Back pain is a symptom, not a diagnosis. That distinction is the whole of the problem, and it is why so many people arrive here having been treated for months without anyone establishing what is actually generating the pain.
Several different structures in the low back can produce pain that feels identical from the outside. Each responds to different treatment. Working out which one is yours is the first job, and it is a job that can be done.
When you point at your lower back and say it hurts, the source is usually one of these:
Two or three of these are often active at once. That is not a complication — it is the normal state of a spine that has been painful for years, and it is why single-modality treatment so often produces partial, temporary relief.
Go to an emergency department, or call 911, if back pain comes with any of the following:
These are uncommon. They are also the presentations where hours matter, and no clinic appointment should come before them.
This practice is diagnostic before it is therapeutic, and the sequence matters more than any individual treatment.
Examination first. Provocative maneuvers load specific structures in specific directions. Which movements reproduce your pain, and which relieve it, narrows the field considerably before any imaging is discussed.
Imaging read against your symptoms, not in isolation. This is where a great deal of back pain care goes wrong. Degenerative findings on MRI are extremely common in people with no pain at all, so a scan showing disc degeneration does not establish that the disc is the source. A scan that does not match the complaint is a trap, not an answer.
Diagnostic blocks where the picture is still ambiguous. A small, precisely placed volume of local anesthetic under ultrasound or fluoroscopic guidance either abolishes the pain temporarily or it does not. That is a test with an answer. It is the difference between a treatment plan and a sequence of guesses with a needle attached.
Conservative care comes first — activity modification, targeted physical therapy, and the metabolic drivers discussed below. Where that is not enough, treatment is matched to the structure:
Pain that improves with treatment and then comes back is the most common story we hear, and it usually means something outside the spine is holding the process open.
Uncontrolled blood sugar changes how nerves conduct and how tissue heals. Poor sleep measurably lowers pain thresholds. Inflammatory load, thyroid function and nutritional deficiencies all alter how pain is generated and sustained. A plan that addresses only the mechanical finding, in a patient whose metabolic picture is driving the process, produces exactly that pattern — relief that works briefly and then stops.
This practice treats those drivers alongside the structural problem rather than referring them out and hoping.
For most back pain, surgery is not the treatment, and that is a statement about the condition rather than about surgery. Pain arising from facet joints, the SI joint, or a sensitized nervous system does not have a structural lesion for a surgeon to correct.
Where there IS a structural problem that needs correcting — a compressive lesion producing progressive neurological deficit, instability, or stenosis that has exhausted every less invasive option — surgery is the right answer, and this practice performs it. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a licensed physician and surgeon with surgical privileges. The practice leads with the least invasive option that can answer the question and reserves surgery for when it is the answer, not the next step.
If you have already had spine surgery and the pain returned or never resolved, that has its own identifiable causes — see continued pain after back surgery.
For back pain that has not resolved in about six weeks, an interventional pain physician can establish which structure is generating it — which is the step most often skipped. Surgeons treat structural problems that need structural correction; primary care manages the early course well. Our page on choosing a pain specialist sets out what to ask.
This is common and it does not mean the pain is imagined. Facet joints, the SI joint and centrally mediated pain are all effectively invisible on standard imaging. It means the diagnosis has to come from examination and diagnostic blocks instead. See why medications and surgery may not fix pain.
Most acute back pain improves within a few weeks. Pain that has lasted longer than about six weeks without a clear trajectory toward resolution is worth a specialist opinion, and so is any pain that has returned after treatment. Read what waiting for pain treatment does to your body.
No. You do not need a referral to be evaluated here, and you do not need to be an existing patient. Some insurance plans require one for their own reasons, which is worth checking with your carrier. Same-day appointments are available for acute pain.
That is not the direction of this practice. The work here is aimed at treating the pain generator directly and reducing medication burden — many patients arrive specifically to come off medication that stopped helping. See whether pain medication can make pain worse.
Yes. The practice is licensed in Missouri and Illinois, with offices on Woodson Road in St. Louis and on Natural Bridge Road in Bridgeton, and sees patients from across the Metro East including Edwardsville and Maryville.
Call (314) 481-5000 or request an appointment. See all conditions we treat.
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Same-day and emergency appointments are available.