Understanding Scoliosis-Related Back Pain and Interventional Pain Management Options

If you’re living with scoliosis—a sideways curvature of the spine—you’re no stranger to back pain. This condition doesn’t just affect posture; it can lead to persistent discomfort that impacts daily life. But how does scoliosis cause pain, and what can interventional pain management offer? Let’s break down the science and evidence-based treatments to help you navigate your options.

Why Scoliosis Causes Back Pain

Scoliosis creates an uneven load on your spine, much like a bent spring wearing down faster under pressure. Over time, this asymmetry can:

1. Accelerate spinal degeneration

Uneven stress damages discs (the cushions between vertebrae) and facet joints (the spine’s “hinges”), leading to arthritis and instability.

2. Compress nerves

Curves in the lumbar (lower back) or thoracolumbar (mid-to-lower back) regions often pinch nerves, causing pain that radiates down the front of the thigh (cruralgia) rather than classic sciatica.

3. Strain muscles

Overworked muscles on one side of the spine struggle to compensate, leading to fatigue and spasms.

4. Worsen osteoporosis

In adults, weakened bones from osteoporosis can amplify pain, especially in severe curves.

Pain is often felt most intensely at the “apex” of the curve and may worsen with activity or prolonged sitting/standing.

Interventional Pain Management: What Works?

While surgery is reserved for severe cases, interventional pain management focuses on minimally invasive procedures to reduce discomfort. However, evidence shows these treatments often provide only short-term relief and work best when combined with other therapies.

1. Epidural Steroid Injections (ESI) and Facet Joint Injections

• How they work: Anti-inflammatory steroids are injected near irritated nerves (ESI) or into inflamed facet joints to reduce swelling and pain.
• The catch: Major guidelines report the benefits fade within weeks to months with no guarantee of lasting improvement.

2. Radiofrequency Ablation (RFA)

How it works: Heat is applied to nerves transmitting pain signals from damaged joints.

Key Takeaway: The CDC and American Academy of Pain Medicine stress that these procedures should only be considered after careful evaluation of risks vs. benefits, alongside physical therapy and lifestyle changes.

Non-Invasive Strategies with Better Support

Bracing

• For whom: Adults with severe curves and chronic pain.
• Effectiveness: Custom braces may offer modest pain relief by stabilizing the spine, but studies show minimal impact on overall quality of life.

Physical Therapy and Exercise

• Why it’s foundational: Targeted exercises improve core strength, posture, and flexibility, reducing strain on the spine.
• Emerging approaches: Sensorimotor training (e.g., balance exercises) and core stabilization programs are under investigation for scoliosis-specific pain. A 2025 BMJ Open trial protocol highlights promising early results.

A Balanced Approach: What Experts Recommend

• Start conservatively: Physical therapy, posture training, and pain-relief medications (e.g., NSAIDs) are first-line treatments.
• Consider short-term interventions: ESI or nerve blocks might help during acute flare-ups but avoid overuse.
• Address osteoporosis: Bone-strengthening therapies can reduce fracture risk in older adults.
• Prioritize mental health: Chronic pain often fuels stress or anxiety, which can worsen symptoms. Cognitive-behavioral therapy (CBT) or mindfulness may help.

The Bottom Line

Scoliosis-related back pain is complex, but relief is possible with a tailored plan. Interventional procedures play a limited role and work best as part of a holistic strategy that includes exercise, bracing (if appropriate), and self-care. Always discuss options with a pain specialist to weigh the pros and cons for your unique case.

Remember: Progress may be gradual, but small steps toward spinal health can lead to meaningful improvements in comfort and mobility.