Diagnosis of lower back pain based on diagnostic blocks

If lower back pain can’t be diagnosed, or if it doesn’t go away, how do you actually help patients?

Lower back pain isn’t simple. It can arise from multiple overlapping causes: facet joints, sacroiliac joints, nerves, hips, or the discs themselves.

Each cause behaves differently, and the treatments that work for one don’t necessarily work for another.

Discogenic pain, pain arising from the discs and the adjacent vertebral endplates, is particularly tricky. It affects around 16-26% of people with low back pain (Verrills et al, 2015; Hirsch et al, Pain Physician 2018), and can show as a deep, constant ache or intermittent sharp pains.

These sensations can radiate to the legs or thighs, and even ordinary movements like sitting, standing, coughing can trigger them.

Unlike nerve pain, which is often straightforward to diagnose and treat, disc pain requires careful investigation. MRI findings such as Modic changes or high-intensity zones give clues, but no single test is perfect.

To help guide treatment, I combine patient history, examination, imaging, and sometimes diagnostic techniques like low-pressure discography. This helps understand the source of pain so we can treat it effectively.

For patients with discogenic pain, one of the anecdotal but most effective treatments I use is Basivertebral Nerve Ablation (BVNA).

This procedure targets the nerves inside the vertebral body that transmit pain from damaged discs. Performed under local anaesthetic or sedation, it’s minimally invasive, well-tolerated, and patients usually go home the same day.

Research indicates that BVNA can provide significant pain relief in 50–70% of patients who meet the right criteria, with benefits lasting up to 5 years (McCormick et al., 2025; Lorio et al., 2022). Side effects are generally minor and temporary, while serious complications are rare.

In short, the challenge in musculoskeletal care isn’t performing the procedure, it’s navigating the uncertainty. And BVNA isn’t a universal solution, but understanding its role gives both clinicians and patients confidence that lower back pain can be diagnosed and effectively treated.

By thoroughly identifying the source of pain, correlating clinical findings with imaging, and applying the right treatment, we move from guesswork to structured, evidence-informed care, delivering better outcomes and clarity for the right patient.

– Dan