic facet joints, compressed nerve roots, or weakened stabilizing muscles go unaddressed, pain doesn’t resolve — it becomes entrenched. And the longer it goes without targeted intervention, the more established the chronic pain state becomes.
The Mechanical Patterns That Caused It Continue
Even when pain is treated, if the biomechanical habits and postural patterns that produced the pain aren’t corrected, the same structures get re-stressed day after day. Poor posture while sitting. Improper lifting mechanics. A weak core forcing the lumbar spine to absorb load it shouldn’t. A muscle imbalance that puts excessive tension on one side of the spine.
These patterns don’t correct themselves. They require deliberate rehabilitation — the kind that physical therapy provides — and a lifestyle commitment to maintaining what’s been gained.
“Once that pain level is reduced, we have a window of time where now you have to correct the factors that led to your pain,” explains Dr. Shukla. “Things like improper mechanics, muscular imbalances, weak core strength. If you don’t change those things, then it’s more likely than not that your pain will return.”
Related: Back Pain from Sitting and Desk Work: A Common Chicago Problem | Back Pain Without Injury: Why It Happens and What to Do
Deep Postural Muscle Atrophy
One of the most clinically significant — and least publicly understood — contributors to chronic back pain is what happens to the deep stabilizing muscles of the spine over time. The multifidus, the deepest and most structurally important muscle running along the spine, operates under autonomous control: it activates automatically, without conscious thought, every time a person stands, walks, or shifts position. It is the spine’s primary postural stabilizer.
In patients with chronic low back pain, MRI imaging consistently reveals that this muscle has atrophied — its active muscle tissue replaced by fat, leaving the spine progressively less supported with every movement. “What we see on MRIs of patients who have chronic low back pain is that that muscle becomes infiltrated with fat — it actually loses the muscle tissue, it atrophies, and then it gets replaced with fat,” says Dr. Shukla. “And so that makes the muscle less effective in maintaining proper posture and proper mechanics.”
Because the multifidus isn’t under voluntary control, standard core strengthening exercises don’t fully reach it. This is one reason why some patients do “everything right” in terms of exercise and therapy and still struggle with persistent pain — the muscle that matters most isn’t responding the way voluntary muscles do.
Pain Avoidance and Deconditioning
Chronic pain creates a difficult behavioral trap. Moving hurts, so patients move less. Moving less leads to muscle weakness and joint stiffness, which makes movement hurt more. This deconditioning cycle is a major driver of pain persistence and one of the reasons that doing nothing — waiting for chronic back pain to resolve on its own — almost never works.
“The longer you wait to address it, the more likely it is that that pain becomes chronic and long lasting,” Dr. Shukla notes. For patients already in the chronic phase, the same principle applies in reverse: the sooner treatment begins, the sooner the deconditioning cycle can be reversed.
The Critical Difference: Palliative vs. Restorative Treatment
One of the most important concepts in chronic back pain care — and one that Dr. Shukla discusses explicitly with his patients — is the distinction between treatments that manage symptoms and treatments that restore function.
Palliative treatment reduces pain while it’s active. An epidural steroid injection, for example, delivers anti-inflammatory medication around a compressed nerve root. It can dramatically reduce pain — but when the medication clears the body, if nothing structural has changed, the pain returns. Palliative treatments are not without value: they play a critical role in getting pain under control so that rehabilitation can begin. But symptom relief alone is not recovery.
Restorative treatment addresses the underlying dysfunction itself. “We’re not just managing symptoms, we’re actually trying to restore function in a patient,” explains Dr. Shukla. “The treatment itself is restoring function rather than just reducing symptoms.”
This distinction matters enormously for chronic pain patients, who have often cycled through palliative treatments without achieving lasting relief. The goal at MAPS is to move patients through a treatment continuum that begins with pain control and progresses toward genuine restoration of function — the mechanics, the muscle strength, the postural habits — that makes sustained relief possible.
Related: Lower Back Pain: Causes, Symptoms, and Treatment Options | Upper Back Pain: Why It Happens and How It’s Treated
Treatment Options for Chronic Back Pain at MAPS
Physical Therapy — The Non-Negotiable Foundation
For chronic back pain patients, physical therapy is not optional. It is where the mechanical patterns that caused and perpetuate pain are identified and corrected — where muscle imbalances are addressed, core stability is rebuilt, and posture is retrained. Without this foundation, other treatments provide only temporary windows of relief.
