Unlike acute backache, Chronic Backache is not self-limited, does not have an easy treatment, persists for prolonged periods (months-to-years), and may cause life long suffering.  Being an end-stage disease, it is much harder to treat and its treatments are as varied as its causes.  It is much more prevalent than acute backache because it is far less reversible and accrues more and more victims over the lifespan.  It results from complex physical disruptions to the integrity of the lumbar spine unit—its discs, joints, vertebrae, curvatures, muscles, and nerves.
      Repeated bouts of acute backache often end in the Chronic Backache Syndrome.  Other common causes include back trauma, back arthritis, failed back surgeries, spine deformities, frailty, weak muscles, poor posture, osteoporosis, obesity, smoking, heavy drinking, depression, lack of exercise, and arthritic bone growths that choke the spinal nerves.  Practically, however, the Chronic Backache Syndrome may be divided into two general groups—surgical and non-surgical.  A detailed clinical examination by an experienced neurosurgeon—coupled with an MRI—can usually stratify patients into surgical or non-surgical groups.  It is the non-surgical group that is the object of this discussion.
      Non-surgical Chronic Back Ache Syndrome has had very many treatments over the years and its treatments, like fashions, seem to cycle in and out of favor across time.  What has remained consistent, nevertheless, is the fact that not any one treatment has ever been shown to be superior to another.  This has caused an endless proliferation of purported treatments, each claiming unique success, but with not a drop of published-scientific-evidence in support its claim.  Indeed, given the inclines of human nature, whenever there is not a valid treatment, invalid treatments seem to proliferate ad infinitum.
      Among the purported treatments for the Chronic Backache Syndrome are—massage, physical therapy, acupuncture, various local injections, epidural steroid injections, chiropractic manipulations, back braces, anti-inflammatory medications, muscle relaxant medications, common analgesics, narcotic analgesics, and sham operations such as cutting a certain foot nerve etc.  Usually, patients favor the easiest treatments because they entail the least personal effort.  Short-term successes are common but long-term outcomes are invariably similar and do not seem to be treatment dependant.  The prognosis is seldom good unless physical fitness is reclaimed through personal, dedicated, long-term commitment to exercise.
      Exercise, the cornerstone of fitness, is also the cornerstone of treatment.  It is the cheapest antidote for the Chronic Backache Syndrome and gives better results than all of the other more expensive treatments combined.  Its only unappealing side is that it is effort dependent rather than operator dependent.  In multiple studies over the years, whenever popular backache treatments were compared, walking one hour a day consistently gave the best results.  Other exercises such as swimming, aerobics, stretching, yoga, Pilates, working out with a trainer, etc. though they have not been formally studied, also seem to be clinically helpful.
      Fear plays a major role in sustaining the vicious cycle of backache.  Because movement hurts, sufferers become fearful of movement and prefer to spend much of their time resting in pain-free positions.  Rest leads to de-conditioning, which weakens the muscles and bones of the spine and increases the backache.  The increased backache leads to increased disability, which causes further decline in back health.
      To overcome this fear of pain, the physician must educate the patient about the difference between hurt and harm.  Movement and walking hurt initially but help in the long run.  Understanding that not everything that hurts is harmful is a key concept that is necessary for arresting the progression of backache disability.
      Depression, a common component of chronic pain, must also be treated because it exaggerates backache and inhibits the personal efforts that are necessary to overcome it.
      De-conditioning may reach a point of no return.  If backache disability is allowed to continue beyond two years, the chances of re-conditioning become very poor.  If re-conditioning is to be successful, it must begin as early as possible after the backache becomes recalcitrant.
      The best antidotes for the Chronic Backache Syndrome are physical and mental fitness.  Fitness implies losing weight, stopping smoking, refraining from heavy drinking, treating osteoporosis and depression, avoiding narcotic medications, maintaining an actively healthy lifestyle, observing back hygiene, and walking at least one hour a day.  Patients who are willing and able to achieve such fitness will either totally recover from backache or else manage to having a normal life in spite of it.
      Narcotic analgesics and pain management schemes, though initially appealing, are actually detrimental because—unlike fitness— they promote dependence, inactivity, obesity, and further mental and physical disability.