Acute back pain is sudden-onset pain in the lower, middle, or upper back that lasts less than 6 weeks. It is one of the most common reasons people seek medical care, affecting up to 80% of adults at some point in their lives. Most acute episodes resolve with appropriate treatment, but without care some can become chronic.

Chronic back pain is defined as pain lasting 3 months or longer, often outlasting the original injury. It is the leading cause of disability worldwide and can profoundly affect quality of life, sleep, mood, and work capacity. Identifying and treating the specific anatomic source of pain is the cornerstone of effective management.

Degenerative disc disease (DDD) occurs when the intervertebral discs — the shock-absorbing cushions between vertebrae — lose hydration and height over time. Despite its name, it is a condition rather than a true disease, and many people with DDD on imaging have no symptoms. When symptomatic, it can cause significant pain and reduced spinal mobility.

A disc herniation occurs when the soft inner material (nucleus pulposus) of a spinal disc pushes through a tear in the outer ring (annulus fibrosus) and presses on nearby nerve roots. This can cause dramatic, sharp pain that radiates into the arms or legs. The good news: with proper treatment, 80–90% of patients improve without surgery.

Facet joints are small paired joints at each spinal level that guide and limit spinal motion. They are lined with cartilage and a synovial membrane, making them susceptible to arthritis and inflammation. Facet-mediated pain is one of the most common — and most treatable — sources of chronic spinal pain, accounting for 15–40% of chronic low back pain cases.

Spinal stenosis is a narrowing of the spinal canal or foraminal openings that house the spinal cord and nerve roots. This narrowing compresses neural structures, leading to pain and neurological symptoms. Lumbar stenosis often causes “neurogenic claudication” — leg pain and weakness brought on by walking that improves with sitting or bending forward.

Sciatica describes pain that travels along the path of the sciatic nerve — from the lower back through the buttock and down one or both legs. It occurs when a nerve root in the lumbar spine (typically L4, L5, or S1) is compressed or irritated. True sciatica follows a specific dermatomal pattern and is often accompanied by neurological symptoms.

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it, destabilizing that spinal segment and potentially compressing nerves. It ranges from Grade I (mild, 1–25% slip) to Grade IV (severe). The condition is graded and managed based on severity, symptom burden, and neurological involvement.

Spondylosis is a broad term for age-related wear and tear of the spinal discs and joints. It is essentially osteoarthritis of the spine, involving disc degeneration, bone spur (osteophyte) formation, and facet joint arthrosis. It is extremely common — detectable on imaging in nearly all adults over age 60 — though many remain asymptomatic.

The sacroiliac (SI) joints connect the sacrum to the iliac bones of the pelvis, transmitting forces between the upper body and legs. When these joints become inflamed or move abnormally, they cause buttock and low back pain that can mimic disc herniation or hip pathology. SI joint pain accounts for 15–25% of chronic low back pain.

Vertebral compression fractures (VCFs) occur when a vertebral body collapses under load, most commonly in the thoracic or lumbar spine. In osteoporotic patients, they can occur with minimal trauma — sometimes just bending or coughing. They cause significant pain and can lead to progressive height loss and kyphosis (“dowager’s hump”) if multiple levels are affected.

Post-laminectomy syndrome (also called failed back surgery syndrome) refers to persistent or recurrent pain following spinal surgery. It does not necessarily mean the surgery failed — rather, it acknowledges that the original pain driver may not have been fully resolved, or that new pain generators have developed. It affects 10–40% of patients after spine surgery.

Pain after spinal cord injury (SCI) is one of the most challenging consequences of SCI, affecting over 80% of individuals with spinal cord injuries. It can be nociceptive (musculoskeletal) or neuropathic (central pain from the injured cord itself), and both types require distinct management strategies. SCI pain significantly impacts mood, sleep, and rehabilitation outcomes.

Acute neck pain is sudden pain in the cervical spine lasting less than 6 weeks. It is the fourth leading cause of disability globally, and most episodes are mechanical — related to muscle strain, poor posture, or minor joint irritation. Although typically self-limiting, prompt evaluation rules out more serious causes and prevents chronicity.

Chronic neck pain persists beyond 3 months and often stems from degenerative changes in the cervical spine, prior injury, or unresolved acute pain. It is frequently underdiagnosed and undertreated, and can lead to significant functional limitations, sleep disturbance, and depression. Identifying the specific pain generator is key to effective treatment.

Cervical radiculopathy results from compression or irritation of a cervical nerve root as it exits the spine, causing pain that radiates from the neck into the shoulder, arm, or hand. Each nerve root follows a distinct path (dermatome), so the pattern of symptoms helps pinpoint the exact level involved. C6 and C7 are the most commonly affected levels.

