Chronic Back Pain Treatment in Lahore — Causes, Diagnosis, and Advanced Solutions
By Alnoor Diagnostic Centre | Shadman, Lahore
The Pain That Has Become Part of Daily Life — But Does Not Have To Be
Back pain is among the most common health complaints in Lahore and across Pakistan. It affects people of every age, every occupation, and every level of physical activity. For many patients it begins as an occasional nuisance — a stiffness after a long day, an ache after heavy work — and gradually becomes a persistent, limiting presence that shapes every aspect of daily life. Getting out of bed becomes difficult. Sitting through a workday becomes an exercise in endurance. Sleep is disrupted. Family and social life contracts around the pain.
What makes chronic back pain particularly frustrating is how frequently it is managed inadequately. Patients receive prescriptions for pain medication and muscle relaxants, are told to rest, and sent home without any investigation into the structural cause of their pain. The medication helps temporarily. The pain returns. The cycle repeats for months and years while the underlying problem continues unaddressed.
Effective management of chronic back pain requires accurate diagnosis of its specific cause — and advanced treatment targeted precisely at that cause. At Alnoor Diagnostic Centre in Shadman, Lahore, we provide both the diagnostic imaging and the interventional radiology services that bring genuine, lasting relief to patients whose back pain has not responded to conventional management.
Understanding What Chronic Back Pain Actually Is
Acute back pain — pain lasting less than six weeks — is extremely common and resolves on its own in the majority of cases with simple conservative management. Chronic back pain is defined as pain persisting for twelve weeks or longer. It affects a different patient population, involves different biological mechanisms, and requires a fundamentally different approach to management.
Chronic back pain is not simply acute pain that has not gone away. Over time, persistent pain produces neurological changes — the pain pathways themselves become sensitised, lowering the threshold for pain perception and making the nervous system increasingly responsive to stimuli that would not normally produce pain. This central sensitisation means that addressing only the peripheral structural cause of pain — the disc, the nerve, the joint — may not be sufficient without also addressing the neurological changes that have developed alongside it.
Understanding this complexity explains why chronic back pain is treated most effectively by a team that combines accurate structural diagnosis with targeted interventional treatment and an understanding of the neurological dimension of persistent pain.
The Most Common Causes of Chronic Back Pain
Chronic back pain is not a single condition — it is a symptom produced by several distinct structural and biological problems that require different diagnostic approaches and different treatments.
Lumbar disc herniation and nerve root compression — The intervertebral discs between the vertebrae of the lumbar spine act as shock absorbers and spacers that maintain the height and flexibility of the spinal column. When a disc is subjected to excessive force or degenerative change, its inner gel-like nucleus can herniate — pushing outward through the tougher outer annulus and pressing against the adjacent nerve root. This compression produces the characteristic pattern of low back pain combined with radiating leg pain — sciatica — that follows the path of the affected nerve down the buttock, thigh, calf, and into the foot.
MRI of the lumbar spine identifies disc herniation with precision, showing the exact level of herniation, the direction of disc protrusion, the degree of nerve root compression, and whether the canal is narrowed. This information directly guides treatment — from targeted epidural steroid injections that reduce nerve root inflammation to surgical decompression when conservative measures have been exhausted.
Lumbar spinal stenosis — As the spine degenerates with age, multiple structures contribute to a gradual narrowing of the spinal canal — disc bulging, facet joint hypertrophy, and thickening of the ligamentum flavum all encroach on the space available for the spinal cord and nerve roots. The result is lumbar spinal stenosis — a condition characterised by back and leg pain that worsens with walking and standing and is relieved by sitting or bending forward. The classical presentation of needing to stop walking after a short distance due to leg heaviness and pain — a symptom called neurogenic claudication — is a hallmark of significant lumbar stenosis.
MRI demonstrates the anatomical extent of stenosis with the detail needed to guide treatment decisions, showing at which levels narrowing is most significant and whether surgical decompression is needed or whether conservative management and targeted injections are appropriate.
Facet joint degeneration — The facet joints are paired bony joints at the back of each vertebral level that guide spinal movement and bear a proportion of axial load. Like all joints, they are subject to degenerative change — cartilage loss, synovial inflammation, and osteophyte formation — that produces localised back pain typically described as deep, aching, and worsened by extension and rotation. Facet joint pain is one of the most common but most frequently unrecognised sources of chronic low back pain.
Diagnosis of facet joint pain is confirmed through image-guided diagnostic medial branch blocks — small injections of local anaesthetic onto the nerves supplying the facet joints under fluoroscopic guidance. When these blocks produce temporary but significant pain relief, the diagnosis is confirmed and radiofrequency ablation of the medial branch nerves provides lasting relief by interrupting pain transmission from the affected joints.
Sacroiliac joint dysfunction — The sacroiliac joints connect the base of the spine to the pelvis on both sides. Dysfunction of these joints — from degeneration, injury, or inflammatory conditions — produces pain in the lower back, buttock, and upper thigh that is frequently misattributed to lumbar disc or facet joint disease. Sacroiliac joint pain is notoriously difficult to diagnose clinically and is identified definitively through image-guided diagnostic injection into the joint. When confirmed, targeted treatment through injection or radiofrequency ablation provides effective relief.
