If you’ve been dealing with lower back pain for months, or years, and nothing has provided lasting relief, you’re not alone. Lower back pain is one of the most common reasons adults seek medical care, and for many people, it becomes a chronic condition that limits everything from work to the activities they enjoy.

Here’s what I want you to understand: lower back pain is rarely coming from just one source. There may be disc issues, facet joint problems, sacroiliac joint dysfunction, or even weakened stabilizing muscles all contributing at the same time. That’s actually good news, because it means there are multiple ways to help.

At Napa Valley Orthopaedic Medical Group, I take a comprehensive, multimodal approach to lower back pain treatment. As a board-certified specialist in both Physical Medicine and Rehabilitation and Pain Medicine, with fellowship training in interventional pain management, I focus on identifying the specific structures generating your pain before recommending any treatment. Every patient’s experience with pain is unique, and the treatment plan should be too.

If conservative treatments haven’t given you the relief you need, advanced minimally invasive options may be the next step. The goal isn’t just managing pain, it’s helping you reclaim your quality of life.

  • –  What Is Lower Back Pain?

    –  Common Causes

    –  Symptoms That Signal a Deeper Problem

    –  How Lower Back Pain Is Diagnosed

    –  Treatment Options

    –  When to See a Specialist

    –  Treatment at Napa Valley Orthopaedic Medical Group

    –  Frequently Asked Questions

Lower Back Pain Treatment in Napa | Jackie Weisbein, DO

What Is Lower Back Pain?

Your lower back, the lumbar spine, is made up of five vertebrae (L1 through L5), separated by cushioning discs and connected by small facet joints. This region supports the weight of your upper body, absorbs shock with every step, and allows you to bend, twist, and move through your day.

Because the lumbar spine handles so much, it’s also where problems are most likely to develop. Lower back pain can be acute, lasting a few days to a few weeks after an injury or strain. When pain persists for three months or longer, it’s considered chronic, and chronic lower back pain often involves more than one underlying cause.

According to the National Institute of Neurological Disorders and Stroke, lower back pain is the most common cause of job-related disability and a leading reason adults seek medical care. Roughly 80% of adults will experience lower back pain at some point in their lives.

What makes chronic lower back pain particularly challenging is that the pain may be coming from the discs, the facet joints, the sacroiliac joint, the nerves, the vertebral endplates, or the surrounding muscles, sometimes several at once. Understanding which structures are involved is the key to finding the right treatment.

Common Causes of Lower Back Pain

Lower back pain can develop from a wide range of conditions, some from everyday wear and activity, others from structural changes in the spine that progress over time.

Muscle and ligament injuries. Strains from heavy lifting, sudden movements, or repetitive activity are among the most common triggers. These injuries often heal on their own, but repeated strain can lead to chronic pain.

Herniated or bulging discs. The soft discs between your vertebrae can rupture or shift out of position, pressing on nearby nerves and causing pain that may radiate into the legs.

Degenerative disc disease. Over time, spinal discs lose hydration and height. This natural aging process can lead to persistent stiffness and pain, particularly with prolonged sitting or bending.

Spinal stenosis. Narrowing of the spinal canal compresses the nerves, often causing pain, numbness, or weakness that worsens with standing and walking. Learn more about spinal stenosis and how it’s treated.

Facet joint disease. The small joints connecting each vertebra can develop arthritis or inflammation, producing localized pain that’s often worse with extension and rotation.

Sacroiliac joint dysfunction. The SI joint, where the spine meets the pelvis, is a frequently overlooked source of lower back pain. When this joint becomes inflamed or unstable, it can mimic disc or hip problems. Read more about sacroiliac joint dysfunction.

Vertebrogenic pain. Damage to the vertebral endplates can irritate the basivertebral nerve, causing deep, chronic lower back pain that doesn’t respond to treatments targeting other structures. Learn about vertebrogenic pain and the procedures designed to address it.

Spondylolisthesis. When one vertebra slips forward over the one below it, it can compress nerves and destabilize the lumbar spine.

Symptoms That May Indicate a Deeper Problem

Most lower back pain improves within a few weeks with rest, activity modification, and over-the-counter medication. But when pain persists, or changes in character, it may be a sign that something more than a simple strain is involved.

Consider scheduling an evaluation if you experience:

•   Pain that lasts longer than four weeks despite self-care

•   Pain that worsens over time rather than improving

•   Sharp or shooting pain that radiates into one or both legs

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

•   Stiffness that significantly limits your range of motion

•   Pain that disrupts sleep or daily activities

Seek immediate medical attention if you notice:

•   Sudden loss of bladder or bowel control

•   Progressive leg weakness or difficulty walking

•   Severe pain following a fall, accident, or injury

These symptoms don’t always mean something serious, but they do mean it’s time to get a clear diagnosis from a specialist who can identify what’s actually causing your pain.

