Overview
Back pain treatment is not a single procedure. It is a stepped pathway that may include self-management advice, physiotherapy and rehabilitation, pain-relieving medication where appropriate, targeted spinal injections, and, in a minority of cases, surgery. The aim is to reduce pain, restore function and help you return to the activities that matter to you.
Treatment is usually described in three broad groups:
- Non-surgical care: This includes education, activity modification, exercise-based rehabilitation, manual therapy, posture and ergonomic advice, weight and lifestyle support, and medication review.
- Interventional procedures: These include image-guided injections such as nerve root blocks, epidurals, or facet joint injections, which can help identify the source of pain and provide temporary relief that supports rehabilitation.
- Surgical treatment: This covers procedures such as microdiscectomy for a prolapsed disc, decompression for spinal stenosis, or stabilisation and deformity correction.
According to the National Institute for Health and Care Excellence (NICE), 80% of people with back pain will see improvement within a few weeks with appropriate care. NICE and NHS guidance emphasise staying active, avoiding prolonged bed rest, and using exercise-based approaches as the foundation of care. Surgery is generally reserved for specific structural problems, particularly where nerve compression is causing significant leg symptoms, or where symptoms have not responded to a fair trial of non-surgical treatment.
Who is it for?
A specialist opinion from Mr Sudarshan Munigangaiah may be beneficial if you recognise several of the following:
- Back pain persisting for more than six weeks despite activity and physiotherapy.
- Pain radiating into the buttock, thigh, calf, or foot, often described as sciatica.
- Numbness, pins and needles, or weakness in a leg or foot.
- Neck pain with arm pain, tingling, or clumsiness in the hands.
- Leg heaviness or cramping on walking that eases when sitting or bending forward.
- Repeated episodes of back pain interfering with work, driving, sleep, or exercise.
- A change in spinal shape or posture in a child or teenager, such as an uneven waist or shoulder.
- Ongoing symptoms after previous spinal surgery.
Not everyone with back pain needs a procedure. Whether an intervention is suitable depends on your diagnosis, imaging findings, general health, and your own goals.
How treatment works
Assessment
Your symptoms and examination help identify the cause of your back pain. Scans are arranged only when they are likely to guide treatment.
Conservative Care
Most patients begin with physiotherapy, exercise, lifestyle advice and appropriate pain relief.
Targeted Injections
If symptoms persist, image-guided injections may relieve pain and help identify the source.
Surgery
Surgery is considered only when non-surgical treatment has not helped or there is significant nerve compression.
Risks and Honest Expectations
Most people with back pain improve without surgery, although recovery varies. Medication and spinal injections may provide temporary relief but can carry risks such as bruising, infection, bleeding or a short-term increase in pain. Scans are only recommended when they are likely to change treatment.
When surgery is appropriate, risks include infection, bleeding, blood clots, nerve injury, dural tear, incomplete symptom relief, recurrence, implant or fusion problems, and the general risks associated with anaesthesia.
Surgery is only ever recommended when non-surgical care has been fully explored and it is genuinely the right option.
QUICK FACTS
Procedure time
20–40 mins consultation
First Treatment
Physiotherapy & exercise
Injection
Under 30 mins
Surgery
1–2 hours
Recovery
Several weeks