Abstract
Complex spinal joint and nerve pain can be difficult to treat because the pain may come from more than one structure at the same time. A worn facet joint, damaged disc, tight muscle, inflamed ligament, and irritated nerve root may all contribute to the same pain pattern. This can make a simple diagnosis or one-size-fits-all treatment less effective.
For people in El Paso and throughout West Texas who continue to have neck pain, back pain, sciatica, numbness, weakness, or limited movement after traditional care, a second opinion may provide a fresh look at the problem. A thorough evaluation may include imaging, neurological testing, movement assessment, medical review, and rehabilitation planning. Depending on the diagnosis, an integrated plan may combine chiropractic care, rehabilitation, shockwave therapy, MLS laser therapy, medically supervised injections, and selected biologic or supportive therapies.
The main goal is not to use every treatment available. The goal is to identify the structures causing the pain and select treatments that match those findings.
What Is Complex Spinal Joint and Nerve Pain?
Complex spinal joint and nerve pain is a useful descriptive term for chronic discomfort caused by overlapping problems involving the vertebrae, spinal joints, discs, muscles, ligaments, and nerve roots.
This phrase is not a specific medical diagnosis. Instead, it describes a situation in which several pain generators may be working together.
The spine contains:
Vertebrae that provide structural support.
Discs that absorb forces between the vertebrae.
Facet joints that guide spinal movement.
Ligaments that help stabilize the spine.
Muscles that control movement and posture.
Nerve roots that carry signals between the spinal cord and the body.
Pain can begin in any of these structures. Because they are located close together, injury to one area can also affect another (Kansas Pain Management, 2026).
For example, a damaged disc may become inflamed and irritate a nearby nerve root. A person may then change the way they walk or move to avoid pain. That compensation can place extra stress on the facet joints and muscles.
Soon, the patient may have disc pain, nerve pain, joint pain, and muscle tightness at the same time.
What Does Nerve Pain Feel Like?
Nerve pain often feels different from ordinary muscle soreness.
Possible symptoms include:
Burning pain.
Electrical or shock-like pain.
Tingling.
Pins-and-needles sensations.
Numbness.
Pain traveling into an arm or leg.
Muscle weakness.
Increased sensitivity.
A compressed or irritated spinal nerve root is known as radiculopathy. Common causes include herniated discs, bone spurs, spinal degeneration, thickened ligaments, inflammation, and narrowing of the spaces where nerves travel (Advanced Orthopaedics & Sports Medicine, n.d.).
Nerve compression may also develop gradually as the spine ages or appear after an injury (Dallas Spine Surgery, 2026).
How Is Joint Pain Different?
Facet joints are small joints located along the back of the spine. They allow the neck and back to bend, rotate, and extend.
Facet joint pain may feel more like:
Deep aching.
Localized neck or low-back pain.
Stiffness.
Pain with twisting.
Pain when standing for a long time.
Pain when extending or arching the spine.
Joint pain and nerve pain can overlap, which is one reason a correct diagnosis is important. Treating nerve pain as if it were only joint pain—or treating joint pain as if it were only a pinched nerve—may lead to disappointing results (Butler, 2026).
Is This the Same as Complex Regional Pain Syndrome?
No.
Complex regional pain syndrome, or CRPS, is a separate neurological condition. CRPS usually affects an arm, leg, hand, or foot and can cause severe pain, swelling, changes in skin color or temperature, and unusual sensitivity.
Cleveland Clinic explains that CRPS involves abnormal nervous system pain processing and may occur after an injury or nerve damage (Cleveland Clinic, 2022).
CRPS is mentioned here because it shows how complicated pain can become when the nervous system remains overly sensitive. However, chronic spinal joint and nerve pain should not automatically be labeled CRPS.
A careful examination is needed to determine the actual diagnosis.
When Should You Seek a Second Opinion in El Paso and West Texas?
A second opinion does not necessarily mean the first doctor was wrong.
Complex spine problems can change over time, and different specialists may look at the same condition from different perspectives.
Consider seeking another evaluation when:
Pain continues after weeks or months of treatment.
Treatment only provides short-term relief.
Sciatica keeps returning.
You have continued numbness or tingling.
You are developing weakness.
Your MRI findings do not seem to match your symptoms.
You have been told surgery is your only option and want to review conservative choices.
You have already had surgery but still have significant pain.
Several treatments have failed.
Your pain began after an automobile, workplace, or sports injury.
Nobody has clearly explained where the pain is coming from.
Your treatment plan focuses on pain control without addressing movement and function.
A second-opinion examination may review your history, MRI or CT findings, X-rays, muscle strength, reflexes, sensation, posture, gait, spinal motion, and response to previous treatment.
Some cases may also require EMG or nerve-conduction testing.
The key question is:
What structure—or combination of structures—is actually generating the pain?
An Integrated Approach to Complex Spine Pain
Once the major pain generators are identified, treatment can be layered according to the patient’s needs.
This is where integrative chiropractic and medical care can be useful.
