Back Pain Overview

Back pain is a common condition that can affect the muscles, joints, discs, nerves and other structures of the spine. It may develop suddenly after an injury or strain, or gradually because of age-related changes, repetitive stress or an underlying spinal condition.

Most episodes of back pain improve with appropriate conservative care. However, persistent, severe or recurring pain, particularly when accompanied by leg pain, numbness, weakness or other concerning symptoms, may require further assessment to identify the underlying cause.

At the Supreme Vascular and Interventional Clinic in Singapore, Dr. Manish Taneja provides specialist assessment for patients with persistent or complex back and spine-related pain and can advise whether interventional treatment may be appropriate.

At a Glance

• Back pain can have many causes, including muscle or ligament strain, disc problems, facet joint pain, nerve compression and spinal degeneration.
• Low back pain is particularly common, but pain can occur anywhere along the spine, including the neck and upper back.
• Pain travelling into the buttock or leg may indicate irritation or compression of a spinal nerve, such as with sciatica.
• Most uncomplicated back pain does not require an invasive procedure and may improve with activity modification, medication, physiotherapy and other conservative measures.
• Persistent or disabling pain may require specialist assessment to determine whether further investigation or an interventional treatment is appropriate.

What Is Back Pain?

Back pain refers to pain or discomfort arising from structures in or around the spine. The spine consists of vertebrae, intervertebral discs, facet joints, ligaments, muscles and nerves, and problems affecting any of these structures can contribute to pain.

Back pain may be described as aching, stiffness, burning, shooting or sharp pain. It can remain localised to the back or radiate into the buttocks, hips, legs, shoulders or arms depending on the underlying cause.

Low Back Pain

Low back pain affects the lumbar region of the spine and is one of the most common forms of back pain. It may be caused by muscular strain, disc-related problems, facet joint pain, sacroiliac joint dysfunction, spinal degeneration or nerve irritation.

Spine and Back Pain

Although the terms are often used interchangeably, spine pain can occur at different levels of the spinal column:

• Cervical spine: neck pain, sometimes extending into the shoulders or arms
• Thoracic spine: pain affecting the upper or middle back
• Lumbar spine: lower back pain, sometimes extending into the buttocks or legs
• Sacral region: pain around the lower spine, pelvis and sacroiliac joints

The location and pattern of pain can help a specialist determine which structures may be involved.

Causes and Risk Factors for Back Pain

Back pain can develop when different structures in and around the spine become strained, irritated, inflamed or damaged. The cause is not always obvious, and more than one factor may contribute to ongoing or recurring pain.

Common causes and conditions associated with back pain include:

Muscle and Ligament Strain

Lifting heavy objects, sudden movements, repetitive activities, poor posture or physical overexertion can strain the muscles and ligaments that support the spine. This is a common cause of acute back pain and often improves with appropriate conservative treatment.

Herniated or Bulging Disc

Intervertebral discs act as cushions between the bones of the spine. A disc may bulge or herniate when its outer layer becomes weakened or damaged, potentially irritating or compressing nearby nerves.

A herniated disc can cause localised back pain as well as pain, numbness, tingling or weakness that extends into the buttock, hip, arm or leg, depending on the location of the affected disc.

Pinched Nerve

A pinched nerve occurs when a spinal nerve becomes compressed or irritated by surrounding structures. This can happen because of a herniated disc, spinal stenosis, bone spurs or other changes affecting the spine.

Nerve compression may cause sharp, burning or shooting pain, as well as numbness, tingling or weakness along the area supplied by the affected nerve.

Spondylosis and Spinal Degeneration

Spondylosis refers to age-related degenerative changes in the spine. These changes can affect the vertebrae, discs and facet joints and may contribute to chronic back or neck pain and stiffness.

Although spondylosis becomes more common with age, symptoms and their severity can vary considerably between individuals.

Spinal Stenosis

Spinal stenosis occurs when spaces within the spinal canal or around the spinal nerves become narrowed. This narrowing can place pressure on the spinal cord or nerves.

Spinal stenosis commonly affects the lower back or neck and may cause back pain, leg pain, numbness, tingling or weakness. Symptoms from lumbar spinal stenosis may become more noticeable when standing or walking and improve when sitting or bending forward.

Sciatica

Sciatica describes pain that follows the path of the sciatic nerve, typically travelling from the lower back or buttock into the leg. It is usually associated with irritation or compression of a nerve root in the lower spine, which can occur with conditions such as a herniated disc or spinal stenosis.

Sciatica may cause shooting or burning pain, numbness, tingling or weakness affecting one leg.

Facet Joint Problems

Facet joints connect the vertebrae and help provide stability and movement in the spine. Degeneration or irritation of these joints can contribute to localised back or neck pain, particularly with certain movements or positions.

