Understanding Chronic Back Pain
Chronic back pain — defined as pain lasting longer than 12 weeks — affects an estimated 20 percent of Americans at some point in their lives. As a triple board-certified pain management specialist in Hoffman Estates, Illinois, I see patients every day whose back pain has persisted despite initial treatments, limiting their ability to work, exercise, sleep, and enjoy time with family. If that describes your experience, this guide is for you.
The good news is that pain medicine has advanced dramatically. Today we have diagnostic tools that can pinpoint the exact source of your pain and treatments that address the cause rather than simply masking symptoms. Understanding your condition is the first step toward finding relief.
Common Causes of Chronic Back Pain
Chronic back pain can arise from many different structures in the spine, and identifying the specific pain generator is essential for effective treatment. The most common causes I see in my Hoffman Estates practice include degenerative disc disease, where the intervertebral discs lose hydration and height with age, leading to pain from the disc itself or from secondary effects on surrounding structures. Facet joint arthropathy is another frequent culprit — the small joints connecting each vertebra can develop arthritis, causing localized back pain that often worsens with extension and rotation. Herniated and bulging discs can cause both local back pain and radiating leg pain when disc material compresses nearby nerve roots. Spinal stenosis, a narrowing of the spinal canal, leads to nerve compression that causes pain, numbness, and weakness, particularly when walking. Sacroiliac joint dysfunction, where the joint connecting the spine to the pelvis becomes inflamed or hypermobile, causes pain in the lower back and buttock. Vertebrogenic pain, originating from the vertebral endplates themselves, has been increasingly recognized as a distinct and treatable cause of chronic low back pain. And myofascial pain from muscle and connective tissue tension can perpetuate chronic back pain even after structural issues are addressed.
The Diagnostic Process
Effective treatment requires an accurate diagnosis, and that begins with a comprehensive evaluation. At my practice, I spend considerable time during the initial consultation understanding your pain history — when it started, how it progressed, what makes it better or worse, what treatments you’ve tried, and how it affects your daily function. The physical examination assesses your range of motion, identifies tender areas, tests nerve function, and evaluates the specific movements that reproduce your pain.
Advanced imaging is usually essential. MRI provides detailed views of discs, nerves, and soft tissues. CT scans show bony anatomy. X-rays, particularly with flexion and extension views, can reveal instability. But here’s something important that many patients don’t realize: imaging findings don’t always correlate with symptoms. Many people have disc bulges or degenerative changes on MRI that cause no pain at all. That’s why I often use diagnostic injections — precise, image-guided injections that temporarily block pain from a specific structure — to confirm the source of pain before recommending definitive treatment.
Treatment Options: A Stepwise Approach
Foundational Treatments
Physical therapy remains one of the most evidence-supported treatments for chronic back pain. A good physical therapy program focuses on core stabilization, flexibility, postural correction, and functional strengthening. I work closely with several excellent physical therapy practices in the Hoffman Estates and Schaumburg area and can recommend a therapist suited to your specific condition. Activity modification and ergonomic optimization — particularly for patients who sit for prolonged periods at work — can make a meaningful difference. Non-opioid medications including anti-inflammatories, muscle relaxants, and certain antidepressant and anticonvulsant medications that modulate pain pathways may also be part of the treatment plan.
Interventional Procedures
When foundational treatments provide insufficient relief, targeted interventional procedures can address the specific pain source. Epidural steroid injections deliver anti-inflammatory medication directly to inflamed nerve roots and are particularly effective for disc-related pain with radiculopathy. Facet joint interventions begin with diagnostic medial branch blocks and, if successful, progress to radiofrequency ablation — a procedure that uses heat energy to disrupt pain signal transmission and typically provides 6 to 18 months of relief. Sacroiliac joint injections can both confirm the SI joint as a pain source and provide therapeutic benefit, with radiofrequency ablation of the lateral branches available for longer-term relief. Basivertebral nerve ablation, also known as the Intracept procedure, is a breakthrough treatment specifically for vertebrogenic chronic low back pain — pain originating from damaged vertebral endplates. This minimally invasive procedure has shown remarkable results in clinical trials, with many patients achieving lasting pain relief.
Neuromodulation
For patients with chronic back pain that persists despite other interventions, spinal cord stimulation and other neuromodulation technologies offer an advanced option. Modern spinal cord stimulators use sophisticated programming to interrupt pain signals and can be tested with a temporary trial before permanent implantation. I also offer dorsal root ganglion stimulation and peripheral nerve stimulation for appropriate candidates.
The Importance of a Comprehensive Approach
The most successful outcomes I see in chronic back pain management come from patients who embrace a comprehensive, multimodal approach. This means combining the right interventional procedure with an active physical therapy program, appropriate activity modifications, stress management techniques, and good sleep hygiene. Chronic pain affects the whole person, and the best treatment plans address the whole person.
If chronic back pain is limiting your life, call (847) 981-3630 to schedule a comprehensive evaluation at our Hoffman Estates office. Visit keithschmidtmd.com to learn more about our practice.
Keith Schmidt, MD, is a triple board-certified pain management specialist serving Hoffman Estates, Schaumburg, Arlington Heights, Palatine, Barrington, and the greater Chicago northwest suburbs at 1555 Barrington Road DOB 3, Suite 2400, Hoffman Estates, IL 60169.