PONOS CLINIC · LOW BACK PAIN PATHWAY
Chronic low back pain: specialist pathway for complex cases
When low back pain persists, the key step is to identify the structure and mechanism driving it.
Chronic low back pain is not a diagnosis
It is a symptom with different possible sources: posterior joints, discs, nerve roots, stenosis, instability, muscles, the sacroiliac joint or coccyx. A precise description of pain guides the pathway.
Low back pain, leg pain and functional limitation are interpreted together with neurological examination, clinical tests and imaging.
Causes to distinguish
Facet joints
Paravertebral pain, often provoked by extension and rotation.
Disc and nerve root
Discogenic pain, herniation or protrusion with possible symptoms along the leg.
Stenosis and instability
Degenerative changes, spondylolisthesis or stenosis assessed in relation to symptoms.
Clinical and differential assessment
- History and symptom map.
- Physical and neurological examination.
- Review of previous MRI, CT or X-rays.
- Targeted diagnostic tests when the result may change the plan.
Imaging often shows changes in people without pain; reports therefore need clinical correlation.
Targeted treatment
The plan may combine education, rehabilitation, medication management and, in selected cases, interventional procedures. Techniques may include diagnostic-therapeutic injections and radiofrequency of identified targets.
Before proposing it, symptoms, examination, imaging and response to a possible infiltration test are assessed together.
Learn how radiofrequency works · Radiofrequency treatment options
Frequently asked questions
When is low back pain considered chronic?
When pain persists or recurs for months and consistently limits activity, sleep or work.
Does a disc herniation on MRI always explain pain?
No. The finding must be correlated with symptom distribution, neurological examination and the clinical picture.
Does a procedure resolve the cause?
It may reduce one component of pain in selected patients; the pathway also includes rehabilitation and management of maintaining factors.
Start with the most useful clinical information
Bring previous images and reports to build a proportionate, personalised pathway.
This information is educational and does not replace an individual medical assessment.