Vertebral compression fractures — In osteoporotic patients — particularly postmenopausal women and elderly men — the vertebral bodies can fracture under minimal force, sometimes without any obvious traumatic incident. These compression fractures cause sudden, severe back pain that can be debilitating. MRI identifies acute fractures and distinguishes them from old healed fractures, while CBCT and CT provide detailed bony assessment. Vertebroplasty and kyphoplasty — image-guided procedures that inject bone cement into the fractured vertebra — stabilise the fracture and provide rapid, often dramatic pain relief.
Why Most Patients With Chronic Back Pain Are Undertreated
The gap between the chronic back pain that patients in Lahore experience and the treatment they receive is substantial. Most patients are managed with oral medication — NSAIDs, muscle relaxants, and eventually stronger analgesics — that suppresses pain temporarily without addressing its structural cause. When medication stops working adequately, patients are frequently offered nothing beyond stronger versions of the same approach.
This treatment gap exists for two main reasons. First, many chronic back pain patients have never had adequate diagnostic imaging. A clinical examination and a plain X-ray — which shows only bone and misses disc, nerve, and soft tissue pathology entirely — are insufficient to identify the specific structural cause of chronic back pain in the majority of cases. MRI is the essential investigation for soft tissue structures and nerve root assessment, and it changes the diagnosis and treatment plan in a large proportion of patients who undergo it.
Second, the interventional radiology procedures that provide targeted, effective relief for specific chronic back pain conditions — nerve root blocks, facet joint injections, medial branch radiofrequency ablation, sacroiliac joint treatment, vertebroplasty — are not universally available or known to patients and referring doctors across Lahore. These procedures deliver treatment to the precise anatomical source of pain under imaging guidance, achieving effects that systemic medication distributed throughout the entire body simply cannot match.
Advanced Treatment Solutions at Alnoor Diagnostic Centre
Image-guided nerve root blocks — When disc herniation or foraminal stenosis is compressing a specific nerve root and producing radiating leg pain, a nerve root block delivers corticosteroid medication directly to the inflamed nerve root under fluoroscopic or CT guidance. The result is targeted anti-inflammatory treatment at the exact site of nerve compression, reducing inflammation and pain with a precision and concentration that oral medication cannot achieve. The procedure is performed under local anaesthesia with mild sedation, takes approximately 30 minutes, and most patients experience meaningful improvement within days.
Epidural steroid injections — For patients with more diffuse nerve root inflammation affecting multiple levels — as seen in lumbar spinal stenosis — epidural injections deliver anti-inflammatory medication into the epidural space surrounding the nerve roots. Image guidance ensures accurate placement and optimal drug distribution to the affected levels.
Facet joint injections and medial branch blocks — Diagnostic and therapeutic injections targeting the facet joints and their nerve supply, performed under fluoroscopic guidance, both confirm the diagnosis of facet joint pain and provide relief. When temporary relief from medial branch blocks confirms facet joint as the pain source, radiofrequency ablation provides lasting denervation — disabling the pain-transmitting nerves for months to years.
Radiofrequency ablation — This minimally invasive procedure uses heat generated by radio frequency energy to disable the specific nerves transmitting chronic pain from facet joints or the sacroiliac joint. Under image guidance, a fine electrode is positioned precisely at the target nerve and radiofrequency energy applied. The procedure provides relief lasting six months to two years in most patients and can be repeated when needed.
Vertebroplasty and kyphoplasty — For osteoporotic vertebral fractures causing severe, disabling back pain, these image-guided procedures inject medical-grade bone cement into the fractured vertebral body under fluoroscopic guidance. The cement stabilises the fracture and eliminates the pain it causes, often within 24 to 48 hours of the procedure. Many patients who were unable to walk comfortably before the procedure are significantly improved within days.
The Role of Advanced Imaging in Back Pain Diagnosis
Every interventional treatment for chronic back pain begins with accurate imaging diagnosis. MRI of the lumbar spine is the essential investigation for identifying disc herniation, nerve root compression, spinal stenosis, facet joint degeneration, and soft tissue pathology. CT provides detailed bony assessment when fracture, instability, or surgical planning is the clinical question. At Alnoor Diagnostic Centre we house the Aquilion ONE 640-slice CT scanner — one of the most advanced CT systems available anywhere — providing image quality that sets the highest diagnostic standard in Lahore.
Accurate imaging determines which specific structure is causing pain, guides the selection of the most appropriate treatment, and provides the anatomical roadmap that makes image-guided procedures safe and precise.
Imaging and Interventional Radiology at Alnoor Diagnostic Centre, Lahore
At Alnoor Diagnostic Centre in Shadman, Lahore, we provide comprehensive spinal imaging alongside the full range of image-guided interventional treatments for chronic back pain. Our experienced interventional radiology team works closely with orthopaedic surgeons, neurosurgeons, and pain specialists across the city to ensure every patient receives an accurate diagnosis and the most appropriate targeted treatment available.