Sacroiliac Joint Pain

The sacroiliac joints connect the lower spine to the pelvis. Irritation or dysfunction of these joints can cause pain in the lower back, buttocks or hip region and may sometimes be mistaken for other sources of lower back pain.

Vertebral Compression Fractures

A weakened vertebra can partially collapse, resulting in a vertebral compression fracture. These fractures are more common in people with osteoporosis and may cause sudden or persistent back pain.

Other, less common causes of back pain include spinal injuries, inflammatory conditions, infections and tumours. Persistent or unexplained back pain should be assessed by a healthcare professional to determine the underlying cause.

How Is Back Pain Diagnosed?

Diagnosing back pain begins with understanding the pattern, duration and characteristics of the symptoms.

During an assessment, the specialist may consider:

• When the pain started
• Where the pain is located
• Whether it radiates into the arms, buttocks or legs
• What activities or positions make it better or worse
• Previous injuries or spinal conditions
• Previous treatments and their effectiveness
• Changes in strength, sensation, reflexes or movement

A physical examination may be performed to assess movement, strength, sensation and neurological function.

Imaging such as X-rays, MRI or CT scans may be recommended when clinically appropriate, particularly when symptoms persist, there are neurological findings, or an underlying structural problem needs to be evaluated. Imaging is not necessarily required for every episode of uncomplicated low back pain.

Where an interventional procedure is being considered, imaging and clinical findings may help identify the structures that could be contributing to pain.

When Back Pain Is Related to the Nerves

Back pain accompanied by pain, numbness, tingling or weakness in a limb may indicate irritation or compression of a spinal nerve.

For example, a herniated disc or narrowing of the spinal canal may affect a nerve root and cause symptoms extending from the lower back into the buttock or leg. This pattern is commonly associated with sciatica or radicular pain.

The distinction between localised back pain and nerve-related pain is important because the underlying cause may influence which treatment options are appropriate.

Does Back Pain Always Require Treatment?

No. Many episodes of back pain improve with conservative management.

Depending on the cause and severity, treatment may include:

• Maintaining appropriate activity
• Physiotherapy and targeted exercises
• Medication for pain or inflammation
• Lifestyle and ergonomic adjustments
• Management of contributing factors
• Specialist assessment where symptoms persist or become difficult to manage

Interventional procedures are generally considered for selected patients when pain persists despite appropriate conservative management, when a specific pain-generating structure has been identified, or when an intervention may help improve function and rehabilitation.

The appropriate approach depends on the underlying cause rather than simply the severity of the pain.

Back Pain Treatment

Treatment for back pain depends on its cause, symptoms, duration and impact on daily life.

For selected patients, minimally invasive interventional procedures may form part of a broader treatment plan. These procedures are designed to target specific sources of pain and may include:

• Epidural steroid injections, including interlaminar and transforaminal approaches
• Facet joint injections
• Medial branch blocks
• Radiofrequency ablation
• Sacroiliac joint injections or nerve blocks
• Sacroiliac joint radiofrequency ablation
• Percutaneous disc procedures
• Vertebroplasty
• Kyphoplasty
• Spinal cord stimulation
• Intrathecal drug delivery

Not every procedure is suitable for every type of back pain. The choice depends on the suspected pain generator, clinical findings, imaging where appropriate, previous treatments and the patient’s overall circumstances. For detailed information about these procedures, see our Interventional Pain Management and Image-Guided Pain Procedures pages.

When Should I See a Specialist for Back Pain?

Consider specialist assessment when back pain:

• Persists despite appropriate conservative treatment
• Keeps returning or progressively worsens
• Significantly interferes with work, sleep or daily activities
• Radiates into the arm, buttock or leg
• Is associated with persistent numbness, tingling or weakness
• Follows a significant injury
• Has not responded adequately to previous treatments
• Requires repeated pain procedures without lasting improvement

A specialist assessment can help determine whether the pain is coming from a disc, nerve, facet joint, sacroiliac joint or another structure and whether further investigation or treatment is appropriate.

Back Pain in Singapore

International patients and Singapore residents experiencing persistent or recurring back pain can seek specialist assessment to understand the possible cause of their symptoms and available treatment options. At the Supreme Vascular and Interventional Clinic, Dr. Manish Taneja provides specialist assessment for selected patients with persistent or difficult-to-manage back pain, including assessment for minimally invasive treatment options where appropriate.

Assessment may include reviewing symptoms, medical history, previous treatments and relevant imaging to determine the likely source of pain and whether an interventional treatment may have a role in the overall treatment plan.

Frequently Asked Questions About Back Pain