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Q: How long do you try to treat back pain without surgery before you send someone for a surgical evaluation? How much time would you give a patient whose primary symptom is pain, and how much time would you spend on physical therapy and injections before you send somebody maybe for surgery if the pain just doesn’t get better?

A: It somewhat depends on what treatments someone has already tried, but I like to give patients about four to six weeks of physical therapy, and maybe a month or two in total of conservative care before we consider surgery for pain control. Conservative care includes medications and injections.

If patients have any weakness, they need to be evaluated by a surgeon right away. Otherwise, I try to prioritize medications and physical therapy before injections, because many times things tend to improve on their own with time. If someone has already tried medications and therapy but haven’t improved over some time, or they’re in a tremendous amount of pain, we tend incorporate everything at the same time. So in general I would say we first try medications and physical therapy for about four to six weeks, then procedures for about one or two months. If things don’t improve at that point I would start to get the surgeon involved. And we have great surgeons right here at the Spine Center.

– Dr. Mike Mizrahi, Rehabilitation Medicine Specialist

This question was answered during the episode of Spine Time called “Back Pain: When is surgery the answer, and when isn’t it?” A video of that episode, held on June 10, 2020, is available here on YouTube. To sign up for future episodes of Spine Time, where you can ask questions of our spine specialists, subscribe here.