Low Back Pain
Low back pain is not a diagnosis — it’s a symptom. Before we treat it, we find out exactly what’s causing it.
Low Back Pain is a symptom. The source is the answer.
The lumbar spine carries the load of the entire upper body. Five vertebrae, the discs between them, the paired facet joints behind them, the sacroiliac joints below, and the nerve roots threading through it all — any one of these structures can produce low back pain, and several can produce pain that feels nearly identical.
This is why so many patients cycle through treatments that don’t work. Two people describing the same ache in the same spot can have entirely different problems: one an irritated facet joint, another a torn disc, another a sacroiliac joint that never healed after a fall. The same injection helps one and does nothing for the others — not because the treatment failed, but because it was aimed at the wrong target.
At National Pain Centers, we don’t guess. We work to identify the specific pain generator — the exact structure producing your symptoms — and build the treatment plan around it. Precise diagnosis first. Precise treatment second.
Find the root of the problem, diagnose it, address it, treat it, and rehabilitate it. Masking symptoms is easy. Resolving them takes accuracy.
What can cause low back pain
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Disc-Related Causes
Lumbar Disc Herniation
When a disc’s outer layer tears and inner material protrudes, it can chemically irritate or physically compress a nerve root — producing back pain that radiates into the buttock, thigh, calf, or foot, often with numbness, tingling, or weakness. This is the most common cause of true sciatica.
Degenerative Disc Disease
Discs lose water content and height with age and load, reducing their shock absorption. The result is axial back pain, stiffness, and secondary overload of the facet joints — a cascade in which one structure’s failure stresses the next.
Internal Disc Disruption & Discogenic Pain
Pain arising from tears within the disc itself, without frank herniation. Typically deep, central, and worsened by sitting, bending, or sustained flexion. It is one of the harder sources to identify without careful diagnostic work.
Lumbar Spondylosis
The broad term for age-related degeneration across discs, joints, and bone. Spondylosis is nearly universal on imaging after a certain age — which is precisely why an abnormal MRI does not prove you’ve found the pain generator.
Joint-Related Causes
Lumbar Facet Arthropathy
The paired facet joints guide spinal motion. When arthritic, inflamed, or injured, they cause deep axial back pain that typically worsens with extension, standing, or twisting, and can refer into the buttock and thigh. Facet pain frequently does not appear on imaging.
Sacroiliac Joint Dysfunction
The SI joints transfer load between spine and pelvis. Injury, pregnancy, arthritis, or fusion above can render them painful — producing pain below the belt line, in the buttock, and sometimes into the groin or thigh. SI joint pain is one of the most frequently missed causes of low back pain.
Hip & Pelvic Referred Pain
Hip arthritis and pelvic pathology can convincingly mimic low back pain. Distinguishing them matters, because treating the spine will never resolve a problem originating in the hip.
Myofascial Pain & Trigger Points
Taut, irritable bands in the paraspinal and gluteal muscles produce local tenderness and predictable referred patterns. Myofascial pain is often secondary — muscle compensating for an underlying joint or disc problem — which is why treating only muscle rarely lasts.
Nerve-Related Causes
Lumbar Radiculopathy (Sciatica)
Compression or irritation of a lumbar nerve root, most often from disc herniation or bone spur. Pain follows the nerve’s distribution down the leg, often with numbness in specific areas or weakness in specific muscles. The pattern helps localize which root is involved.
Lumbar Spinal Stenosis
Narrowing of the spinal canal, usually from degenerative change. The hallmark is neurogenic claudication: leg pain and heaviness with walking or standing that eases with sitting or leaning forward. It is highly treatable when correctly identified.
Spondylolisthesis
One vertebra slips forward on another, which can narrow the canal and stress the joints and discs. It may be developmental or degenerative, and it can produce both axial pain and nerve symptoms.
Central Sensitization
When pain persists, the nervous system itself amplifies — turning up the volume on signals that would otherwise be minor. Pain becomes widespread, disproportionate, and resistant to structure-directed treatment. Recognizing it changes the entire strategy, and it is an area of particular expertise here.
Traumatic, Post-Surgical & Systemic Causes
Vertebral Compression Fracture
Often from osteoporosis or trauma, a collapsed vertebra causes sudden, focal, severe back pain. It is treatable — and frequently missed as “just a strain” in older patients.
Post-Laminectomy Syndrome & Adjacent-Segment Disease
Persistent pain after spine surgery, including accelerated degeneration at the levels above or below a fusion. Many of these patients are told nothing more can be done. Frequently, that isn’t true — it usually means the actual pain generator was never identified.
Sprain, Strain & Postural Overload
Ligament and muscle injury from lifting, sudden movement, or sustained poor mechanics. What begins as a strain can become structural if the mechanics are never corrected — which is why rehabilitation belongs in every plan.
Inflammatory, Infectious & Other Causes
Less commonly, back pain reflects inflammatory arthritis such as ankylosing spondylitis, infection, or tumor. A thorough evaluation is designed to identify these rather than assume a mechanical cause — because the rare diagnosis missed is the one that matters most.
When low back pain is an emergency
Seek immediate care — call 911 or go to an emergency room — if low back pain occurs with: loss of bowel or bladder control; numbness in the groin or inner thighs (saddle anesthesia); progressive leg weakness; severe pain after major trauma; fever with back pain; or unexplained weight loss with night pain. These can signal cauda equina syndrome, fracture, infection, or tumor. This page is educational and is not a substitute for evaluation.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Where the pain lives, what provokes it, what relieves it, how it refers, and what the neurologic exam shows. This is where most of the diagnosis is made — and it’s why our visits are longer than the industry norm.
