Back pain without sciatica

How is this different from sciatica?

Back pain is often felt across the lower back and may spread into the buttocks or upper thighs. Sciatica usually travels farther down one leg because a nerve leaving the spine is irritated. It may also cause tingling, numbness or weakness.

Some people have both. The distinction matters because the most useful tests and treatments can differ.

What might be causing the pain?

Muscles, ligaments, discs and the small joints at the back of the spine can all become sensitive. The sacroiliac joints, where the spine meets the pelvis, may sometimes contribute. Pain can also be affected by stiffness, reduced strength, sleep, general health and concern about movement.

Terms such as “disc pain” or “facet-joint pain” describe possible sources rather than facts that can be read directly from an MRI. Often there is no single damaged structure that explains everything.

What can a scan tell us?

Age-related disc and joint changes are common, including in people who have no pain. An MRI can identify some important problems, but ordinary wear-and-tear findings may be unrelated to the symptoms.

NICE recommends scans in specialist care only when the result is likely to change what happens next. A scan may be useful when symptoms are unusual, an examination raises concern, or a particular treatment is being considered.

How is back pain assessed?

The consultation looks at when the pain began, where it is felt, what affects it, and how it changes sleep, work, movement and everyday life. The examination checks the back, hips and nerves and looks for signs that point to a different condition.

The aim is not always to name one painful structure. It is to rule out important causes, understand the main factors keeping the pain going and identify treatments that are proportionate and realistic.

What treatment may help?

Most care begins with a clear explanation and a gradual return to movement. Exercise is chosen around the person rather than prescribed as one universal programme. Hands-on treatment may help some people, but NICE recommends using it as part of a package that includes exercise.

Medicines require an individual discussion about health risks and likely benefit. Anti-inflammatory medicines may be suitable for some people for a limited period. Strong painkillers are generally not a good long-term solution.

Persistent pain can understandably affect sleep, confidence and mood. Addressing these effects alongside physical rehabilitation does not mean the pain is imagined.

Do injections have a role?

NICE advises against routine spinal injections for low-back pain. However, a carefully selected injection can sometimes provide useful diagnostic information and temporary relief.

Medial branch blocks—often described to patients as facet-joint injections—place local anaesthetic around the small nerves carrying feeling from the joints at the back of the spine. A clear but temporary improvement may support considering radiofrequency denervation, which uses heat to interrupt those pain signals for longer. Results vary, and neither procedure is appropriate for non-specific back pain without a plausible target.

When might specialist or surgical advice help?

Specialist assessment may help when pain remains intrusive despite appropriate care, the diagnosis is uncertain, or a targeted treatment is being considered. Surgery is not routinely recommended for back pain alone. Referral to a surgical colleague is usually reserved for a specific problem that an operation could reasonably address.