When Chronic Low Back Pain Stops Responding to Injections

By Jacqueline Weisbein, D.O.
Double Board-Certified in Physical Medicine & Rehabilitation and Pain Medicine

Quick Insights:

Facet joint injections typically provide relief lasting from weeks to months; however, some patients may experience reduced effectiveness with repeated treatments. Patient selection factors like pain location, imaging findings, and response patterns predict injection outcomes. Diagnostic nerve blocks are commonly used to identify whether facet joints are the source of pain; their effectiveness in diagnosing pain from other spinal structures is less established. Spinal cord stimulation shows significant pain reduction and functional improvement in injection-resistant chronic low back pain.

Key Takeaways

• Facet joint injections typically provide relief lasting from weeks to months; however, some patients may experience reduced effectiveness with repeated treatments.
• Patient selection factors like pain location, imaging findings, and response patterns predict injection outcomes.
• Diagnostic nerve blocks are commonly used to identify whether facet joints are the source of pain; their effectiveness in diagnosing pain from other spinal structures is less established.
• Spinal cord stimulation shows significant pain reduction and functional improvement in injection-resistant chronic low back pain.

Why It Matters

If facet joint injections cease to provide relief for chronic low back pain, it may indicate the need to reassess and identify the primary pain source. Understanding why relief diminishes empowers you to pursue accurate diagnosis rather than repeating ineffective treatments. Advanced interventional procedures can restore function, improve sleep quality, and help you return to activities you've avoided. Recognizing injection failure as a diagnostic clue—not a dead end—opens pathways to targeted, evidence-based solutions.

Introduction

As a double board-certified physician in Physical Medicine & Rehabilitation and Pain Medicine serving patients from Napa to Sonoma, I've guided hundreds of patients through this exact frustration. Learn more about Dr. Jacqueline Weisbein, DO—board-certified pain management physician and how her expertise guides individualized care.

Some patients may find that the relief duration from facet joint injections decreases over time, potentially indicating the need for alternative treatment strategies for chronic low back pain in Napa-area residents. It doesn't mean you've run out of options—it means we need to identify the true pain source. Evidence shows that interventional procedures work best when matched precisely to your specific pain generator, whether that's facet joints, vertebral endplates, or nerve pathways. Many patients experience shorter relief periods with each injection because the underlying condition evolves, requiring a different treatment approach entirely.

At Napa Valley Orthopaedic Medical Group, I perform advanced diagnostic procedures to pinpoint exactly what's causing your pain and determine which interventional options will actually work.

If you are exploring next steps after injections have failed, you may also be interested in our overview of vertebrogenic low back pain and its hidden causes or learning about what to expect during recovery after the Intracept procedure.

This article explains why injections lose effectiveness and what evidence-based solutions remain when conservative care reaches its limit.

Why Injections Stop Working for Chronic Low Back Pain

Facet joint injections are designed to alleviate symptoms associated with inflammation and nerve irritation; however, they may not address underlying structural changes contributing to chronic low back pain. When I evaluate Napa patients whose injections have stopped working, I typically find that the pain source has evolved or that we're treating the wrong structure entirely. Research on facet joint nerve blocks shows that relief duration often shortens with repeated injections, suggesting disease progression rather than treatment failure.

In some cases, the diminishing effectiveness of facet joint injections may be due to changes in the underlying pain source over time. Facet joint inflammation may initially respond to steroid injections; however, response rates vary significantly among patients, and these injections may become less effective over time in addressing underlying mechanical issues. Similarly, epidural steroid injections may offer temporary relief for nerve root irritation; however, they are not designed to halt the progression of disc degeneration or vertebral endplate damage.

Studies examining therapeutic nerve blocks demonstrate that patient response varies significantly based on the actual pain source. When injections work initially but then fail, it often means we've been treating secondary inflammation rather than the primary structural problem. In my practice, I use this pattern as a diagnostic clue to guide more targeted evaluation.

