Back pain is a symptom, not a diagnosis. That difference is the whole problem. It is why so many people arrive here after months of treatment, with no one having found what is actually causing the pain.
Several different structures in the low back can cause pain that feels the same from the outside. Each needs a different treatment. Finding 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 hurt for years. It is why one-track treatment so often brings only partial, short-lived relief.
Go to an emergency department, or call 911, if back pain comes with any of the following:
These are uncommon. But they are the cases where hours matter. No clinic appointment should come before them.
This practice finds the cause before it treats. The order matters more than any single treatment.
Examination first. Specific moves load specific structures in specific directions. Which moves bring on your pain, and which ease it, narrows the field a lot before anyone talks about imaging.
Imaging read against your symptoms, not in isolation. This is where a lot of back pain care goes wrong. Wear-and-tear findings on MRI are very common in people with no pain at all. So a scan showing disc wear does not prove 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, precise dose of numbing drug is placed under ultrasound or fluoroscopic guidance. Either the pain goes away for a while or it does not. That is a test with an answer. It is the difference between a treatment plan and a string of guesses with a needle attached.
Non-surgical care comes first. That means changing activities, targeted physical therapy, and the metabolic drivers discussed below. When that is not enough, treatment is matched to the structure:
Pain that gets better with treatment and then comes back is the most common story we hear. It usually means something outside the spine is keeping the problem going.
High blood sugar changes how nerves carry signals and how tissue heals. Poor sleep lowers pain thresholds in ways we can measure. Inflammation, thyroid function and poor nutrition all change how pain is made and kept going. Some plans treat only the mechanical finding, in a patient whose metabolism is driving the problem. Those plans cause exactly that pattern — relief that works briefly and then stops.
This practice treats those drivers along with the structural problem. We do not refer them out and hope.
For most back pain, surgery is not the treatment. That is a statement about the condition, not about surgery. Pain from facet joints, the SI joint, or a sensitized nervous system has no structural flaw for a surgeon to fix.
Sometimes there IS a structural problem that needs fixing. That could be a pinched nerve causing worsening nerve loss, an unstable spine, or stenosis that has failed every less invasive option. Then 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 starts with the least invasive option that can answer the question. It saves surgery for when it is the answer, not just the next step.
If you have already had spine surgery and the pain came back or never went away, that has its own causes we can find. See continued pain after back surgery.
Sometimes back pain comes from a worn joint or ligament, and cortisone keeps wearing off sooner. Then orthobiologic treatment is the next step between therapy and surgery. That means an image-guided intra-articular injection of PRP injections or bone marrow concentrate into the sacroiliac or facet joints, matched to the structure that hurts.
More on this condition from Dr. Padda on YouTube:
For back pain that has not cleared up in about six weeks, an interventional pain doctor can find which structure is causing it. That is the step most often skipped. Surgeons treat structural problems that need structural repair. Primary care handles the early course well. Our page on choosing a pain specialist explains what to ask.
This is common, and it does not mean the pain is imagined. Facet joints, the SI joint and centrally driven pain are all basically invisible on standard imaging. So the diagnosis has to come from the exam and diagnostic blocks instead. See why medications and surgery may not fix pain.
Most sudden back pain improves within a few weeks. Pain that has lasted longer than about six weeks without clearly getting better is worth a specialist’s opinion. So is any pain that has come back after treatment. Read what waiting for pain treatment does to your body.
No. You do not need a referral to be seen here, and you do not need to be a current patient. Some insurance plans require one for their own reasons, so check with your carrier. Same-day appointments are available for sudden pain.
That is not the direction of this practice. The work here aims to treat the source of the pain directly and cut the medicine load. Many patients come here just to get off medicine that stopped helping. See whether pain medication can make pain worse.
Yes. The practice is licensed in Missouri and Illinois. It has offices on Woodson Road in St. Louis and on Natural Bridge Road. It sees patients from across the Metro East, including Edwardsville and Maryville.
Call us or request an appointment. See all conditions we treat.
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Same-day and emergency appointments are available.