Instead of asking one treatment to solve every problem, several treatments may address different parts of the condition.
Chiropractic Care and Rehabilitation
Integrative chiropractic care may focus on improving how the spine and surrounding joints move.
Depending on the diagnosis, care may include:
Chiropractic adjustments or mobilization.
Soft-tissue therapy.
Spinal decompression.
Posture correction.
Neuromuscular retraining.
Mobility exercises.
Core strengthening.
Balance and stability training.
Nerve-mobility exercises.
Progressive rehabilitation.
Chiropractic treatment should be based on examination findings and should not be used when a condition requires urgent medical or surgical treatment.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes his clinical approach as combining chiropractic biomechanics, functional medicine, rehabilitation, personal injury care, and medical collaboration (Jimenez, n.d.).
In his clinical observations, restoring movement is only one part of the process. Rehabilitation also needs to teach the body how to maintain better movement after treatment.
Shockwave Therapy
Extracorporeal shockwave therapy uses acoustic energy delivered into targeted tissues.
It may be considered when chronic pain has a strong muscular, fascial, tendon, or soft-tissue component.
Research has found improvements in pain and function among some patients with chronic low-back pain who received shockwave therapy, although larger, higher-quality studies are still needed (Liu et al., 2023).
Shockwave therapy should not be described as physically removing a herniated disc or bone spur.
Instead, it may serve as an adjunct to rehabilitation when the clinical findings support its use.
MLS Laser Therapy
MLS laser therapy is a form of therapeutic light treatment, often discussed within the broader area of photobiomodulation or low-level laser therapy.
The goal is to deliver light energy to targeted tissues without surgery.
Some patients may use laser therapy as part of a plan for:
Pain management.
Soft-tissue irritation.
Muscle discomfort.
Joint inflammation.
Rehabilitation.
Research on laser treatment for low-back pain has produced mixed results. Some studies report short-term pain improvement, while others have not shown meaningful additional benefit compared with exercise alone (Cochrane, 2008).
Therefore, MLS laser therapy is best viewed as a possible supportive treatment rather than a replacement for proper diagnosis, exercise, or treatment of serious nerve compression.
Epidural Spinal Injections
When inflammation surrounds a spinal nerve root, an epidural injection may sometimes be considered.
Epidural steroid injections place anti-inflammatory medication near irritated spinal nerves.
They may be useful for conditions such as:
Lumbar radiculopathy.
Cervical radiculopathy.
Disc-related nerve irritation.
Selected cases of spinal stenosis.
A 2025 American Academy of Neurology review evaluated epidural steroid injections for cervical and lumbar radicular pain and spinal stenosis. Evidence suggests that these injections may provide limited short-term improvement for some patients (American Academy of Neurology, 2025).
An epidural injection does not rebuild a damaged disc. Its role is mainly to reduce inflammation and pain enough to help the patient move and participate in rehabilitation.
PRP and Platelet/Fibrin Therapies
Platelet-rich plasma, or PRP, is prepared from a patient's own blood. Platelets contain signaling proteins involved in normal tissue repair.
PRP is being studied for several orthopedic conditions.
Some clinicians also use platelet-and-fibrin preparations, sometimes called PFP or platelet fibrin products, to create a fibrin-rich environment around selected damaged tissues.
Their use must be based on the exact structure being treated.
For spinal disc or nerve-related conditions, these applications remain an evolving area of research. Patients should understand the evidence, possible risks, cost, alternatives, and regulatory status before treatment.
These therapies should not be presented as guaranteed ways to regenerate a spinal disc or permanently eliminate nerve compression.
MFAT: Micro-Fragmented Adipose Tissue
Micro-fragmented adipose tissue, or MFAT, is prepared from a patient's own fat tissue and has been explored mainly for orthopedic and joint conditions.
Its potential role in tissue-supportive care is being studied, but spinal applications are not established treatments for every form of back or nerve pain.
The U.S. Food and Drug Administration warns that many regenerative products marketed for orthopedic conditions have not been FDA-approved for conditions such as back pain, neck pain, or disc disease. Patients should ask exactly what product is being proposed and what evidence supports its use (U.S. Food and Drug Administration, 2021).
A responsible treatment plan should discuss both possible benefits and limitations.
IV Infusion Therapy
IV therapy can deliver fluids, medications, or specific nutrients directly into the bloodstream.
Its purpose depends entirely on what is being infused.
For example, medically indicated IV treatment may help address:
Dehydration.
Documented nutritional deficiencies.
Certain medication needs.
Specific pain conditions under medical supervision.
Cleveland Clinic notes that IV ketamine is sometimes used in selected severe CRPS cases, although this is very different from routine nutritional IV therapy (Cleveland Clinic, 2022).
Routine vitamin IV infusions should not be described as directly repairing a herniated disc or decompressing a spinal nerve.
Within an integrative program, IV treatment is best considered supportive medical care when a clear indication exists.
Why Combining Treatments Makes Sense
A carefully designed plan may include several layers of treatment.