“Physical therapy is probably one of the most important players in the realm of treatments for low back pain,” says Dr. Shukla, who speaks from personal experience as well as clinical practice. “It’s ultimately where the patient will learn to correct a lot of the things that may have led to their back pain.”
For chronic pain patients, the formal PT program is the beginning — not the entirety — of a rehabilitation commitment. Home exercises developed during therapy must continue consistently, two to four times per week, indefinitely. “If you can stay committed to that, then you have sustained pain relief and likely not even need to come back to see me again,” Dr. Shukla says. “But if you don’t make those changes, then you would likely be coming back to see me sooner than I want you to.”
Injection-Based Treatments
Targeted injections serve a critical role in chronic back pain care — not as a long-term standalone solution, but as a tool for getting pain low enough that meaningful rehabilitation can take hold.
Epidural Steroid Injections deliver anti-inflammatory medication directly to the site of nerve compression, providing relief from radicular pain that makes movement and therapy participation difficult. Facet Joint Injections address the arthritic joints between vertebrae that are a primary pain source in degenerative chronic back pain. Radiofrequency Ablation (RFA) uses controlled heat to disable the small nerves transmitting pain signals from arthritic facet joints — providing relief that can last a year or more before the nerve regenerates.
The key framing Dr. Shukla uses with his patients: “What this injection has done is it’s given you a window of opportunity to correct the muscular imbalances, the postural inefficiencies, the weaknesses in your body that may have led to this pain. What you do with it is ultimately going to determine the type of recovery that you have.”
Spinal Cord Stimulation
For chronic back pain patients who have not achieved adequate relief through conservative and injection-based treatments, spinal cord stimulation (SCS) represents one of the most well-evidenced advanced options available. Implantable SCS devices modulate pain signals before they reach the brain, reducing perceived pain levels and improving function.
Dr. Shukla describes this category of treatment as having “probably some of the best studies that have the most evidence as far as chronic back pain treatments for improving a patient’s quality of life, reducing reliance on prescription pain medications.” For the right patient, SCS can be genuinely life-changing — restoring the ability to engage in activities that chronic pain had made impossible.
Multifidus Muscle Stimulation — Restorative Treatment
The newest and most conceptually significant development in chronic back pain treatment is multifidus muscle stimulation — an implantable device that directly addresses the deep spinal muscle atrophy that MRI consistently reveals in chronic pain patients.
Because the multifidus operates under autonomous control — firing without conscious input — it cannot be rehabilitated through voluntary exercise alone. An implantable stimulator targets the muscle directly, activating and rebuilding its function in a way that traditional therapy cannot replicate.
“By being able to stimulate that muscle with an implantable stimulator, we can actually restore the function of that muscle,” says Dr. Shukla. This is the defining feature of restorative treatment: the therapy itself rebuilds the structural capacity that chronic pain has eroded, rather than simply managing symptoms while that capacity continues to decline.
Related: Back Pain That Radiates: When Pain Travels to the Legs or Hips
What Recovery From Chronic Back Pain Actually Looks Like
Chronic pain patients deserve honest, realistic expectations about recovery — not false promises of quick fixes, and not hopeless forecasts either. Dr. Shukla’s approach is to be straightforward from the very first appointment.
“Something that developed over years and years of wear and tear or improper mechanics can’t just be fixed in a short amount of time,” he explains. “It’s somewhat like a marathon or a journey. When I’m establishing a doctor-patient relationship, I’ll counsel my patients: you have to trust me a little bit. This might be a longer process than you initially thought, but there is a clear path to recovery. And if you are committed to it and willing to put the effort in along with myself, we can certainly get you on the path to recovery.”
Recovery from chronic back pain typically unfolds in three phases:
- Pain reduction — Getting symptoms under control through medications, injections, or other interventional treatments so that rehabilitation can begin. This is the phase most patients recognize as “treatment” — but it is only the first step.
- Active rehabilitation — Structured physical therapy that corrects the mechanical patterns, strengthens the weakened muscles, and retrains the movement habits that caused and perpetuate pain. This is where the real work happens.
- Lifestyle maintenance — The ongoing commitment to home exercise, postural awareness, and healthy movement habits that prevents recurrence. This phase doesn’t have an endpoint — it’s the new normal that makes long-term relief sustainable.
