Low back pain (lumbago): treatment without surgery in Buenos Aires

Low back pain (lumbago) is one of the most common reasons people seek medical care. Most acute episodes resolve within 4 to 6 weeks; when the pain persists for more than three months it is considered chronic and calls for a different approach. The vast majority of patients benefit from non-surgical treatments: medication adjustment, targeted physical therapy, image-guided nerve blocks and radiofrequency ablation. Surgery is reserved for selected cases with a clear indication.

What low back pain is

Lumbago, low back pain, an aching lower back: they are different names for the same problem — pain in the lower part of the spine. Most acute episodes — the classic "pulled back" after lifting or straining — resolve on their own within 4 to 6 weeks with relative rest, heat and sensible pain management. The trouble starts when the pain stays: when the weeks go by and your back still bothers you every day, when you start avoiding activities, sleeping poorly, taking more pain relievers than you would like.

We speak of chronic low back pain when the pain persists for more than three months. At that point the mechanisms change: the initial inflammation is no longer the main driver — instead there is sensitization of the nervous system, muscle spasm that perpetuates itself and, in some cases, neuropathic components that anti-inflammatory drugs do not touch. That is why simply raising the ibuprofen dose rarely solves the problem, while it does increase the risks: gastritis, kidney failure, high blood pressure.

The central point is this: not all low back pain is the same, and not all of it is treated the same way. Very often the pain does not come from the disc, but from the facet joints, the sacroiliac joint, the deep muscles or the nerves that exit the spine. Locating the pain generator is the first step of any serious treatment.

I am a physician anesthesiologist with postgraduate training in Pain Medicine and Interventional Pain Management, and in daily practice I see that patients with chronic low back pain arrive, on average, much later than they should — after months or years of trying scattered treatments without a clear plan. That delay has a concrete cost: the longer the pain persists, the more changes develop in the nervous system that make the pain harder to treat. In chronic pain, time works against you.

Common causes

Lumbar facet joint syndrome

The facet joints are small joints on either side of the spine that allow movement between the vertebrae. Over time they wear down and produce localized low back pain that gets worse after standing for a long time, when arching the back or when getting up from a chair, and usually eases when sitting or leaning forward. It is a very common — and underdiagnosed — cause after age 50. I explain facet pain and the facet joint block here →

Lumbar herniated disc

A herniated disc occurs when the outer ring of the disc weakens or tears and the inner core pushes outward, usually compressing a nerve root. The pain typically radiates down the leg, with tingling or numbness. Most symptomatic lumbar herniations improve with well-conducted conservative treatment within six to twelve weeks, and the great majority resolve without surgery. Treatment options for a herniated disc, stage by stage →

Sacroiliac joint pain (sacroiliitis)

The sacroiliac joint connects the sacrum to the bones of the pelvis. When it becomes irritated or wears down it produces very low back pain, off to one side, that gets worse after sitting for a long time or when getting up from a chair, and is easily mistaken for sciatica or hip pain. An estimated 15 to 30% of chronic low back pain cases have a significant sacroiliac component. How sacroiliitis is recognized and treated →

Lumbar spinal stenosis

Spinal stenosis is a narrowing of the spinal canal, usually due to progressive degenerative changes, and is more common after age 60. The typical picture is neurogenic claudication: pain or heaviness in the legs when walking that forces you to stop, and that improves when you sit down or lean forward (the classic relief of leaning on a shopping cart at the supermarket). The non-surgical treatments for spinal stenosis →

Sciatica

Sciatica is not a disease in itself but a symptom: pain that radiates from the lower back down the leg along the path of the sciatic nerve. It is always the consequence of something — a herniated disc, stenosis, piriformis syndrome, a sacroiliitis that mimics it — and each cause has its own treatment. Why sciatica hurts and how it is diagnosed →

How it is treated: the treatment ladder

Low back pain is treated in stages. You do not start with a procedure: you start with the diagnosis and with the simplest measures, and you move up only when needed.

