There are many causes of back pain. The good news is that 90% of cases of acute back pain get better by 8 weeks. The most common acute causes include soft tissue injury, including muscle tears, ligament sprains and disc tears. Other causes are seen, particularly with chronic back pain including facet arthritis, nerve injury and referred pain from other areas (such as thoracic fractures, hip arthritis) are also frequent causes of back pain.
Since there are so many potential causes for back pain, if a particular treatment doesn’t work, it may indicate that the diagnosis is wrong or that another process is contributing. A careful history and physical examination are the cornerstones of diagnosing back pain. When initial conventional measures have failed, additional imaging may show an unexpected cause.
We have a variety of options for patients with back pain. In addition to conservative options, there are a number of minimally invasive procedures that generally provide profound pain relief once the primary pain generator is determined. The more commonly helpful procedures include epidural steroid injections, medial branch injection or ablation, kyphoplasty, sacroiliac joint injection or ablation and lumbar sympathetic plexus blocks.
As long as patients do not have certain warning signs such as low of bowel or bladder control, perineal pain, significant motor impairment (ie, lower extremity muscle weakness, foot drop), back pain can usually be managed safely and effectively without surgery or narcotics.