What Happens When Conservative Care Reaches Its Limit

Conservative treatments like physical therapy, medications, and injections form the foundation of chronic low back pain management, but they have clear limitations. When these approaches stop providing meaningful relief, many Napa-area patients feel stuck or believe they've exhausted all options. I see this frustration regularly, and it's important to understand that reaching the limit of conservative care doesn't mean you're out of solutions—it means we need to identify the true pain generator.

Recent systematic reviews of facet joint injections reveal significant variability in patient response based on selection factors like pain location, imaging findings, and symptom patterns. When I evaluate someone whose injections have failed, I look for specific indicators that suggest we're either treating the wrong structure or that the condition has progressed beyond what injections can address. These indicators include pain that spreads beyond the injection site, symptoms that worsen with specific movements, and imaging showing advanced structural changes.

The transition point from conservative to interventional care isn't arbitrary. It's based on functional decline, quality of life impact, and evidence that the pain source requires a different treatment approach. In my experience, patients who continue repeating ineffective injections often delay diagnosis of the actual problem, whether that's vertebral endplate damage, facet joint arthropathy, or nerve pathway sensitization.

For those unsure about their next step when conservative measures have not worked, our resource on when to seek a specialist for back pain can help clarify when to consider further escalation.

Advanced Diagnostic Approaches for Napa Patients After Injection Failure

When injections stop working, precise diagnosis becomes critical. I use advanced diagnostic procedures to pinpoint exactly which structure generates your pain, moving beyond the assumption that inflammation is the primary problem. Diagnostic nerve block protocols help differentiate between facet-mediated pain, discogenic pain, and sacroiliac joint dysfunction by temporarily blocking specific nerve pathways and observing your response.

The diagnostic process typically involves controlled nerve blocks with careful documentation of pain relief patterns, duration, and functional improvement. If a diagnostic block provides significant but temporary relief, it confirms that we've identified the correct pain generator and can proceed with definitive treatment. If the block provides no relief, we've ruled out that structure and can focus diagnostic efforts elsewhere.

Advanced imaging plays a crucial role in this evaluation. Standard X-rays and MRI scans show structural changes, but they don't always correlate with pain sources. I combine imaging findings with physical examination, symptom patterns, and diagnostic block responses to create a complete picture. This comprehensive approach prevents the common mistake of treating what shows up on imaging rather than what actually causes your pain.

Evidence-Based Interventional Options Beyond Injections

When injections fail, several advanced interventional procedures can provide durable relief by addressing the underlying pain generator rather than just inflammation. Spinal cord stimulation demonstrates significant pain reduction and functional improvement in patients with chronic low back pain who haven't responded to conservative treatments, including injections.

Spinal cord stimulation works by delivering mild electrical pulses to the spinal cord, interrupting pain signals before they reach the brain. FDA-approved systems for intractable low back pain offer programmable options that can be adjusted to match your specific pain patterns. The procedure involves a trial period where you test the system before committing to permanent implantation, ensuring it provides meaningful benefit.

Other interventional options available in Napa include basivertebral nerve ablation for vertebral endplate pain, radiofrequency ablation for facet joint arthropathy, and minimally invasive lumbar decompression for spinal stenosis. Each procedure targets a specific pain generator identified through diagnostic evaluation. In my practice, I match the intervention to your diagnosis rather than offering a one-size-fits-all approach, which is why accurate pain source identification matters so much.

To learn more about how advanced procedures can help, see our detailed guide to chronic pain treatment options or read about why some patients opt for radiofrequency ablation for spine pain.

How Napa Residents Know When It's Time to Escalate Treatment

Several clear indicators suggest it's time to move beyond injections and pursue advanced interventional options. The most obvious sign is diminishing relief duration—if injections that once provided months of benefit now last only weeks or days, the underlying condition has likely progressed. Functional decline despite treatment represents another critical threshold, particularly when pain prevents you from working, sleeping, or performing basic daily activities.

I also consider escalation when patients require increasingly frequent injections to maintain even minimal relief, as this pattern suggests we're chasing symptoms rather than addressing the root cause. Quality of life impact matters significantly—if chronic low back pain dominates your daily experience despite conservative treatments, more definitive intervention may be appropriate.