First step: conservative treatment

This includes relative rest (not absolute rest — prolonged inactivity makes things worse), pain relievers and anti-inflammatory drugs on structured schedules for limited periods, muscle relaxants for the associated spasm and, when the pain radiates with tingling, specific medications for neuropathic pain that are not anti-inflammatories and usually work far better in chronic pain. Physical therapy is a cornerstone, with one condition: it has to be specific to the underlying problem — the work for a herniated disc is not the same as for spinal stenosis or sacroiliitis — and guided by a professional who knows the treatment of low back pain.

Second step: the diagnostic block

When the pain persists, the source has to be confirmed before any procedure is recommended. A diagnostic block involves placing a small amount of local anesthetic, under image guidance, exactly on the structure we suspect: the medial branches of the facet joints, a nerve root, the sacroiliac joint. If the pain drops markedly while the anesthetic lasts, that confirms the source. In facet pain, this step is the single best predictor of a good result from the subsequent radiofrequency ablation, and skipping the diagnostic step is one of the most common reasons treatments fail. In the sacroiliac joint, the image-guided diagnostic block is the definitive test to confirm the source of the pain. When the pain is radicular, the indication rests on the physical exam and an MRI that explains the pain. One detail that matters: MRI shows "findings" in a very large proportion of adults with no pain at all, so the image alone does not decide. What decides is the correlation between your symptoms, the physical exam and the study.

Third step: the procedure, according to the source

Once the pain generator is confirmed, the procedure is chosen accordingly. All are outpatient and image-guided:

• Facet origin → lumbar facet radiofrequency ablation. Controlled heat is applied to the medial branch to interrupt the pain signal coming from the facet joint. When it works, relief usually lasts between six months and a year, sometimes longer, and the procedure can be repeated if the pain returns.
• Radicular pain (herniated disc or spinal stenosis) → lumbar epidural injection. A corticosteroid with local anesthetic is placed near the irritated nerve root to reduce inflammation and calm the pain running down the leg. The evidence shows modest to moderate relief, mostly in the first three months: a window of relief that is used to make progress with physical therapy.
• Sacroiliac origin → image-guided injection. An intra-articular sacroiliac block with anesthetic and corticosteroid is the most effective option in the short and medium term; when relief is good but short-lived, radiofrequency ablation of the lateral branches can extend it (6 to 18 months).

I want to be clear about this, because it is where the most overselling happens: these procedures treat the pain — they do not repair the structure. The arthritis or the herniated disc is still there. What we aim for is to lower the pain so you can move, do your rehabilitation and get your daily life back. The procedure opens the door; movement sustains the result.

Where surgery fits in

Surgery is one more option within the range, with specific indications: progressive neurological deficit (muscle weakness that is getting worse), cauda equina syndrome — which is a surgical emergency — or disabling pain that does not respond to a well-conducted course of conservative treatment over 8 to 12 weeks. The decision is made by weighing the imaging findings, the symptoms, the physical exam and the response to previous treatment, case by case. When a case needs a surgeon's perspective, we work as a team: my job is to manage the pain well at every stage of the journey.

When to see a doctor

In short: if your low back pain has lasted more than three months, does not ease with common pain relievers, limits your daily activities or radiates down the leg with tingling or weakness, a dedicated pain evaluation adds value. And if you have been taking anti-inflammatory drugs every day for more than a month, that is a signal in itself to seek help.

I devote a full article to when to seek help and what to expect from the first visit: Chronic low back pain: when to see a doctor →

Where I see patients: locations in Buenos Aires

I see patients at two locations: Hepta, in San Isidro (Av. Fondo de la Legua 577, Zona Norte) and CIAREC, in Villa Urquiza (Av. Monroe 4770, CABA). I receive patients from across Zona Norte (northern Greater Buenos Aires) and the City of Buenos Aires, and I also offer virtual first consultations to point you in the right direction and organize the next steps. Phone: +54 9 11 5895-3260.

Dr. Mauricio Casarsa

Anesthesiologist. Postgraduate training in Pain Medicine and Interventional Pain Management (UBA — Fundación Dolor; UNLP — CAIDBA). Staff physician at Hospital Alemán de Buenos Aires.

MN 137.756 (Argentine medical license) · San Isidro · Villa Urquiza