Whiplash is an injury caused by rapid acceleration-deceleration forces that hyperextend and then hyperflex the cervical spine — most commonly from rear-end motor vehicle collisions. It can injure muscles, ligaments, discs, facet joints, and nerve roots simultaneously. Although often dismissed as minor, whiplash can cause lasting disability and chronic pain in a substantial minority of patients.

A cervical disc herniation occurs when the inner nucleus of a cervical disc protrudes through its outer wall and presses on the spinal cord or a nerve root. Cervical herniations can cause both arm symptoms (radiculopathy) and, when large, myelopathy — weakness and coordination problems from spinal cord compression — which requires urgent evaluation.

The facet joints of the cervical spine are a frequently overlooked but highly treatable source of neck and headache pain. They are particularly susceptible to injury in whiplash and develop arthritis with age. Cervical facet pain is estimated to account for 36–67% of chronic neck pain following whiplash and is accurately diagnosed using diagnostic nerve blocks.

Tension-type headaches (TTH) are the most prevalent headache disorder worldwide, affecting up to 78% of the general population at some point. They present as a steady, band-like pressure around the head without the pulsating quality or severe nausea of migraines. Episodic TTH can become chronic (15+ days per month) and significantly impact quality of life.

Migraine is a complex neurological disorder characterized by recurrent episodes of severe, often pulsating head pain accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Chronic migraine is defined as 15 or more headache days per month for over 3 months. Migraine affects over 39 million Americans and is three times more common in women.

Cluster headaches are among the most severe pain conditions known to medicine, sometimes called “suicide headaches” due to their excruciating intensity. They occur in cyclical patterns (clusters) lasting weeks to months, with attacks of intense, unilateral pain around one eye that typically last 15–180 minutes and occur up to 8 times per day. They affect predominantly men.

Occipital neuralgia is a distinct headache disorder caused by irritation or injury to the greater, lesser, or third occipital nerves — which run from the upper cervical spine to the scalp. It produces pain that travels from the back of the neck up and over the scalp to behind the eyes. It is often mistaken for a migraine but has distinct characteristics and responds to specific nerve block treatments.

Cervicogenic headache (CGH) is a secondary headache arising from structural problems in the cervical spine — most often the upper cervical facet joints (C0–C2) or discs. The cervical and trigeminal pain pathways converge, meaning neck pathology is perceived as head pain. It is frequently misdiagnosed as migraine and can be definitively diagnosed with targeted cervical nerve blocks.

Osteoarthritis (OA) is the most common joint disease worldwide, affecting over 32 million Americans. It involves the progressive breakdown of articular cartilage, underlying bone changes, and synovial inflammation. While OA is often thought of as “wear and tear,” it is a dynamic disease process involving the entire joint — cartilage, bone, synovium, ligaments, and surrounding muscles.

The shoulder is the most mobile joint in the body, making it vulnerable to a range of painful conditions. Rotator cuff injuries — involving the four muscles that stabilize and move the shoulder — are among the most common, ranging from tendinitis and partial tears to full-thickness ruptures. Shoulder pain is the third most common musculoskeletal complaint in primary care.

Lateral epicondylitis (“tennis elbow”) and medial epicondylitis (“golfer’s elbow”) are the two most common elbow conditions seen in pain clinics. Despite their sports-related names, most cases occur in non-athletes due to repetitive forearm motions at work. They involve degeneration of the tendon insertion at the elbow rather than true inflammation, explaining why standard anti-inflammatories have limited effectiveness.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder, affecting 3–6% of adults. It results from compression of the median nerve as it passes through the carpal tunnel — a narrow passageway in the wrist bounded by bones and ligaments. CTS is often bilateral and can significantly impact hand function and sleep.

Hand and finger pain encompasses a broad spectrum of conditions, from small joint arthritis and trigger finger to de Quervain’s tenosynovitis and Dupuytren’s contracture. The hand’s intricate anatomy — 27 bones, 29 joints, and over 30 muscles — makes precise diagnosis essential. Our musculoskeletal ultrasound expertise enables both accurate diagnosis and guided treatment of specific structures.

Hip pain can originate from within the joint (intra-articular — labral tears, osteoarthritis) or outside it (extra-articular — bursitis, tendinopathy, IT band syndrome). Accurately distinguishing between these sources is critical because treatment differs significantly. The hip joint supports the full weight of the body, making it highly susceptible to both degenerative and inflammatory conditions.

