Back Pain

Understanding Back Pain

Back pain is one of the most common reasons patients walk into my office, and one of the most misunderstood. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, back pain is one of the most common medical problems in the United States. Globally, research published in The Lancet identifies low back pain as the single leading cause of disability worldwide, affecting people of every age, background, and activity level.

Back pain generally falls into two categories. Acute back pain comes on suddenly and typically lasts a few days to a few weeks. It is often the result of an injury, a muscle strain, or a sudden awkward movement. Chronic back pain persists for three months or longer and may be caused by conditions like degenerative disc disease, arthritis, or nerve compression. Some patients experience recurring episodes, periods of relief followed by flare-ups, which can be just as disruptive as constant pain.

Back pain can originate anywhere along the spine, from the base of your neck to your tailbone. It can involve muscles, ligaments, discs, joints, or nerves — and in many cases, more than one structure is contributing. Identifying the specific region and source of your pain is the foundation of everything I do.

If your pain is focused specifically in your lower back, you may find our dedicated lower back pain page helpful for information about lumbar-specific conditions and treatments.

Symptoms of Back Pain

Back pain can show up in different ways depending on what is causing it and where it originates along your spine. Common symptoms include:

  • Dull, persistent aching in the upper, middle, or lower back

  • Sharp or stabbing pain that comes on suddenly with movement

  • Radiating pain that travels down one or both legs, sometimes reaching the feet

  • Stiffness and reduced range of motion, especially in the morning or after sitting for long periods

  • Muscle spasms: involuntary tightening that can be painful and limiting

  • Numbness or tingling in the legs, feet, or toes, which may indicate nerve involvement

Some patients notice their pain worsens with specific activities like standing for long periods, bending forward, or sitting at a desk. Others describe pain that improves with movement but flares at rest. These patterns are important because they help point to the underlying cause.

⚠️ WHEN BACK PAIN IS AN EMERGENCY

Go to an emergency room or call 911 immediately if you experience sudden loss of bowel or bladder control, rapid onset of severe weakness or numbness in both legs, back pain following a serious fall or trauma, or back pain accompanied by high fever. These symptoms may indicate a condition that requires urgent medical evaluation.

Common Causes of Back Pain

When a patient comes to me with back pain, my first job is to figure out where it is coming from. Back pain has many possible causes, and understanding the source is what guides the treatment plan.

Structural Causes

  • Herniated or bulging discs. When the soft cushion between vertebrae ruptures or shifts, it can press on nearby nerves and cause pain, numbness, or weakness.

  • Degenerative disc disease. Over time, spinal discs lose moisture, height, and flexibility, which can lead to chronic stiffness and pain.

  • Spinal stenosis. Narrowing of the spinal canal puts pressure on the spinal cord and nerves, often causing pain that worsens with standing or walking.

  • Scoliosis. Abnormal curvature of the spine can create uneven pressure on the joints and muscles, leading to pain that develops gradually.

  • Compression fractures. Weakened vertebrae can collapse under normal stress, particularly in patients with osteoporosis.

Muscular and Soft Tissue Causes

  • Muscle or ligament strain. Overexertion, heavy lifting, or sudden awkward movements can stretch or tear the soft tissues that support the spine.

  • Connective tissue injuries. Sprains and tears in the tendons and ligaments surrounding the spine are a common source of acute pain.

Degenerative and Inflammatory Causes

  • Osteoarthritis. Wear and tear on the facet joints of the spine can cause chronic inflammation, stiffness, and pain.

  • Bone spurs. Bony growths that develop along the vertebrae can narrow the space around nerves.

Neurological Causes

  • Sciatica. Compression or irritation of the sciatic nerve can cause shooting pain that radiates from the back down through the buttock and leg.

  • Pinched nerves. A herniated disc, bone spur, or swollen tissue can compress a nerve root, causing localized or radiating pain.

Other Causes

  • Failed back surgery syndrome. Some patients continue to experience pain after a previous spinal surgery, which may require a different treatment approach.

  • SI joint dysfunction. The sacroiliac joint connects the spine to the pelvis, and when it becomes inflamed or misaligned, it can mimic lower back pain.

  • Osteoporosis. Loss of bone density weakens the vertebrae and increases the risk of compression fractures.

  • Tumors. Rarely, growths in or near the spine can cause back pain and may require specialized evaluation.