How Lower Back Pain Is Diagnosed

When a patient comes to me with chronic lower back pain, my first priority is understanding the full picture, not just where it hurts, but how the pain behaves, what makes it better or worse, and how it’s affecting your daily life.

Every evaluation begins with a thorough conversation about your medical history, previous treatments, and what you’ve already tried. From there, I perform a physical examination to assess your posture, range of motion, muscle strength, and any signs of nerve involvement.

Diagnostic imaging ( including MRI, X-ray, or CT scan) helps me visualize the structures of your lumbar spine in detail. In many cases, I also use diagnostic injections to confirm which specific structure is generating your pain. If a targeted injection to the facet joint, sacroiliac joint, or a specific nerve provides temporary relief, that tells me exactly where the problem is, and exactly which treatment is most likely to help.

This step matters more than most patients realize. Chronic lower back pain that involves multiple generators requires a precise diagnosis before any procedure is recommended. The goal is never to guess. It’s to know, and then build a treatment plan around what we find.

Treatment Options for Lower Back Pain

For many patients, lower back pain responds well to conservative care. Physical therapy, targeted exercise, medication management, and lifestyle modifications, including weight management and ergonomic adjustments, can provide meaningful relief, particularly for acute injuries and early-stage conditions.

But when conservative treatments have been given a fair trial and pain persists, that doesn’t mean you’ve run out of options. It means the underlying pain generator may require a more targeted approach. That’s where interventional pain management begins.

Epidural Steroid Injections and Nerve Blocks

Epidural steroid injections deliver anti-inflammatory medication directly to the area around compressed or irritated spinal nerves. For patients with disc herniation, nerve root compression, or radiculopathy causing pain that radiates into the legs, these injections can reduce inflammation and provide relief that lasts weeks to months. Research published in Frontiers in Pain Research found that targeted epidural approaches produced statistically significant pain relief and functional improvement at one, three, and six months. Learn more about spinal injections.

Radiofrequency Ablation

Radiofrequency ablation uses controlled heat to reduce pain signals from specific nerves, most commonly the medial branch nerves that supply the facet joints. When diagnostic blocks confirm that facet joint disease is driving your lower back pain, radiofrequency ablation can provide months of sustained relief. A 2022 network meta-analysis published in Frontiers in Surgery found that conventional radiofrequency denervation was more effective than placebo for both short-term and long-term pain reduction in facet joint-derived chronic lower back pain.

Minimally Invasive Lumbar Decompression (MILD)

The MILD procedure is designed for patients with lumbar spinal stenosis caused by thickened ligament tissue that narrows the spinal canal. Through a small incision, the thickened tissue is removed to restore space for the compressed nerves. A Cleveland Clinic study published in Pain Practice found that MILD was durable over five years, only 9 out of 75 patients required surgical decompression during follow-up, and patients experienced significant reductions in both pain and opioid use. Learn more about spinal stenosis treatment options.

Basivertebral Nerve Ablation (Intracept Procedure)

Some chronic lower back pain originates not from the discs or joints, but from the vertebral endplates themselves. The Intracept procedure targets the basivertebral nerve, the nerve responsible for transmitting pain signals from damaged endplates. Patients with vertebrogenic pain and Modic changes visible on MRI may be candidates. The INTRACEPT randomized trial, published in The Spine Journal, demonstrated cost-effectiveness over five years with durable improvements in pain and disability. Learn more about vertebrogenic pain and how it’s diagnosed.

Spinal Cord Stimulation and Neuromodulation

For patients with treatment-resistant chronic pain, including failed back surgery syndrome, spinal cord stimulation may offer a path forward. An implanted device delivers mild electrical pulses that modulate pain signals before they reach the brain. Newer burst stimulation technology is designed to replicate natural nerve firing patterns, and a meta-analysis in Pain Physician found that burst stimulation was superior to conventional tonic stimulation for chronic lower back pain relief. Explore spinal cord stimulation in detail.

Restorative Neurostimulation (ReActiv8)

A five-year study published in Neuromodulation found that restorative neurostimulation produced some of the most durable outcomes in the chronic lower back pain literature, pain scores improved from 7.3 to 2.4 on a 10-point scale, and 71.8% of patients achieved at least 50% pain relief. ReActiv8 works by activating the lumbar multifidus muscles, restoring the neuromuscular control that chronic pain often disrupts. For patients with refractory mechanical lower back pain and impaired multifidus function, this approach addresses the underlying cause rather than masking symptoms.

