No one is quite certain of the cause for back pain. In a seminal study dating to 1994, Jensen reported that “On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”
All 3 versions of non-surgical back pain (Low Back Pain, discogenic pain, and sciatica) are real conditions and functional imaging is now able to demonstrate some of the relevant brain mechanisms of pain. Because the local cause for the pain syndrome is not readily apparent the treatment is rarely a surgical approach. A wide variety of non-surgical treatments have been applied to the condition. Anti-inflammatory treatments can include NSAID’s and COX-2 inhibitors, or direct application of corticosteroids to specific regions. Another promising treatment is the careful injection of etanercept into the perispinal region, as described by Tobinick. Physical therapy and spine-health training are vital aspects as we seek to both manage the pain condition and also prevent the ever-worsening situation of weakness / re-injury / debilitation.