Lower-back and leg pain: Causes and treatments

Some common causes of lower back and leg pain may include:

Lumbar degeneration and arthritis

This is the most frequent cause of lower back pain that may travel to the buttocks and thighs, but not past the knees. It is not typically associated with numbness or tingling. This type of pain can be due to sacroiliac joint and facet arthritis, as well as tears in the disc and changes at the junction between the disc and the vertebral bone. An MRI or x-ray alone may not give the diagnosis and specialised test blocks may be needed to identify the source of the pain. A qualified pain specialist who understands the full range of diagnostic procedures can help determine the root of the problem. Once a definitive diagnosis is made, specific solutions can be found to fit your pain.

Herniated disk

A lumbar herniated disk is a ruptured disk in your lower back. It occurs when the nucleus, the soft inner portion of the disk is pushed out of your spinal disk through a tear. This can cause severe pain that radiates down your leg.

Sciatica

Sciatica is lower back pain caused by or associated with the sciatic nerve. The sciatic nerve runs from the lower back down the back of each leg. Pain caused by stress on the nerve can affect the lower back, pelvic area, hips, and legs. Symptoms of sciatica pain are often isolated to one leg and include muscle weakness, tingling sensations, and numbness.

Lumbar Spinal Stenosis (LSS)

Lumbar spinal stenosis is a condition in which there is narrowing of the spinal canal. This narrowing, called spinal stenosis, may cause pressure on the sciatic nerve leading to a dull and aching pain in the legs with or without back pain. Pain is usually worsened when standing or walking. You may feel relief when you lean forward or sit. For most people, LSS develops gradually over time and is most common in adults over the age of 60. The pain from spinal stenosis worsens with standing and walking.

Neuropathic pain

The symptoms of neuropathic pain are numbness, tingling, burning pain, with or without hypersensitivity, and allodynia (light touch or cold can cause pain). The type of pain can occur on one side or both sides of your body.

• Symmetrical painful peripheral neuropathies can occur in the setting of diabetes, small fiber neuropathy, after radiation and chemotherapy, as well as idiopathic (cause cannot be defined). The pain tends to be worse at night.
• Asymmetric neuropathic pain can occur long after the person has healed from an injury or surgery. It can also be due to entrapment of a peripheral nerve. Symptoms may include burning pain, hypersensitivity, discoloration, and pain from normal stimuli such as light touch or light stroking of the region. In the past this was called reflex sympathetic dystrophy but is now termed complex regional pain syndrome.

It is important to have an early, accurate diagnosis and a multidisciplinary approach that is personalised to the specific needs of each individual patient. After a trial of 3 months of conservative options (medications, restorative therapies, and behavioral treatments), if your pain does not improve, seek a pain management consultation from a qualified physician who can give an accurate diagnosis on the source of pain and offer a highly personalised treatment regimen tailored to your specific needs. 

Medication

In some cases, your doctor may recommend over-the-counter pain medications. Prescription pain medications may help relieve leg and back pain. These medications include anti-inflammatory, anti-seizure drugs, anti-depressants, muscle relaxants and others, often used alone or in combination. If symptoms don’t improve after 12 weeks of trial of various pain medications, your doctor may recommend alternative treatment options.

Restorative therapies and alternative therapies

With the right plan, physical therapy exercises can help strengthen the muscles in your lower back and legs to improve posture, relieve nerve pressure, and reduce pain to manageable levels. Physical therapy may assist with pain in some cases, and success levels will vary as each person's pain is unique.

Behavioural therapies

Behavioural based therapies, such as mindfulness, coping strategies and cognitive therapies may assist with addressing pain, including potentially as complimentary to other therapy options.

Interventional treatments

If you have severe lower back and leg pain that has not responded to non-interventional treatments, it may be time to consider other treatment options with your treating doctor.

Depending on your condition, it may be worthwhile to explore alternative options such as radiofrequency (RFA) ablation and spinal cord stimulation (SCS).

Spinal Cord Stimulation Therapy (SCS)

SCS therapy is a procedure that uses an implanted device to deliver mild electrical impulses to your spinal cord. This interrupts the pain signals that your nerves send, which can help prevent you from feeling the pain.

Radiofrequency Ablation (RFA)

Axial non-radicular lower back and buttock pain can arise from specific structures. Your pain doctor may perform a test block to precisely delineate the source of the pain, and then follow up with radiofrequency ablation (RFA) of the affected nerve. Patients who respond well to RFA can expect pain relief that lasts from six to 12 months.^1,2,3

Persistent leg and back pain are often symptoms of more severe medical conditions. In some cases, pain may improve within a few days, but some conditions can cause debilitating pain for weeks at a time.

If you begin to experience regular, daily pain or worsening symptoms, seek immediate medical assistance. Discuss treatment options with your doctor to ensure that your treatment needs are met with the right pain management solution. To get started, you can use our doctor locator to find a pain specialist near you.