Sacroiliac Joint Procedures

The sacroiliac joint, where the base of the spine meets the pelvis, is one of the most frequently overlooked sources of chronic lower back pain. When diagnostic injections confirm SI joint dysfunction, treatment options range from therapeutic injections to minimally invasive SI joint fusion. A systematic review in The Spine Journal found that minimally invasive fusion was more effective than conservative management, with significant improvements in pain and physical function that remained durable at two years. Learn more about sacroiliac joint dysfunction.

When to See a Specialist for Lower Back Pain

Many of my patients tell me they waited too long before seeking specialized care. They spent months, sometimes years, cycling through primary care visits, physical therapy rounds, and medication adjustments without ever getting a clear answer about what was actually causing their pain.

If any of this sounds familiar, it may be time for a different approach:

•   Conservative treatments have been given a fair trial but haven’t provided lasting relief

•   Pain has persisted for three months or longer

•   Your daily activities, sleep, or work are consistently affected

•   You’ve been told there’s nothing more that can be done

That last one is worth addressing directly. In my experience, patients who’ve been told they’re out of options often haven’t had a thorough diagnostic workup to identify every contributing pain generator. Different sources of pain require different treatments, and finding the right match starts with asking the right questions.

A consultation doesn’t commit you to a procedure. It gives you information.

Lower Back Pain Treatment at Napa Valley Orthopaedic Medical Group

I built my practice around a simple idea: chronic pain deserves more than a one-size-fits-all approach.

As a double board-certified, fellowship-trained interventional pain management specialist, I’ve spent over a decade helping patients throughout Napa Valley find relief from conditions that other treatments couldn’t resolve. That experience, thousands of procedures over a decade and a half, shapes how I evaluate every patient who walks through our door. I don’t start with a procedure. I start with a conversation.

I’m also deeply committed to advancing the field. As President of Women Innovators in Pain Management and one of the country’s top spinal cord stimulation implanting physicians, I actively train fellow physicians on the same advanced techniques I offer my patients here in Napa. That means you’re receiving care informed by the latest evidence and clinical innovation, not just what was standard five years ago.

Patients from throughout Napa Valley and the surrounding wine country, from American Canyon to St. Helena, choose our practice for the combination of nationally recognized expertise and boutique, physician-led care. I accept most insurance plans, and telehealth appointments are available for initial consultations.

To learn more about my background and approach, visit my provider page.

Frequently Asked Questions

  • There isn’t a single answer, because chronic lower back pain usually involves more than one source. The most effective approach starts with a thorough diagnostic evaluation to identify exactly which structures are generating your pain, then matches each pain generator to the most appropriate treatment. That may be a single procedure or a combination of approaches.

  • If lower back pain has lasted longer than three months, isn’t responding to conservative care, or is affecting your ability to work, sleep, or stay active, a specialist evaluation can help determine whether an underlying structural cause has been missed.

  • Several. Depending on the diagnosis, options may include epidural steroid injections, radiofrequency ablation, the MILD procedure for spinal stenosis, basivertebral nerve ablation for vertebrogenic pain, spinal cord stimulation, restorative neurostimulation, or sacroiliac joint fusion. Each targets a different pain source, candidacy depends on your specific condition.

  • It varies by procedure. Some injections provide relief within days. Radiofrequency ablation results typically develop over one to three weeks. Implanted neurostimulation devices often show progressive improvement over the first several months as the body responds to treatment.

  • Many insurance plans cover these procedures when medically indicated. Coverage varies by plan and procedure. Our office can help verify your specific benefits before treatment begins.

  • A pain management specialist is a physician with advanced board certification and fellowship training who can perform diagnostic procedures, image-guided injections, and surgical implants. Chiropractic care focuses primarily on spinal manipulation. Both have a role in managing back pain, but interventional pain management addresses conditions that require medical-level intervention.

  • Yes. Most of the procedures I offer are minimally invasive, meaning they’re performed through small incisions or needles, typically as outpatient procedures with short recovery times. These are not open surgeries. They’re targeted interventions designed to address specific pain generators.

  • Your first appointment includes a comprehensive consultation, a detailed conversation about your pain history, a physical examination, and a review of any imaging you’ve already had. From there, I’ll explain what I think is causing your pain, what diagnostic steps may be needed to confirm it, and what treatment options make the most sense for your situation. There’s no pressure. The goal is to give you a clear understanding of where your pain is coming from and what can be done about it.

Schedule a Consultation

If chronic lower back pain is affecting your quality of life, a comprehensive evaluation is the first step toward finding the right treatment. Jackie Weisbein, DO welcomes new and existing patients at Napa Valley Orthopaedic Medical Group.

New patients: Call (707) 254-7117 or submit an Online Appointment Request

Existing patients: Call (707) 603-1078

Medical Disclaimer

This content 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.

Reviewed by Jackie Weisbein, DO — Napa Valley Orthopaedic Medical Group

Last reviewed: April 2026