Knee pain is one of the most common musculoskeletal complaints, affecting people across all ages. The knee is complex — housing cartilage, two menisci, multiple ligaments, a bursa network, and the patellofemoral joint — each capable of generating pain. Accurate localization of the pain source is the first step toward effective, targeted treatment.

Chronic ankle pain often follows acute sprains that were inadequately treated, leaving ligament instability, syndesmotic injury, or peroneal tendon damage. The ankle is also a common site for osteoarthritis (post-traumatic), gout, and tendinopathy. Given its role as the primary load-bearing joint above the foot, chronic ankle pain significantly affects mobility and quality of life.

Plantar fasciitis is the most common cause of heel pain, affecting over 2 million Americans per year. It involves degeneration and microtearing of the plantar fascia at its calcaneal origin. Heel spurs — bony calcium deposits seen on X-ray — are often an associated finding but are not themselves the source of pain. Fortunately, 90% of cases resolve with proper conservative treatment.

Tendonitis (or more accurately, tendinopathy) is a condition of tendon degeneration characterized by pain, swelling, and impaired function. The Achilles tendon — the strongest tendon in the body — is the most commonly affected, especially in runners and older adults. Contrary to its name, tendonitis involves collagen disorganization rather than true inflammation, which is why it responds better to regenerative therapies than to anti-inflammatories alone.

Bursae are fluid-filled sacs that cushion bones, tendons, and muscles near joints. When inflamed (bursitis), they cause localized pain and tenderness. There are over 150 bursae in the body, but the most clinically significant are at the shoulder (subacromial bursa), hip (trochanteric bursa), knee (prepatellar and pes anserine bursa), and elbow (olecranon bursa).

Joint stiffness and inflammation encompass a range of conditions — from the inflammatory arthritides (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) to reactive arthritis and crystal-induced arthropathy (gout, pseudogout). Distinguishing inflammatory from mechanical pain is critical because inflammatory joint disease often responds to disease-modifying therapies, while mechanical pain responds best to targeted injections and physical rehabilitation.

Myofascial pain syndrome (MPS) is a chronic pain disorder characterized by the presence of trigger points — hyperirritable spots within tight bands of skeletal muscle that produce local and referred pain. Trigger points can be found in virtually any muscle and produce predictable patterns of referred pain that often mislead diagnosis. MPS is extraordinarily common and frequently underlies or complicates other pain conditions.

Fibromyalgia is a complex central sensitization syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive difficulties (“fibro fog”). It affects approximately 4 million Americans and is 7 times more common in women. Fibromyalgia results from altered pain processing in the central nervous system — the “volume control” for pain is turned up too high — rather than tissue damage.

Peripheral neuropathy results from damage to the peripheral nervous system — the network of nerves outside the brain and spinal cord. It affects over 20 million Americans, with diabetes being the most common cause. Neuropathic pain arises from injured or dysfunctional nerves generating abnormal signals, creating burning, electric, or stabbing sensations even without ongoing tissue damage.

Radiculopathy occurs when a spinal nerve root is compressed, irritated, or inflamed as it exits the spine through the intervertebral foramen. It produces pain, numbness, and weakness that follow a specific dermatomal (sensory) and myotomal (motor) distribution. Lumbar radiculopathy (sciatica) and cervical radiculopathy are the two most common forms. Electrodiagnostic testing (EMG/NCS) confirms the diagnosis and levels involved.

Complex Regional Pain Syndrome (CRPS) is a chronic, debilitating condition involving severe, disproportionate pain — typically in a limb — following an injury, surgery, stroke, or other event. It involves the nervous system and immune system in ways not fully understood, creating pain far exceeding what would be expected from the original trigger. Early aggressive intervention dramatically improves outcomes.

Post-herpetic neuralgia (PHN) is the most common complication of shingles (herpes zoster), persisting after the rash heals. It occurs because the varicella-zoster virus damages the nerve fibers during the acute infection, leaving them sending exaggerated or false pain signals. PHN affects 10–15% of shingles patients, with the risk increasing dramatically after age 60. It can be severe, lasting months to years.

Trigeminal neuralgia (TN) is considered one of the most painful conditions known to medicine, sometimes called the “suicide disease” due to its severity. It is characterized by brief, recurrent episodes of electric-shock-like facial pain along one or more branches of the trigeminal nerve (V1, V2, or V3). Episodes are typically triggered by everyday activities and can be completely disabling.