For example:
Reduce severe nerve irritation with appropriate medical treatment when indicated.
Restore safe spinal and joint movement through chiropractic or manual care.
Address soft-tissue restrictions with rehabilitation, shockwave, or laser therapy when appropriate.
Improve stability through strengthening and neuromuscular retraining.
Consider biologic procedures only when the diagnosis, evidence, risks, and patient goals support them.
Address health factors such as sleep, nutrition, inflammation, metabolic health, and physical conditioning.
The point is not to perform PRP, MFAT, epidurals, IV therapy, laser, and shockwave on every patient.
The better approach is to determine which treatment has a reasonable purpose for that individual patient.
A Multidisciplinary Model in El Paso, Texas
At Injury Medical Clinic PA in El Paso, Dr. Jimenez works within a multidisciplinary model that combines chiropractic care with medical oversight, functional medicine, personal injury care, and rehabilitation.
Clinic materials identify Maria Guadalupe Cardenas, MD, as an internal medicine physician, medical director, and collaborative physician, with more than 40 years of medical experience.
Public NPI records identify Dr. Cardenas as an internal medicine physician with NPI #1164426749 and Texas medical license #J2933.
Clinic materials describe Dr. Cardenas as board-certified in internal medicine and working alongside Dr. Jimenez to provide medical direction for complex and integrative cases.
This type of MD-DC collaboration allows each professional to contribute within the appropriate scope of practice.
Dr. Jimenez may focus on:
Chiropractic evaluation.
Spinal biomechanics.
Joint mobility.
Neuromusculoskeletal rehabilitation.
Functional medicine.
Personal injury evaluation.
Return-to-activity planning.
Medical oversight can include:
Review of health risks.
Medication considerations.
Medical diagnoses.
Laboratory assessment when indicated.
Screening before medical procedures.
Medical management of chronic conditions.
Coordination with specialists.
Together, these services can create a broader treatment picture than focusing on only one painful structure.
Do Not Ignore Neurological Warning Signs
Some symptoms should not wait for a routine second-opinion appointment.
Seek urgent medical evaluation for symptoms such as:
New loss of bladder or bowel control.
Numbness around the groin or saddle area.
Rapidly increasing arm or leg weakness.
Severe symptoms after significant trauma.
Fever combined with severe unexplained spinal pain.
Sudden difficulty walking.
New major loss of coordination.
These signs may indicate serious neurological or spinal disease.
A Second Opinion Can Change the Question
For many people with long-term spinal pain, the question begins as:
“Why does my back still hurt?”
A more useful set of questions may be:
Is my pain coming from a disc, joint, nerve, muscle, or several structures?
Is there active nerve compression?
Is inflammation keeping the nerve irritated?
Have movement problems developed around the original injury?
What treatment has already failed?
Which options are supported by evidence for my specific diagnosis?
Can conservative treatment still help?
When is a medical procedure appropriate?
When should surgery be considered?
That is the value of a thorough second opinion.
For patients with complex spinal joint and nerve pain in El Paso and West Texas, the goal should be more than temporarily covering up pain. A well-designed treatment plan attempts to understand the pain generator, improve function, protect the nervous system, restore movement, and give the patient a realistic path forward.
References
Advanced Orthopaedics & Sports Medicine. (n.d.). Radiculopathy.
American Academy of Neurology. (2025). Epidural steroids for cervical and lumbar radicular pain and spinal stenosis.
Butler, B. (2026, April 7). Nerve pain vs. joint pain: Understanding the differences and finding proper relief. Oakland Spine & Physical Therapy.
Cleveland Clinic. (2022, September 30). Complex regional pain syndrome (CRPS).
Cochrane. (2008). Low level laser therapy for low-back pain.
Dallas Spine Surgery. (2026, April 3). What causes nerve compression in the spine?.
Jimenez, A. (n.d.). Dr. Alex Jimenez: El Paso chiropractor and personal injury specialist.
Jimenez, A. (n.d.). Dr. Alex Jimenez professional profile. LinkedIn.
Kansas Pain Management. (2026, March 18). Is your back pain coming from nerves, muscles, or joints?.
Liu, K., Zhang, Q., Chen, L., Zhang, H., Xu, X., Yuan, Z., et al. (2023). Efficacy and safety of extracorporeal shockwave therapy in chronic low back pain: A systematic review and meta-analysis of 632 patients. Journal of Orthopaedic Surgery and Research, 18, 455.
Manipal Hospitals. (n.d.). Spine problems affect the vertebrae, discs, nerves, and surrounding muscles [Video]. Facebook.
U.S. Food and Drug Administration. (2021). Important patient and consumer information about regenerative medicine therapies.
YouTube. (n.d.). Spinal pain educational video resource [Video].
YouTube. (n.d.). Spine and nerve pain educational video resource [Video].
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We are here to help you and your family.
Blessings
Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-State Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
New York APRN License #: N25929, Verified: APRN-N25929*
License Verification Link: Nursys License Verifier
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ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