The decision to escalate treatment should be based on comprehensive evaluation, not desperation. In my practice, I ensure patients understand their diagnosis, why previous treatments haven't worked, and what specific problem the proposed intervention will address. This approach prevents the cycle of trying procedures without clear rationale and helps set realistic expectations for outcomes.

If your pain is mostly located in your spine or lower back, and minimally invasive techniques are under consideration, explore our solutions for minimally invasive back pain procedures designed to address both mechanical and nerve-related causes.

One Patient's Experience

As a pain medicine physician, I value hearing directly from patients about their treatment experiences. These real-world perspectives help me understand what matters most when someone is navigating chronic pain care.

David recently shared his experience with injection procedures at our practice. He wrote:

"This was my second injection experience with Dr Weisbein, and it was another pleasant (almost!) experience. Answering my questions about this procedure versus my previous one, and her ongoing explanation as to what she was doing was helpful and all went just as she said it would! I am enjoying significant relief from my pain at this time!"

— David

This is one patient's experience; individual results may vary.

David's feedback highlights something I prioritize in every procedure: clear communication about what to expect. When injections provide meaningful relief, they serve an important role in chronic pain management. When that relief diminishes over time, it signals the need for a different diagnostic and treatment approach.

Conclusion

When chronic low back pain stops responding to injections, it's not the end of the road—it's a signal that we need to identify the true pain source. Diminishing relief often means the underlying condition has evolved beyond what anti-inflammatory treatments can address. As a double board-certified physician in Pain Medicine and Physical Medicine & Rehabilitation, I've helped many patients transition from repeated ineffective injections to targeted interventional solutions like spinal cord stimulation, basivertebral nerve ablation, and diagnostic nerve blocks. Evidence-based patient selection criteria help determine which advanced options will actually work for your specific pain generator. At Napa Valley Orthopaedic Medical Group, I perform comprehensive diagnostic evaluations to pinpoint exactly what's causing your pain and create a personalized treatment plan. Serving Napa, Vallejo, and surrounding areas, I'd be honored to help you reclaim your quality of life. Nearby facilities include Santa Rosa Memorial Hospital.

If you're ready for the next step, schedule a consultation to discuss advanced options and restore your function.

This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

Frequently Asked Questions

Why do injections eventually stop working for chronic low back pain?

Facet joint injections are designed to alleviate symptoms associated with inflammation and nerve irritation; however, they may not address underlying structural changes contributing to chronic low back pain. As your condition progresses, the pain source often shifts from inflammation to mechanical problems that steroids can't fix. Some patients may find that the relief duration from facet joint injections decreases over time. When this happens, it's a diagnostic clue that we need to identify the true pain generator through advanced imaging and diagnostic nerve blocks rather than repeating the same treatment.

What happens after I've tried multiple injections without lasting relief?

After injection failure, I perform diagnostic procedures to pinpoint your exact pain source—whether it's facet joints, vertebral endplates, or nerve pathways. This evaluation includes controlled nerve blocks with careful documentation of your response patterns and advanced imaging review. Once we identify the true pain generator, we can match you to the right interventional option. Appropriateness criteria for advanced procedures help determine candidacy for treatments like spinal cord stimulation, radiofrequency ablation, or minimally invasive decompression based on your specific diagnosis and functional goals.

Is spinal cord stimulation an option when injections fail?

Yes, spinal cord stimulation shows significant pain reduction and functional improvement in patients with chronic low back pain who haven't responded to injections. The procedure involves a trial period where you test the system before permanent implantation, ensuring it provides meaningful benefit. I evaluate candidacy based on your pain patterns, diagnostic findings, and functional goals. Not everyone qualifies, but for well-selected patients, neuromodulation can restore function and reduce pain when other treatments have failed.

Where can I find chronic low back pain treatment in Napa?

Dr. Jacqueline Weisbein at Napa Valley Orthopaedic Medical Group offers physician-guided chronic low back pain treatment tailored to your specific pain generator. Located in Napa, our practice provides advanced diagnostic procedures and interventional options including spinal cord stimulation, basivertebral nerve ablation, and radiofrequency ablation. Schedule your consultation today to explore evidence-based solutions beyond injections.