Patients who complete phases one and two but skip phase three are the ones Dr. Shukla sees return to his office months later. “If you just finished the physical therapy and then you go back to your old lifestyle and you don’t do anything different, chances are the pain will return.”
Is Medicare Covered for Chronic Back Pain Treatment?
Yes. MAPS accepts Medicare, and the full spectrum of chronic back pain treatments — including physical therapy, epidural steroid injections, facet joint procedures, radiofrequency ablation, and spinal cord stimulation — are covered under Medicare for eligible patients. “If a patient has general Medicare coverage, we will be able to treat them and provide almost all of the treatments that we have available to us,” confirms Dr. Shukla.
This is significant news for many of MAPS’ older Chicagoland patients who have been managing chronic back pain on their own, assuming that comprehensive care is financially out of reach.
FAQs: Chronic Back Pain
Q: At what point does back pain become “chronic”? A: Clinically, back pain is classified as chronic when it has persisted for three months or more. However, the transition from acute to chronic is a spectrum — pain that recurs repeatedly or that never fully resolves between episodes is functionally chronic even if individual episodes are shorter.
Q: Can chronic back pain ever fully go away? A: Yes — for many patients, meaningful and lasting relief is achievable. The likelihood of full resolution depends on the underlying cause, how long pain has persisted, the patient’s overall health, and critically, their commitment to the rehabilitation process. Some patients achieve complete pain relief; others reach a state of minimal, manageable pain that allows them to return to full, active lives. Both outcomes represent genuine recovery.
Q: I’ve been in chronic pain for years. Is it too late to benefit from treatment? A: No. While earlier intervention generally leads to better outcomes, effective treatment options exist for patients at any stage of chronic back pain. Advanced procedures like spinal cord stimulation and multifidus muscle stimulation were specifically developed for patients who have exhausted more conservative approaches. Dr. Shukla’s message is consistent: there is always a next step, and there is always reason for hope.
Q: Why did my back pain come back after injections that worked the first time? A: Injections reduce pain — they don’t correct the underlying structural or mechanical cause. If the biomechanical patterns, muscle weaknesses, and postural habits that produced the pain remain unchanged, the pain will return once the injection wears off. This is why injections at MAPS are always paired with a rehabilitation plan: to use the window of pain relief productively.
Q: How is chronic back pain treatment at MAPS different from what I’ve tried before? A: MAPS takes a team-based, individualized approach that moves patients through a full continuum of care — from accurate diagnosis through pain control, active rehabilitation, and long-term maintenance. The goal is not just temporary relief but sustained recovery. For patients who haven’t responded to conventional treatments, MAPS also offers advanced and restorative options — including spinal cord stimulation and multifidus muscle stimulation — that address chronic pain at a structural level.
You Don’t Have to Just Tough It Out
The most damaging misconception about chronic back pain is that it’s inevitable — that at some point, people just have to accept it and adjust their lives around it. Dr. Shukla pushes back on that directly: “Don’t feel like you have to sit at home and suffer and your back pain is just going to be there and you have to tough it out. That’s one of the most common misconceptions I see.”
Right now, in pain medicine, there are more effective treatment tools available than at any previous point in history. The team at MAPS — double-board-certified pain specialists, physical therapists, and support staff working together — is equipped to build a personalized recovery plan for every chronic pain patient who walks through the door.
Across eight Chicagoland locations — Chicago North Side, Chicago Midway, Des Plaines, Franklin Park, Hazel Crest, Woodridge, Frankfort, and St. John, Indiana — MAPS makes expert chronic pain care accessible throughout the region.
Call MAPS at 773-917-8400 or schedule your consultation online at mwpain.com. The path forward is there. It starts with a conversation.
Reviewed by Adarsh Shukla, MD, LCP-C — Board-Certified Pain Management Specialist, MAPS Centers for Pain Control. This content is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for diagnosis and treatment.
Related Articles
Back Pain Relief in Chicago: Causes, Symptoms, and Non-Surgical Treatment Options
What Causes Back Pain? Common Triggers You Shouldn’t Ignore
Lower Back Pain: Causes, Symptoms, and Treatment Options
Upper Back Pain: Why It Happens and How It’s Treated
Back Pain That Radiates: When Pain Travels to the Legs or Hips
Back Pain from Sitting and Desk Work: A Common Chicago Problem
Back Pain Without Injury: Why It Happens and What to Do
