- Most back and neck pain improves with time, activity, physical therapy and, when needed, targeted injections.
- In Dr. Braithwaite’s experience, more than 80 to 85 percent of patients with chronic pain get better without ever needing surgery.
- A few warning signs need urgent care: loss of bladder or bowel control, numbness in the groin, or weakness that is getting worse.
- Surgery works best when there is a clear structural problem that matches your symptoms and conservative care has not been enough.
Most back pain gets better without surgery
A new episode of low back pain usually improves within several weeks, whatever is done. Even pain that has lasted months often responds to treatment that does not involve an operation. As Dr. Braithwaite told a national TV audience, surgery is usually the last resort.
What to try first
- Stay active. Gentle walking and normal movement help more than bed rest.
- Physical therapy and exercise. Strengthening the core and hips takes load off the spine.
- Sleep, weight and daily habits. Poor sleep and long periods of sitting make pain worse.
- Medication, used thoughtfully. Anti-inflammatories and other non-opioid medicines can help you stay active.
- Time. Many disc herniations shrink on their own over weeks to months.
National guidelines recommend starting with these non-drug and non-invasive treatments for most low back pain (American College of Physicians).
Where injections and ablation fit
If pain is still limiting you after several weeks of conservative care, image-guided procedures can help, both to treat the pain and to identify where it is coming from:
- Epidural steroid injections for sciatica and arm pain from a pinched nerve
- Radiofrequency ablation for pain from arthritic spine joints
- Sacroiliac joint injections for pain at the base of the spine
These treatments often give enough relief to make physical therapy work, and they help many people avoid or delay surgery.
Warning signs that need urgent care
Go to an emergency room or call 911 if back pain comes with any of these:
- Loss of bladder or bowel control, or new trouble urinating
- Numbness in the groin or inner thighs
- Leg or arm weakness that is new or getting worse
- Fever with severe back pain
- Back pain after a significant fall or accident
- Back pain with a history of cancer or unexplained weight loss
When surgery is the right choice
Surgery is reasonable to consider when:
- A nerve or the spinal cord is compressed and you have weakness that is progressing
- Leg or arm pain from a herniated disc or stenosis has not improved after a fair trial of non-surgical care, usually six weeks or more
- The spine is unstable or deformed in a way that is causing symptoms
- Imaging shows a clear structural problem that matches your symptoms
Surgery is most predictable for arm or leg pain caused by a pinched nerve. It is less predictable for pain that is only in the back or neck with no clear structural cause.
Questions to ask before deciding
- What exactly is causing my pain, and how sure are we?
- What happens if I wait?
- Which non-surgical options have I not tried?
- What result should I expect from surgery, and what are the risks?
- What is the recovery like?
A pain specialist and a spine surgeon often work together. Seeing one does not rule out the other. The goal is the least invasive treatment that will get you back to your life.
Sources
- Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017
- KNOE / CNN Newsource: Why surgery for pain isn’t always needed (August 28, 2025)
This page is general education and is not medical advice. It does not replace an evaluation by your own physician, who knows your history and can examine you. If you have new weakness, numbness in the groin, loss of bladder or bowel control, or other emergency symptoms, call 911 or go to the nearest emergency room.