Back, spine & sacroiliac conditions

Chronic / Low Back Pain

Chronic / Low Back Pain can reflect several different structures and mechanisms. The location and quality of symptoms help organize the evaluation, but they do not establish one diagnosis or treatment path.

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Spine symptoms, examination findings, and imaging shown as three inputs that require clinical correlation. — Clinical illustration.

Quick orientation

What to know first

The symptom region is a starting point, not a diagnosis.

History and examination determine which anatomy and tests matter.

Urgent, neurologic, infectious, vascular, traumatic, and systemic causes stay visible until reasonably excluded.

What we may consider next

How we may treat this

Treatments that may be considered after an evaluation. Which option, if any, fits depends on the cause of your pain, your examination, prior treatment and your health history; your physician will explain the benefits, limits and risks.

Establish first

Diagnostic or prognostic steps help clarify the pain generator or whether a later option fits.

Diagnostic / prognostic step

Lumbar Medial Branch Block

Diagnostic block when facet-joint back pain is suspected; exam and imaging alone cannot confirm the source

Diagnostic / prognostic step

Sacroiliac Joint Injection

When the SI joint is the suspected source after evaluation

Options that may be considered

These are options, not required steps. Selection depends on the diagnosis and individual review.

Treatment option

Lumbar Epidural Steroid Injection

For selected patients with lumbar nerve-root (radicular) leg pain and matching findings; not for back pain alone; relief is usually short-term

Treatment option

Spinal Cord Stimulation

For selected persistent back and leg pain after other care, including after spine surgery and, with some devices, selected cases without prior surgery; a trial comes first

May come later

A later procedure is considered only when evaluation and the response to earlier steps support it.

Later treatment option

Lumbar Radiofrequency Ablation

For selected facet-joint back pain after positive diagnostic blocks; relief varies and may not be permanent

Alternatives, not a sequence

These options may be considered separately; one does not automatically lead to another.

Selected alternative

Caudal Epidural Steroid Injection

Alternative route for selected lumbar nerve-root leg symptoms, including some patients after spine surgery

Choose the guide that matches your question

Symptoms help define a syndrome, but they do not confirm which structure is responsible. Distribution, timing, aggravating factors, neurologic findings, function, and important alternatives all shape the evaluation.

Location, radiation, timing, quality, sensory change, weakness, stiffness, swelling, activity, position, sleep, and function help define the pattern.

Similar symptoms may arise from a joint, tendon, muscle, spine, peripheral nerve, circulation, or systemic condition.

Imaging and test abnormalities require clinical correlation and may not identify the symptom source.

Relevant anatomy

What causes low back pain

The region includes joints, muscles, tendons, nerves, blood vessels, and possible referral pathways. Their symptom territories overlap, so the examination and selective testing must answer a defined clinical question.

History and examination first

How low back pain is diagnosed

Evaluation begins with the patient question, safety screen, history, and focused examination. Testing is selected only when it can clarify a competing diagnosis, guide treatment, or change referral urgency.

Degenerative disc changes and focal disc herniation shown as distinct imaging concepts. — Clinical illustration.

Keep the differential open

Conditions that can feel like low back pain

Keep common and serious alternatives open until the evidence supports a narrower conclusion.

Local joint, tendon, muscle, ligament, bursa, bone, or soft-tissue disorders

Spinal referral, nerve-root, plexus, or peripheral-nerve disorders

Traumatic, infectious, inflammatory, vascular, metabolic, medication-related, or oncologic causes

Core care

Non-surgical care for low back pain

Procedure discussions belong inside a broader plan that protects neurologic function and daily activity.

Education, pacing, sleep and activity strategies matched to the diagnosis

Rehabilitation focused on mobility, strength, tolerance, and function when safe

Medication and comorbidity review with the appropriate clinician

Reassessment when symptoms, neurologic findings, function, or response changes

Evidence at a glance

Evidence strength, comparator, follow-up, and selection affect interpretation.

Chronic low-back pain benefits from person-centered, biopsychosocial, non-surgical care matched to the clinical presentation.

A single imaging finding rarely explains the full experience of persistent low-back pain.

Procedures require a narrower working diagnosis and target than the broad symptom label.

Decision quality matters

Evidence, limits, and who it may fit

A listed option does not establish candidacy. Diagnosis, anatomy, prior care, risk, alternatives, goals, and evidence must align.

Referral and urgent signs

When low back pain needs urgent care

These findings can change the timing or destination of care.

New loss of bowel or bladder control, saddle sensory loss, or rapidly progressive weakness

New problems with balance, hand dexterity, walking, or widespread numbness that may suggest spinal cord involvement

Fever, major trauma, cancer history, unexplained weight loss, severe night pain, or other concern for infection, fracture, vascular disease, or cancer

The visit

Your first visit for low back pain

The visit should narrow the diagnosis, identify safety and referral needs, review imaging and prior care in context, and choose the next useful decision. The clinician should explain uncertainty and what a treatment is expected to add before it is performed.

Define the location, timing, triggers, sensory features, functional effect, prior injury, and prior care

Examine the relevant joint, spine, muscles, nerves, circulation, gait, strength, sensation, and reflexes as appropriate

Use imaging, electrodiagnostic testing, laboratory work, or referral only when it answers a clinical question

Choose education, rehabilitation, medical care, further diagnostic work, a selected procedure discussion, or referral based on the working diagnosis

Common questions

Chronic / Low Back Pain FAQ

These answers are educational and cannot determine an individual diagnosis or treatment plan.

When should I see a pain specialist for low back pain?

When pain lasts more than a few weeks despite rest, activity changes and medicines, keeps returning, limits work or sleep, or comes with leg pain, numbness or weakness. Seek emergency care for new difficulty urinating, loss of bladder or bowel control, numbness in the groin or saddle area, or rapidly worsening leg weakness.

What can cause long-lasting low back pain?

Common sources include the facet joints, discs, sacroiliac joints, nerve roots and back muscles, and more than one can contribute. A history and examination help narrow the likely source before any procedure is considered.

Do I always need an MRI for back pain?

No. Imaging is used when the result would change care, for example after significant trauma, with new or worsening weakness or other concerning nerve symptoms, with signs of infection, cancer or fracture, or before certain procedures.

Where can I be seen for back pain?

New-patient visits are available at the Allen office, Monday to Friday, and at the Wylie office on Tuesdays. Image-guided spine procedures, such as epidural steroid injections, medial branch blocks and radiofrequency ablation, are performed in Allen.

Diagnosis before procedure

See a pain specialist for low back pain in Allen, TX

A focused evaluation can clarify the diagnosis, important alternatives, and the next step that fits the clinical picture.

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