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Back pain treatment and procedures

Persistent back pain is treated here by first working out which structure is generating it — facet joint, sacroiliac joint, disc or nerve root — and then matching the procedure to the source. Diagnostic blocks, lumbar radiofrequency rhizotomy, epidural and nerve root injections are combined with a rehabilitation plan.

Low back pain that has persisted beyond three months is seldom explained by the scan report. Disc bulges, facet arthropathy and degenerative change are present in most adults who have no pain at all, so the question is not what the scan shows but which structure is actually generating your pain. Pain medicine has tools to answer that question directly, and the answer determines the treatment.

Working out the source

The pattern of pain, examination and imaging narrow the possibilities. Back-dominant pain that is worse with standing and extension suggests the facet joints; pain over the buttock and upper pelvis with a positive examination suggests the sacroiliac joint; leg-dominant pain in a nerve distribution suggests a nerve root. Where the facet or sacroiliac joint is suspected, a diagnostic block numbs the nerves to that joint for a few hours — if the pain goes, the joint is the source. This is a test, and its result decides what follows.

Facet joint pain: medial branch blocks and rhizotomy

Where a block confirms a facet joint source, radiofrequency rhizotomy of the same nerves interrupts the pain signal for months — commonly six to twelve, with wide individual variation — and can be repeated as the nerves regenerate. Lumbar rhizotomy is one of the most frequently performed procedures in this practice and one of the better supported in the evidence for a properly selected patient. Facet joint injections are used selectively, mainly where there is an inflammatory flare.

Sacroiliac joint pain

The sacroiliac joint is a recognised and under-diagnosed source of low back and buttock pain, particularly after pregnancy, a fall, or lumbar fusion surgery. Image-guided injection into the joint is both diagnostic and therapeutic, and radiofrequency treatment of the lateral branch nerves is available where injections help but briefly.

Sciatica and nerve root pain

Leg pain from an irritated nerve root — sciatica — usually settles over weeks to months. Where it does not, or where the pain is severe, an epidural injection or a more selective transforaminal injection places anti-inflammatory medication at the irritated nerve. The transforaminal approach also tells a surgeon which level matters where the scan is ambiguous. These injections reduce pain for weeks to months in many people; they do not shrink a disc, and whether surgery is eventually needed is a separate decision.

Where procedures do not fit

Some persistent back pain is not generated by any one structure, and in that situation injecting structures achieves little. Dr Martin will say so. The plan then centres on rehabilitation, medication review and, for a small number of people with persistent nerve pain after surgery, neuromodulation.

What the procedure is for

A procedure creates a window — weeks or months of lower pain. What determines the long-term outcome is what happens in that window: graded return to activity, strengthening, and return to work. Each procedure here is booked with that plan attached.

Risks

Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Common questions

Can you tell from my MRI what is causing my back pain?

Usually not on its own. MRI shows structure, not pain, and most adults have disc and facet changes that cause nothing. The scan narrows the options; diagnostic blocks and examination identify which structure is actually responsible.

What is the difference between a medial branch block and a rhizotomy?

A medial branch block is a short-acting test — it numbs the nerves to a facet joint for a few hours to see whether the pain goes. A rhizotomy is the treatment that follows a positive test, using radiofrequency heat to interrupt the same nerves for months.

Do I need to have a block before a rhizotomy?

Both blocks and radiofrequency treatment are available, and the sequence is decided at the consultation according to your presentation and the guidance relevant to your situation.

Will an epidural fix my disc bulge?

No. It reduces inflammation around the irritated nerve, which can relieve leg pain for weeks to months while the disc settles naturally. The bulge itself is unchanged by the injection.

How soon can I return to work after a back procedure?

Most people return to desk work within a day or two and to physical work within a week, depending on the procedure. Specific advice is given with your written post-procedure instructions.