Not every patient fits neatly into one category. In my experience, chronic back pain often involves more than one of these causes at the same time, which is why a thorough evaluation matters.

Risk Factors for Back Pain

Certain factors can increase your likelihood of developing back pain. Understanding your personal risk profile helps you take meaningful steps toward prevention.

  • Age. Back pain becomes more common after 45 as discs lose flexibility and joints begin to show wear.

  • Fitness level. Weak core and back muscles provide less support for the spine, making injury more likely.

  • Excess weight. Extra body weight places added stress on the spinal structures, particularly in the lower back.

  • Occupation. Jobs involving heavy lifting, repetitive bending, or prolonged sitting all increase risk.

  • Stress and poor sleep. Chronic tension and inadequate rest can amplify pain sensitivity and slow recovery.

  • Smoking. Tobacco use reduces blood flow to the spine and impairs the body's ability to heal.

Whether you spend your days working in the vineyards, hiking the trails above Napa, or sitting at a desk, understanding your risk factors is the first step toward protecting your back.

When to See a Back Pain Specialist

Most back pain improves on its own within a few weeks. But if your pain is not getting better, or if it is getting worse, waiting longer rarely helps.

I recommend scheduling an evaluation if you experience:

  • Back pain that persists for more than two to three weeks

  • Pain that does not improve with rest, ice, or over-the-counter medications

  • Pain that radiates down one or both legs

  • Numbness, tingling, or weakness in your legs or feet

  • Pain that wakes you up at night or interferes with your ability to work, exercise, or enjoy daily activities

You do not need a referral to see me. At my practice here in Napa Valley, I welcome patients from throughout the region, whether you have been managing back pain on your own for weeks or have been dealing with it for years. If other treatments have not worked, that does not mean nothing will. It often means the right diagnosis has not been made yet.

How Back Pain Is Diagnosed

The most important part of diagnosing back pain is listening to your story. When you come in for an evaluation, I start by asking about your symptoms: when they started, what makes them better or worse, what treatments you have tried, and how the pain is affecting your daily life. That conversation often tells me more than any scan.

From there, I perform a physical examination to assess your posture, range of motion, and areas of tenderness. I check your reflexes, coordination, and muscle strength to look for signs of nerve involvement.

In many cases, I do not order imaging right away. Research published in The Lancet has found that overuse of imaging for back pain is a widespread problem in medicine, and for most types of non-specific back pain, early MRIs and X-rays do not change the treatment plan. When imaging is needed (for example, if there are signs of nerve compression, progressive weakness, or pain that has not responded to initial treatment), I order the right study to give us a clear picture. If you have already had imaging done elsewhere, bring those records. Reviewing prior studies is often the fastest way to get started.

One of the most valuable tools in my practice is the diagnostic injection. A precisely placed injection can help identify which structure is generating your pain, whether it is a facet joint, a disc, a nerve root, or the SI joint. This kind of precision matters because back pain rarely comes from just one source. There are often multiple pain generators contributing, and identifying each one is the only way to build a treatment plan that actually works.

Treatment Options for Back Pain

Once I understand where your pain is coming from, I build a treatment plan around the least invasive approach that can address your specific pain source. According to clinical practice guidelines from the American College of Physicians, the recommended first step for most back pain is nonpharmacologic treatment, and that aligns with how I practice. Every patient's plan is different because every patient's pain is different.

Conservative Treatments

For many patients, back pain improves with a combination of physical therapy, anti-inflammatory medications, and targeted lifestyle changes. Strengthening your core muscles, improving your posture, and managing your weight can make a meaningful difference, particularly for patients whose pain is related to muscle strain or early degenerative changes. I often work with physical therapists here in Napa Valley to coordinate a program specific to your condition.

Minimally Invasive Procedures

When conservative treatment is not enough, I offer a range of image-guided procedures designed to target specific pain generators. Epidural steroid injections can reduce inflammation around compressed spinal nerves. A systematic review in Pain Physician found Level I evidence supporting their use for radicular pain from disc herniation. Facet joint injections and medial branch blocks address pain originating in the small joints of the spine. Radiofrequency ablation uses heat energy to reduce pain signals from affected nerves, and a 2025 systematic review in Current Pain and Headache Reports confirmed significant improvement in pain relief and function from these procedures. Each of these is performed using fluoroscopic guidance for precision and safety. Learn more about our full range of spinal injections.

