Condition

Chronic Low Back Pain Treatment in Tallahassee, FL

Persistent low back pain that hasn’t responded to physical therapy, medications, or injections is not the end of the road. A comprehensive evaluation is the first step toward identifying what is actually causing your pain.

Overview

What Is Chronic Low Back Pain?

Chronic low back pain is defined as pain in the lower back that has persisted for three months or longer. Unlike an acute injury that heals with rest and time, chronic low back pain is typically driven by an ongoing structural or nerve-related problem — and it rarely resolves on its own without addressing the underlying source.

The lower back is a complex region. Pain can originate from the discs, the vertebral endplates, the facet joints, the sacroiliac joints, or the surrounding muscles and nerves. Because these structures can produce overlapping symptoms, identifying the true source of pain requires a thorough diagnostic evaluation rather than a one-size-fits-all approach.

Causes

What Causes It

Chronic low back pain has many potential causes. Degenerative disc disease, facet joint arthritis, vertebrogenic pain from damaged vertebral endplates, sacroiliac joint dysfunction, and nerve root compression are among the most common. Vertebrogenic low back pain — caused by activation of the basivertebral nerve inside the vertebral body — is a particularly important and frequently overlooked source. It is associated with Modic changes visible on MRI and often persists despite injections and surgery because it originates inside the bone itself, not in the disc or surrounding soft tissue. Many patients with chronic low back pain have more than one contributing factor, which is why a diagnostic-first approach matters.

Evaluation

How We Evaluate It

We begin with a detailed history — understanding not just your pain, but everything you have already tried and how you responded. We perform a physical examination and review all existing imaging, including MRI, CT, and X-ray, with particular attention to findings such as Modic changes, disc degeneration, facet arthropathy, and nerve compression. When imaging alone is insufficient to identify the pain source, diagnostic injections such as medial branch blocks or epidural injections can help confirm which specific structure is responsible before any treatment is recommended.

Treatment

How We Treat Chronic Low Back Pain

Treatment is matched to the source. For patients with facet-related pain, medial branch blocks are used to confirm the diagnosis, followed by radiofrequency ablation to provide longer-term relief. For patients with disc-related or nerve root pain, epidural steroid injections can reduce inflammation and improve function. For patients whose MRI shows Modic changes and whose pain has not responded to other treatments, basivertebral nerve ablation targets the vertebrogenic source directly. For patients with more complex or refractory pain, spinal cord stimulation, peripheral nerve stimulation, or intrathecal drug delivery may be evaluated.

Our approach is stepwise and individualized. We do not recommend any procedure without a clear understanding of what is driving your pain and a reasonable expectation that the proposed treatment will address it. A consultation is the right starting point — and for many patients who have been told there is nothing more that can be done, there often is.

Frequently Asked Questions

Common Questions

Low back pain is generally considered chronic when it has persisted for three months or longer. Unlike acute back pain — which typically resolves with rest and conservative care — chronic low back pain is often caused by an underlying structural or nerve-related problem that requires a more targeted evaluation and treatment approach.
Vertebrogenic low back pain is a specific type of chronic low back pain caused by damage to the vertebral endplates — the cartilage layers between the vertebral body and the disc. This damage activates the basivertebral nerve inside the vertebral body, which transmits pain signals to the brain. It is often associated with Modic changes visible on MRI and is frequently missed by conventional treatments including injections and surgery.
Patients who have not responded to physical therapy, chiropractic care, medications, and injections still have meaningful interventional options available. Depending on the specific source of your pain, these may include basivertebral nerve ablation for vertebrogenic pain, radiofrequency ablation for facet-related pain, spinal cord stimulation, peripheral nerve stimulation, or intrathecal drug delivery. A comprehensive evaluation is the first step to identifying which approach is most likely to help.
Identifying the source of chronic low back pain requires a thorough approach that goes beyond a single imaging study. We review your complete history, perform a physical examination, and analyze existing imaging including MRI, CT, and X-ray. In some cases, diagnostic injections — such as medial branch blocks or epidural injections — help confirm the specific structure generating your pain before any treatment decision is made.
No. Many patients with treatment-resistant chronic low back pain are candidates for minimally invasive interventional procedures that do not involve open surgery. Options such as basivertebral nerve ablation, radiofrequency ablation, spinal cord stimulation, and peripheral nerve stimulation can provide meaningful and lasting relief for carefully selected patients. When surgery is the most appropriate next step, we will refer you to a spine surgeon.
Modic changes are specific findings on MRI that indicate damage or inflammation at the vertebral endplates — the boundary between the disc and the vertebral bone. They are significant because they are strongly associated with vertebrogenic low back pain, a condition caused by activation of the basivertebral nerve inside the vertebral body. Patients with Modic changes who have chronic low back pain may be candidates for basivertebral nerve ablation, a minimally invasive procedure that targets this nerve directly.

Ready to Explore Your Options?

Our clinical team will review your history, imaging, and prior treatments to determine the most appropriate path forward.

Request an Appointment (850) 559-2355