Chronic Low Back Pain: Clinical Patient Journey

Reviewed by: Name, MD – Board-Certified Pain Medicine Physician
Affiliation: The Medical Group of New Jersey

Chronic low back pain is one of the most common reasons adults seek medical care and a leading cause of disability worldwide. While many episodes of back pain improve within a few weeks, pain that persists for 12 weeks or longer may require a more comprehensive evaluation to identify the underlying cause and develop an effective treatment plan.

At The Medical Group of New Jersey, our Pain Medicine specialists take a personalized, multidisciplinary approach to chronic low back pain. Rather than simply treating symptoms, we work to identify the source of pain and develop individualized treatment plans that may include rehabilitation, medications, image-guided procedures, minimally invasive interventions, and collaboration with specialists across multiple disciplines.

1: Symptom Onset & Initial Evaluation

Chronic low back pain may begin suddenly after lifting a heavy object, a fall, or another injury. In many patients, however, symptoms develop gradually as the spine undergoes normal age-related changes or repetitive stress over time.

Pain may be constant or intermittent and can range from mild discomfort to severe pain that interferes with work, sleep, exercise, and routine daily activities.

Common symptoms include:

Persistent pain in the lower back lasting more than 12 weeks
Stiffness, especially after sitting or waking in the morning
Pain that worsens with prolonged standing, walking, bending, or lifting
Muscle tightness or spasms
Pain that improves or worsens with certain positions
Difficulty performing everyday activities
Fatigue resulting from chronic pain

Some patients also experience symptoms suggesting irritation or compression of spinal nerves, including:

Pain radiating into the buttocks or legs
Numbness or tingling
Burning or electric shock-like sensations
Muscle weakness
Difficulty walking long distances

During your initial consultation, your Pain Medicine physician will review:

When your symptoms began
Previous injuries or surgeries
Activities that worsen or relieve pain
Prior treatments and their effectiveness
Current medications
Occupational and recreational activities
Overall medical history

Understanding how pain affects your daily life, including sleep, work, exercise, and emotional well-being, helps guide the development of a personalized treatment plan.

Certain symptoms, sometimes called “red flags,” may require urgent evaluation. These include new bowel or bladder dysfunction, progressive leg weakness, fever, unexplained weight loss, severe trauma, or a history of cancer with new back pain.

2: Diagnosis

Accurately identifying the source of chronic low back pain is essential because many different structures within the spine can generate pain, including discs, joints, muscles, ligaments, nerves, and surrounding soft tissues.

Comprehensive Physical Examination

Your physician will perform a detailed examination that may include assessment of:

Posture and spinal alignment
Range of motion
Muscle strength
Reflexes
Sensation
Walking and balance
Areas of tenderness
Flexibility
Hip and pelvic function

Special examination maneuvers may help determine whether pain originates from the spine itself, surrounding muscles, sacroiliac joints, or compressed nerves.

Diagnostic Imaging

Depending on your symptoms and examination findings, imaging studies may include:

X-rays to evaluate spinal alignment, arthritis, or fractures
MRI to assess discs, nerves, ligaments, spinal stenosis, and soft tissues
CT scans when additional bony detail is needed
Bone density testing when osteoporosis is suspected

Imaging is generally recommended when symptoms persist despite conservative treatment, neurological symptoms develop, or specific underlying conditions are suspected.

Additional Diagnostic Testing

Some patients benefit from additional testing such as:

Electromyography (EMG) and nerve conduction studies to evaluate nerve function
Laboratory testing when infection, inflammatory arthritis, or other medical conditions are suspected
Diagnostic injections to identify the specific source of pain before proceeding with additional treatments

Treatment

Treatment depends on the underlying cause of pain, symptom severity, overall health, and individual goals. Most patients benefit from combining several therapies rather than relying on a single treatment.

Activity Modification & Education

Remaining active is often one of the most important parts of recovery. While brief periods of rest may help during severe flare-ups, prolonged inactivity can contribute to muscle weakness, stiffness, and delayed recovery.

Your physician may recommend:

Modifying activities that worsen pain
Improving body mechanics
Ergonomic adjustments at work
Safe lifting techniques
Home exercise programs

Physical Therapy & Rehabilitation

Physical therapy is frequently a cornerstone of chronic low back pain treatment.

Treatment may include:

Core strengthening exercises
Flexibility training
Posture correction
Manual therapy
Stretching programs
Balance and stability exercises
Functional movement training

The goal is to improve spinal support, reduce stress on painful structures, and restore normal movement patterns.

Medications

Depending on your condition, medications may include:

Anti-inflammatory medications (NSAIDs)
Acetaminophen
Muscle relaxants
Neuropathic pain medications
Topical medications

Medication recommendations are individualized, with careful consideration given to balancing symptom relief with potential side effects. Whenever possible, treatment emphasizes therapies that reduce reliance on long-term opioid medications.

Image-Guided Injections

For patients whose pain does not improve with conservative therapy, image-guided procedures may help reduce inflammation, confirm the source of pain, or provide longer-lasting symptom relief.

Common procedures include:

Epidural steroid injections
Facet joint injections
Medial branch nerve blocks
Sacroiliac (SI) joint injections
Trigger point injections

Fluoroscopic or ultrasound guidance helps improve precision and accuracy during many of these procedures.

Radiofrequency Ablation (RFA)

For selected patients with chronic pain originating from the facet joints, radiofrequency ablation may provide longer-lasting relief by interrupting pain signals traveling through small sensory nerves.

This minimally invasive outpatient procedure is often considered after successful diagnostic nerve blocks and may provide pain relief lasting several months or longer in appropriate candidates.

Collaborative Specialty Care

Some patients benefit from coordinated care involving multiple specialists, including:

Physical Medicine & Rehabilitation (PM&R)
Neurology
Orthopedic specialists
Rheumatology
Neurosurgery
Physical therapy
Behavioral health providers

Surgery is generally reserved for patients with significant structural abnormalities, progressive neurological deficits, or symptoms that do not respond to appropriate nonsurgical treatment.

Ongoing Management & Prevention

Chronic low back pain often requires ongoing management rather than a one-time treatment. Long-term success typically involves maintaining healthy habits that support spinal health and reduce future flare-ups.