02 — Correlated imaging
X-ray, MRI, or CT interpreted against your symptoms and exam, never in isolation. The question is never “what’s abnormal?” but “what’s abnormal and explains this patient’s pain?”
03 — Virtual MSK Movement Assessment
Our proprietary, wearable-free remote assessment measures how your body actually moves — objective data on range, control, and compensation that a static image can never show.
04 — Diagnostic nerve blocks
The definitive step. Anesthetizing a specific nerve that carries pain from a specific structure — and observing whether your pain temporarily resolves — confirms the pain generator with a precision no scan can match. A block that works tells us where to treat. One that doesn’t rules a structure out.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Lumbar Medial Branch Blocks
The medial branch nerves carry pain from the facet joints. Anesthetizing them is the diagnostic test for facet-mediated back pain and confirms whether radiofrequency ablation is likely to help. This step is required before any ablation is considered.
Lumbar Radiofrequency Ablation (RFA)
For confirmed facet-mediated pain, RFA uses controlled heat to interrupt the medial branch nerves’ ability to transmit pain, often providing relief lasting many months to years.
Dr. Joshi uses smaller-gauge needles — where many providers reach for far larger ones to compensate with an oversized lesion — along with a longer-duration, lower-temperature, tissue-sparing lesion. Precision means we don’t need to be destructive to be effective, and we preserve the healthy tissue around the target.
Lumbar Transforaminal Epidural Steroid Injection
For lumbar radiculopathy and disc-related nerve irritation, a transforaminal epidural delivers anti-inflammatory medication precisely to the affected nerve root, relieving leg pain and improving function.
Dr. Joshi pioneered the use of a blunt needle for lumbar transforaminal epidural steroid injections — a genuine safety advance that reduces the risk of catastrophic intravascular and intraneural injury. It is one of several first-in-the-world techniques he has contributed to the field. Note: we do not perform transforaminal epidurals in the cervical or thoracic spine, where we consider the risk unacceptable.
Sacroiliac Joint Injections & Ablation
For confirmed SI joint pain, targeted injections both diagnose and treat. When appropriate, radiofrequency ablation of the nerves supplying the joint can provide durable relief for a condition that is too often overlooked entirely.
Caudal & Interlaminar Epidural Injections
Alternative epidural approaches selected based on your specific anatomy and pathology — because the right approach is the one that fits the patient, not the one the practice happens to prefer.
Trigger Point Injections
For myofascial pain and taut muscular bands. We treat muscle as part of a larger picture — usually alongside the joint or disc problem driving the compensation, not instead of it.
Regenerative Medicine & Orthobiologics
For appropriate candidates, platelet-rich plasma (PRP) and orthobiologic approaches aim to support the body’s own repair of injured tissue rather than simply suppressing inflammation. We are physician-led early adopters — and candid about what the evidence supports today and what remains emerging.
Ketamine Infusion Therapy
When back pain is driven or amplified by central sensitization, treating only the back will not be enough. Ketamine infusions can reduce the nervous system’s amplified pain response. We built America’s first surgery-center-based outpatient ketamine program and have delivered thousands of infusions.
Rehabilitation & Whole-Person Care
A procedure that relieves pain without correcting the mechanics that caused it invites the problem back. Our multi-disciplinary team — including chiropractic and musculoskeletal expertise — builds rehabilitation into the plan, because the goal is not a good week. It’s a durable result.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Low Back Pain, answered
The patterns differ. Discogenic pain often worsens with sitting and bending forward. Facet pain typically worsens with extension, standing, and twisting. SI joint pain sits below the belt line and may refer into the buttock or groin. History and examination narrow it, and a diagnostic block can confirm it definitively.
Because ablation should only be performed once we’ve proven the facet joints are the source. A diagnostic medial branch block temporarily anesthetizes the nerves carrying pain from those joints. If your pain resolves during that window, ablation is likely to help. If it doesn’t, we’ve learned something equally valuable and spared you an unnecessary procedure.
Dr. Joshi pioneered using a blunt needle for lumbar transforaminal epidural injections. A sharp needle can inadvertently enter a blood vessel or nerve; a blunt needle is far less likely to do so, reducing the risk of rare but catastrophic complications. It is a first-in-the-world safety contribution to the field.
No. Dr. Joshi has never prescribed OxyContin or oxycodone in over three decades, and he warned of the opioid epidemic before it was widely acknowledged. Our approach identifies and treats the source of pain rather than suppressing the signal. Even our procedural sedation is non-opioid.
Not necessarily. Disc bulges and degenerative changes are extremely common in people with no pain at all. An imaging finding only matters if it explains your specific symptoms and exam. This is exactly why we correlate imaging with the clinical picture and, when appropriate, confirm with diagnostic blocks.
Usually, yes. Persistent post-surgical pain may stem from adjacent-segment disease, untreated facet or SI joint pain, nerve irritation, or central sensitization. Being told nothing more can be done often means the actual pain generator was never identified.
Very likely not — at least not yet. A stimulator is a legitimate tool for the right patient at the right time, but it is an implant, and we treat it as a genuine last resort rather than an early default. First we find the root cause, treat it, and rehabilitate it.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.