Back Pain Treatment in Castle Rock
Why Treating Back Pain Starts with Finding the Source
Back pain is not one condition - it is a symptom with many possible causes. The reason many patients go months or years without meaningful relief is that the specific source of their pain was never clearly identified. Generic treatments like pain medications and general physical therapy can help, but if the underlying pain generator is not addressed, the pain keeps coming back.
Dr. Carrera's team takes a different approach. The first step is always determining where the pain is actually coming from. Back pain can originate from the discs, the facet joints, the sacroiliac joints, the vertebral body itself, the nerves, or the surrounding muscles and ligaments. Each source requires a different treatment. The team uses your history, physical examination, imaging (MRI, X-ray, CT), and sometimes diagnostic injections to identify the pain generator before recommending a treatment plan.
Common Sources of Back Pain
Facet joint arthritis (spondylosis): The facet joints along the back of the spine develop arthritis over time, causing pain that is worse with leaning back, twisting, and prolonged standing. This is one of the most common causes of chronic back pain. Treatment includes facet joint injections, medial branch blocks, and radiofrequency ablation (RFA) for longer-lasting relief. More on the facet arthritis page.
Disc herniation: When part of a disc's soft center pushes through a tear in the outer layer and presses on a nerve, it can cause back pain along with radiating leg pain (sciatica) or arm pain. Treatment typically involves epidural steroid injections to reduce inflammation around the compressed nerve. More on the disc herniation page.
Degenerative disc disease: As discs lose water content and height with age, they can become a source of chronic aching back pain. Treatment depends on the specific pain generator - it may include Intracept (for vertebrogenic pain with Modic changes on MRI), facet treatments (if facet joints are overloaded due to disc height loss), epidural injections (if nerves are affected), or PRP. More on the degenerative disc disease page.
Spinal stenosis: Narrowing of the spinal canal compresses the nerves, causing leg pain, heaviness, or numbness that is worse with standing and walking and improves with sitting or leaning forward. Treatment includes epidural steroid injections and MILD for patients with thickened ligamentum flavum. More on the spinal stenosis page.
Sacroiliac (SI) joint dysfunction: The SI joints, where the spine connects to the pelvis, can become inflamed or develop arthritis. SI joint pain is one of the most commonly overlooked causes of low back pain - studies estimate it accounts for 15 to 30% of cases. Treatment includes SI joint injections and SI joint radiofrequency ablation. More on the sacroiliac joint dysfunction page.
Vertebrogenic pain (Modic changes): Some chronic back pain originates from the vertebral body itself, caused by nerve ingrowth into damaged endplates adjacent to degenerated discs. The Intracept procedure ablates the basivertebral nerve responsible for this pain and provides durable relief.
Spondylolisthesis: When one vertebra slips forward on the one below it, it can cause back pain and sometimes leg symptoms. Most cases can be managed non-surgically with facet treatments, epidurals, physical therapy, and activity modification. More on the spondylolisthesis page.
Muscle and ligament strain: Acute muscle strains and sprains are the most common cause of short-term back pain. These typically resolve with rest, anti-inflammatory medications, and gradual return to activity. If pain persists beyond a few weeks, a deeper evaluation is warranted to look for structural causes.
Symptoms That Require Urgent Evaluation
Most back pain can be evaluated on a non-emergency basis. However, seek immediate medical attention if you experience new or worsening loss of bowel or bladder control, rapidly progressive weakness in one or both legs, severe numbness in the groin or saddle area, or back pain accompanied by fever, chills, or unexplained weight loss.
How is Back Pain Evaluated?
At the initial visit, Dr. Carrera's team will review your history, examine your spine and related structures, and review any available imaging. Depending on the findings, the team may recommend an MRI (if one has not been done), diagnostic injections to identify the pain source, physical therapy, medications, or a targeted procedure.
One of the most important parts of the evaluation is determining what type of back pain you have. Axial pain (pain in the back that does not radiate below the knee) and radicular pain (pain that radiates into the leg along a specific nerve pattern) come from different sources and are treated differently. The team identifies which pattern applies to you and directs treatment accordingly.
How is Back Pain Treated?
Treatment depends entirely on what is causing the pain. Dr. Carrera's team does not take a one-size-fits-all approach. Common treatment pathways include:
Conservative care: Physical therapy, anti-inflammatory medications (NSAIDs), nerve-calming medications (gabapentin, pregabalin, amitriptyline), and activity modification.
Epidural steroid injections: For nerve-related pain from disc herniations, stenosis, or bone spurs. More on the epidural page.
Facet joint injections, medial branch blocks, and RFA: For facet joint-related pain. More on the facet joint injection, MBB, and RFA pages.
SI joint injection and RFA: For sacroiliac joint pain. More on the SI joint injection page.
Intracept: For vertebrogenic pain with Modic changes on MRI. More on the Intracept page.
MILD: For lumbar stenosis with neurogenic claudication caused by ligamentum flavum hypertrophy. More on the MILD page.
PRP: For disc, facet, or SI joint pain as a steroid-free alternative. More on the PRP page.
Spinal cord stimulation: For chronic nerve pain that has not responded to other treatments. More on the SCS page.
Kyphoplasty: For vertebral compression fractures. More on the kyphoplasty page.
When is Surgery Needed for Back Pain?
Most back pain does not require surgery. Surgery is typically considered for progressive neurological symptoms (worsening weakness, loss of bowel or bladder function), severe structural instability, or pain that has not responded to a thorough trial of non-surgical treatments. Dr. Carrera's team works closely with spine surgeons and will coordinate a surgical referral when appropriate.
Schedule an Evaluation
If your back pain has lasted more than a few weeks, is getting worse, or is limiting your daily activities, Dr. Carrera's team can identify the source and recommend targeted treatment. Most new patients are seen within two weeks of referral. For acute compression fractures or new disc herniations with severe symptoms, the team can arrange faster access.