The causes of back pain are more complicated than you think

A small but significant minority of people experience recurrent, chronic, and even disabling back pain. The condition can be as difficult to diagnose as it is to treat. But it is treatable. / Image courtesy of Mayfield Brain & Spine A small but significant minority of people experience recurrent, chronic, and even disabling back pain. The condition can be as difficult to diagnose as it is to treat. But it is treatable. / Image courtesy of Mayfield Brain & Spine A small but significant minority of people experience recurrent, chronic, and even disabling back pain. The condition can be as difficult to diagnose as it is to treat. But it is treatable. / Image courtesy of Mayfield Brain & Spine CINCINNATI (WKRC) – Eighty-five percent of us experience acute back pain at least once in our lives, whether from severe trauma or your garden variety nicks and scrapes. Then mercifully it goes away.

Sometimes, though, it doesn’t. For a small but significant minority of people, the pain is recurrent, chronic, and even disabling. It sits upon us like an unwelcome visitor, halting our exercise routines, interrupting our holidays, and all but ruining the time we spend with family.

The problem with back pain is it’s difficult to understand and a process to treat. It’s mind-boggling the amount of nerves we have in our spine; likewise with the number of things that can go wrong with them. Treatment, meanwhile, can be both piecemeal and incremental. You get an injection, it wears off. You get another one, it doesn’t work. You’re in the middle of your physical therapy and you’re wondering what the point is.

There is a point. To understand it better, we turned to Marc Orlando, MD, physical medicine and rehabilitation specialist at Mayfield Brain & Spine . He broke it down for us as only a Mayfield doctor can.


Buckle in here for a moment, because we need to understand a bit about spine anatomy first. The spine is made up of stacked lateral segments called vertebrae. The vertebrae are connected to each other in two places, in the front by flat discs, and in the back by hinges called facet joints. This is what gives our spine flexibility.

The spine encircles and protects the epidural canal, through which a bundle of root nerves—your spinal cord—delivers information to your brain. The spine has nerves of its own, though. These branch nerves flare out from your spinal cord through gaps near the facet joints.

You feel pain when your nerves are compressed and pinched together. Sciatica—the running, shooting pain up your back and down your leg—results from stenosis, or a compression of the spinal column. Facet syndrome—localized back stiffness and pain—results from compression of those medial branch nerves.

What causes nerve compression? Simple enough. Nerve compression occurs whenever something else encroaches upon the nerves. By definition, whenever one part of your spine is inflamed, your nerves lose out. Perhaps you have a bulging disc, or disc degeneration, or bone spurs on your vertebrae or facet joints. The key takeaway is that compression can come from different sources, which makes back pain difficult to diagnose.

In sum, your vertebrae are connected in front by discs and in back by facet joints. Both discs and facet joints can encroach upon your nerves, creating nerve compression and back pain. How the pain is treated depends on the nerves compressed and the source of the compression.


The first step in treating back pain is to see your primary care physician. After some tests, they might recommend physical therapy as well as Tylenol, Advil, or the like. If the pain is significant and continuous, they’ll refer you to a specialist like Dr. Orlando at Mayfield Brain & Spine. Dr. Orlando will then attempt to determine the cause of the pain and treat it using all the tools in his toolbox.

Among those tools is an array of injections. Steroidal injections are designed to reduce pain for a long period of time—weeks or months—by alleviating compression. Nerve block injections are designed to numb a few nerves for a short period of time in order to determine where specifically the pain is coming from. In that sense, steroidal injections, though they might have some diagnostic use, are primarily intended as a treatment. Conversely, nerve block injections are almost entirely diagnostic.

You’ve probably heard of “an epidural.” These particular injections—epidural steroid injections (ESI)—target compression of the spinal cord. Because the ESI is steroidal, it is meant as a treatment that might last several months. You can receive another injection when pain relief wears off; or, if the injection is not effective, you can discuss surgical options. Importantly, an ESI does not address the underlying cause of the compression— disc herniation, disc degeneration, or facet syndrome—so it is not a treatment in the sense of being a cure, but it may enable you to recover and avoid the need for surgery.

Another injection might target the facet joints. Remember, these joints are inflamed and irritated as a result of facet syndrome. The steroid is injected into the facet joints, which can reduce inflammation and alleviate joint pain for a span of weeks or months. You can receive ongoing injections if they prove effective.

Here’s the thing about branch nerves, though: they stretch across facets. One nerve can serve several facets. One facet can host several nerves. Dr. Orlando can narrow the pain down, but getting the injection in the right place is part of the equation. That’s where nerve blocks come in. They numb certain nerves for hours or days so he can get a better understanding of exactly which facet and nerve are the problem. Hence their use primarily as a diagnostic.

And when the right nerve is found, it’s time to burn or melt the nerve with radiofrequency waves that heat a needle tip to a safe temperature and are precisely delivered. Similar technology is used to stop cardiac arrhythmias. Relief from this procedure may last from 6 months to a lifetime. As always, that is something you should discuss with your specialist first—and there’s not a better place to do it than Mayfield Brain & Spine.

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Internationally recognized as a leader in neurological surgery, Mayfield has forged a rich and lasting heritage through technical innovation, research, and a commitment to patient care. Mayfield physicians are continuously recognized among the Best Doctors in America and Top Doctors in Greater Cincinnati.

Mayfield Brain & Spine has four convenient locations in Greater Cincinnati: Rookwood Exchange (3825 Edwards Road, Suite 300, Cincinnati, 45209); Green Township (6130 Harrison Ave., 45247); West Chester (9075 Centre Point Drive, 45069); and Northern Kentucky (350 Thomas More Parkway, Suite 160, Crestview Hills, 41017).

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