Managing Chronic Low Back Pain Through Precision Diagnosis and Targeted Treatment
Pain Spa Case Study
From Daily Agony to Active Recovery: A Structured Approach to Chronic Low Back Pain
How a woman in her mid-30s regained quality of life through targeted interventional pain management and rehabilitation.
Patient Snapshot
A woman in her mid-30s, who had previously worked in a physically demanding retail role, was referred to Pain Spa with persistent low back pain. She had previously enjoyed an active lifestyle but had become increasingly limited by pain, reduced mobility, poor sleep, and difficulty managing normal daily activities.
The Presentation
A young woman’s life put on hold by persistent back pain
The patient had been living with low back pain for more than two years when she was referred to Pain Spa. What began as an intermittent ache had progressively worsened following a spontaneous flare-up, with no injury or fall to explain the deterioration.
By the time she sought specialist help, the pain was affecting almost every aspect of her daily life. She had been forced to stop working in retail. On her worst days, she struggled to manage even short distances and occasionally had to crawl on all fours to get around her home. She was unable to walk her dog regularly and was finding it increasingly difficult to sleep because of unrelenting discomfort.
She described a constant aching pain across the lower back, worsened by standing, walking, sitting for extended periods, and performing even light household tasks such as washing up. She also reported intermittent pins and needles in her left leg, although this was clearly secondary to her back symptoms.
What the Imaging Showed
Understanding the anatomy behind her pain
The patient had previously seen a consultant spinal surgeon, who had arranged an up-to-date MRI scan of the lumbar and thoracic spine. The imaging showed disc degeneration at L4/5 and L5/S1 with minor disc bulges, alongside mild facet joint degenerative changes from L3/4 to L5/S1.
There were also Modic type 1 and type 2 endplate changes at L4/5, suggesting an active disc-related inflammatory component. Importantly, there was no significant nerve compression and no clear surgical target.
Her spinal surgeon concluded that her symptoms were most likely driven by a combination of discogenic pain and facetogenic pain — pain arising from the discs and the small joints of the spine — and referred her to Dr Krishna at Pain Spa for specialist pain management.
The Treatment Journey
A Carefully Structured, Stepwise Approach
Dr Krishna’s approach at Pain Spa centres on a thorough assessment followed by a logical, evidence-informed treatment plan — not a one-size-fits-all injection protocol. For this patient, this meant a phased strategy addressing both her facet joints and her discs, combined with a clear rehabilitation pathway.
Comprehensive assessment & formulation
Dr Krishna carried out a detailed consultation, taking a thorough history and reviewing the available imaging. A clear diagnosis was formed: combined discogenic and facetogenic low back pain, with rehabilitation as the long-term cornerstone of management and interventional treatment used to help break the pain cycle.
Bilateral lumbar facet joint & sacroiliac joint injections
Under ultrasound guidance, Dr Krishna performed bilateral lumbar facet joint injections and sacroiliac joint injections as a day-case procedure. The patient experienced good initial pain relief in the first few days following treatment.
Recognising the discogenic component
At follow-up, the patient reported that while she had initially felt some benefit, the pain had gradually returned. Dr Krishna recognised that her ongoing symptoms were likely being driven significantly by the L4/5 disc and proposed a lumbar epidural injection to target this component directly. The rationale, realistic expectations, and risks were discussed transparently before proceeding.
Lumbar epidural injection at L4/5
A lumbar epidural injection was performed at the L4/5 level with local anaesthetic and steroid, without complication. The procedure was uneventful, and the patient was advised to continue her rehabilitative approach while awaiting the treatment effect.
Significant improvement reported
At subsequent review, the patient reported excellent benefit from the lumbar epidural injection. The treatment had provided meaningful and sustained pain relief, allowing her to refocus on rehabilitation — the foundation of her long-term recovery.
The Pain Spa Approach
Four Pillars of Structured Pain Management
Thorough assessment
A detailed clinical history and imaging review to understand the precise pain generators before any treatment decision is made.
Targeted intervention
Precision-guided injections directed at the specific anatomical sources of pain, performed safely under imaging guidance.
Honest expectation-setting
Transparent discussion of likely outcomes, limitations, and risks so patients can make genuinely informed decisions about their care.
Rehabilitation pathway
Injection treatment creates a window of reduced pain — which is then used to build core stability and long-term functional strength through specialist physiotherapy.
“Injection treatment is not the destination — it is the bridge. Our goal is to reduce pain sufficiently so that patients can commit fully to rehabilitation, which is what builds lasting recovery.”
Dr Murli Krishna — Consultant in Pain Medicine, Pain Spa
Outcome
What changed for the patient
Following the lumbar epidural injection, the patient reported a significant and sustained improvement in her symptoms. For someone who had spent more than two years struggling with daily pain, the improvement was meaningful — not just physically, but in terms of her ability to engage with daily life and move towards a rehabilitation-focused future.
Key improvements reported
- ✔ Significant and sustained reduction in low back pain following lumbar epidural injection at L4/5.
- ✔ Improved tolerance of standing, walking, and daily activities.
- ✔ Able to re-engage with a rehabilitative approach, including core stability physiotherapy.
- ✔ Referral to specialist physiotherapy to consolidate long-term gains.
- ✔ Clear follow-up plan in place to monitor progress and adjust management if needed.
This case illustrates how a structured, stepwise approach — starting with careful assessment, moving through targeted interventional treatment, and transitioning into active rehabilitation — can meaningfully restore quality of life even in patients who have suffered for years.
Your Specialist
About Dr Murli Krishna
Dr Murli Krishna
Consultant in Pain Medicine — Pain Spa
MBBS • FRCA • FFPMRCA • Fellow of the Faculty of Pain Medicine
Dr Krishna is a highly experienced Consultant in Pain Medicine practising at Pain Spa’s clinics in Bristol, including Willow Surgery in Downend and the Chesterfield Nuffield Hospital in Clifton. He specialises in the diagnosis and interventional management of complex chronic pain conditions, with a particular interest in spinal pain.
His philosophy is rooted in a comprehensive, patient-centred approach: understanding the precise anatomical source of pain, applying appropriately targeted treatments, and supporting patients through a rehabilitation pathway for sustained benefit. He works closely with specialist physiotherapists and referring consultants to ensure seamless, coordinated care.
Dr Krishna consults both in person and via video, and sees patients on a self-pay basis. He regularly receives referrals from consultant spinal surgeons and other specialists across the UK.
Important Note
Individual results from pain management treatments vary. Injection treatment does not guarantee symptom relief and carries risks, which are discussed in full during consultation. The information in this case study does not constitute medical advice. Please contact Pain Spa to discuss your individual circumstances.
Pain Spa
Willow Surgery, Downend • Chesterfield Nuffield, Clifton
clinic@painspa.co.uk • www.painspa.co.uk • 0117 2872383