Phantom limb pain (PLP) is the experience of pain in a limb that has been amputated. It affects 50–80% of amputees and is a genuine neurological phenomenon — not psychological. The brain continues to maintain a representation of the missing limb, and this neural map, combined with reorganization of the nervous system after amputation, generates real pain signals. Stump pain (at the residual limb) often co-occurs.

Nerve entrapment syndromes occur when a peripheral nerve is compressed or constricted as it passes through a narrow anatomical space. Beyond carpal tunnel, common entrapments include cubital tunnel syndrome (ulnar nerve at the elbow), meralgia paresthetica (lateral femoral cutaneous nerve at the hip), and tarsal tunnel syndrome (tibial nerve at the ankle). EMG/NCS is the gold standard for diagnosis.

Intercostal neuralgia is pain caused by irritation, inflammation, or injury to one or more intercostal nerves — the nerves that run along the underside of each rib. The pain follows the course of the rib around the chest wall, often described as a tight band or burning sensation. It is frequently misdiagnosed as cardiac or pulmonary pain, leading to unnecessary workup.

Pudendal neuralgia is a chronic pelvic pain condition caused by irritation or injury to the pudendal nerve — the main nerve of the perineum supplying the genitals, urethra, anus, and perineum. It is often described as a burning, stabbing, or crushing pain that is worse with sitting and relieved by standing. It is frequently under-recognized and misdiagnosed, leading to years of suffering before correct identification.

Peripheral nerve injuries range from mild neurapraxia (temporary conduction block that fully recovers) to neurotmesis (complete nerve transection requiring surgical repair). Between these extremes lies axonotmesis — axon disruption with intact surrounding structures, allowing slow regeneration. Pain following nerve injury (neuropathic pain, neuroma pain) can be severe and requires targeted intervention beyond what standard analgesics provide.

Chemotherapy-induced peripheral neuropathy (CIPN) affects 30–40% of cancer patients receiving neurotoxic agents such as paclitaxel, cisplatin, and oxaliplatin. Radiation-induced neuropathy can damage nearby nerves within the radiation field. These conditions cause significant pain and functional impairment, often limiting cancer treatment doses and reducing quality of life during and after cancer care.

Chronic abdominal pain persisting beyond 3–6 months is one of the most diagnostically challenging problems in medicine. It can have visceral origins (gut, liver, pancreas), somatic origins (abdominal wall muscles and nerves), or central/neuropathic origins after prior surgery or injury. Abdominal wall pain from entrapped cutaneous nerves — diagnosed by the Carnett test — is frequently missed and responds dramatically to targeted injections.

Chronic pelvic pain (CPP) is defined as non-cyclic pain lasting 6 months or more in the pelvic region. It affects 15–20% of women and a significant number of men, and is associated with significant disability, depression, and reduced quality of life. It frequently involves multiple pain generators simultaneously — visceral, somatic, and neuropathic — requiring a comprehensive, multidisciplinary approach.

Groin pain has a broad differential — spanning hip joint pathology, inguinal hernia, sports hernia (athletic pubalgia), nerve entrapment (ilioinguinal, genitofemoral nerves), hip flexor pathology, and referred pain from the lumbar spine. Because several structures converge in this region, accurate diagnosis requires systematic examination and often diagnostic nerve blocks to isolate the pain generator.

Work-related musculoskeletal disorders (WMSDs) encompass a wide range of injuries to muscles, tendons, nerves, and joints from occupational activities. Repetitive strain injuries (RSIs) develop gradually from cumulative microtrauma rather than a single event. They are the most costly occupational health problem, accounting for over 30% of all worker compensation cases in the US.

Motor vehicle accidents (MVAs) generate a unique spectrum of injuries — from soft tissue whiplash and facet joint damage to disc herniations, rib fractures, and traumatic brain injury. The sudden, high-energy forces involved can injure multiple structures simultaneously. Without proper early treatment, many MVA injuries transition from acute to chronic pain, resulting in long-term disability and reduced quality of life.

Sports injuries range from acute sprains and strains to stress fractures, tendon ruptures, and chronic overuse conditions. The goal of sports injury treatment is not just pain relief but full return to activity with optimal function. Our physicians’ backgrounds in physical medicine and rehabilitation give us unique expertise in assessing biomechanics, guiding rehabilitation, and performing image-guided procedures to accelerate healing.

Chronic post-surgical pain (CPSP) is defined as pain persisting more than 3 months after surgery when other causes have been excluded. It affects 10–50% of patients after common surgeries including thoracotomy, cardiac surgery, mastectomy, hernia repair, and total joint replacement. The transition from acute to chronic pain after surgery involves nerve sensitization, scar formation, and central sensitization changes that require targeted pain management.