Advanced Interventional Treatments

For patients with chronic back pain that has not responded to more conservative approaches, advanced neuromodulation may help. Spinal cord stimulation uses a small implanted device to reduce or interrupt pain signals before they reach the brain, offering relief for patients who have not responded to other treatments. A 2024 systematic review and meta-analysis published in JAMA Network Open found that spinal cord stimulation therapies were associated with significantly greater improvements in pain compared with conventional medical management alone. I also offer intrathecal pain pumps for complex chronic pain and kyphoplasty for patients with painful vertebral compression fractures.

When Surgery May Be Considered

Most of my patients find meaningful relief without surgery. But when conservative and minimally invasive treatments are not providing adequate improvement, I work with patients to determine the right next step, which may include a referral to the appropriate surgical specialist. The goal is always to find the path that gives you the best outcome with the least disruption to your life.

Preventing Back Pain

While not all back pain can be prevented, these habits can reduce your risk and support a healthier spine:

  • Stay active. Regular low-impact exercise like walking, swimming, or cycling strengthens the muscles that support your back.

  • Build core strength. A strong core provides a stable foundation for your spine and helps prevent strain.

  • Maintain a healthy weight. Extra weight, especially around the midsection, places added stress on your lower back.

  • Practice good posture. Whether sitting, standing, or lifting, keeping your spine aligned reduces unnecessary pressure on your discs and joints.

  • Lift with your legs. Bend at the knees and keep the load close to your body rather than bending at the waist.

  • Take breaks from prolonged sitting. Stand, stretch, and move every 30 to 60 minutes if your work or lifestyle involves extended time at a desk.

Small, consistent changes add up. Many of my patients are surprised by how much better their back feels once they build a few of these habits into their daily routine.

Frequently Asked Questions About Back Pain

What kind of doctor should I see for back pain?

For back pain that has not improved with rest or basic self-care, a specialist in interventional pain management can both diagnose the source of your pain and offer a full range of treatments, from conservative therapy to advanced minimally invasive procedures. A physician who is board-certified in pain medicine and fellowship-trained in interventional techniques has the depth of training to evaluate complex or persistent cases. You can learn more about my background and training on my provider bio page.

How do I know if my back pain is serious?

Most back pain improves within a few weeks with rest and basic care. You should see a specialist if your pain persists beyond two to three weeks, radiates down your legs, or is accompanied by numbness or weakness. Go to an emergency room or call 911 immediately if you experience sudden loss of bowel or bladder control, rapid onset of leg weakness, or severe pain following a fall or injury.

What is the most effective treatment for chronic back pain?

There is no single treatment that works for everyone. Effective management depends on identifying what is actually causing your pain. Evidence-based guidelines from the American College of Physicians recommend starting with nonpharmacologic approaches like exercise, physical therapy, and multidisciplinary rehabilitation before moving to medications or procedures. When those approaches are not enough, interventional options like targeted injections, radiofrequency ablation, or spinal cord stimulation may provide meaningful relief.

Can back pain be treated without surgery?

In most cases, yes. The majority of patients I treat for back pain find significant improvement through a combination of conservative care and minimally invasive procedures, without requiring surgery. Research supports this approach: clinical guidelines consistently recommend exhausting non-surgical options first, and advances in interventional pain management now offer treatments that were not available even a decade ago.

Does insurance cover back pain treatment?

Most back pain evaluations and many treatment procedures are covered by Medicare and major commercial insurance plans when medical necessity criteria are met. Coverage varies by plan and by procedure, so I encourage patients to contact our office at 707-254-7117 to verify benefits before their first visit. Our team can help you understand what your plan covers so there are no surprises.

Schedule a Consultation

If back pain is limiting the life you want to live, there are options you may not have tried yet. Schedule a consultation at our Napa Valley office to find out what is causing your pain, and what we can do about it.

New patients: Call (707) 254-7117 or submit an online appointment request.

Existing patients: Call (707) 603-1078.

Medical Disclaimer

This page is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.

Medically reviewed by Jacqueline Weisbein, DO. Board-Certified in Physical Medicine and Rehabilitation and Pain Medicine. Fellowship-Trained in Interventional Pain Management. Member, Board of Directors, Women Innovators in Pain Management (WIPM). Over fifteen years of experience and thousands of procedures helping Napa Valley patients find relief from chronic pain.

View Dr. Weisbein's provider bio →

Last reviewed: April 2026

Napa Valley Orthopaedic Medical Group