Surgery is frequently the ‘final answer’ when pain just won’t go away. It’s not generally the first option and it’s by no means the only one. A huge number of people achieve long-term relief through non-surgical pain management (i.e., treating the cause rather than just cutting into the tissue). Dr. Rodolfo Gari is an interventional pain physician and will review the usual options with you before you consider surgery. The blog outlines how non-surgical pain management works and when a procedure may still be required. Please read it and then come in for a relaxed, face-to-face consultation with your questions. 

Why Surgery Is Not Always the First Answer 

Operations carry risks (infection, aesthetic complications, etc.), and recovery can take months. When you’re looking at alternatives to surgery for chronic pain, the first thing you must do is understand what an operation can and can’t do. For the most common problems (low back pain, etc.) most acute episodes will settle with conservative management. The American College of Physicians guidelines state that in that scenario you start with non-drug therapy. That’s why in most cases a carefully considered approach to the management of chronic pain will begin with the least invasive option that is appropriate to the diagnosis. That’s the principal Dr. Gari will follow in building each chronic pain management plan: achieve stable pain at the lowest level with the minimum possible risk. 

Conservative Treatments Worth Knowing

 Most patients won’t require every tool in the box. A good plan uses a few tools appropriate to the cause of pain. 

Medication and Self-Care Strategies 

Short courses in anti-inflammatories can be of help in bringing a flare down. Muscle pain medication (i.e., a muscle relaxant) is generally for short-term use, as it can cause drowsiness. Heat or gentle stretching can help relieve pain between visits. Opioids are not generally recommended as a long-term treatment for chronic pain according to the 2022 CDC Clinical Practice Guideline. As ever, talk to your doctor about any medication you’re considering, as they’ll know your full medical history. 

Physical Therapy and Exercise 

Supervised exercise is one of the most well-studied tools for managing chronic pain (especially low back pain). The therapist can strengthen the stabilising muscles, improve posture and retrain movement patterns that may be aggravating a joint. Improvements take time to accrue but can lead to long-term relief from muscle pain. It can be used in conjunction with muscle pain medication rather than as a replacement for it. It remains a cornerstone of pain management. 

Image-Guided Injections and Nerve Blocks 

Image-guided injections are one of the interventional pain treatments whereby medication is placed close to the source of the pain under X-ray guidance. The most common examples would be epidural steroid injections, facet joint injections and nerve blocks. They’re appropriate for some nerve problems and not others. The degree of pain relief varies widely from patient to patient and can last as little as a few days or as long as many months. Many patients will use that window of relief to make progress in their rehab. They can be a useful part of a non-surgical pain management plan. 

Interventional Pain Treatment Methods for Nerve Problems 

A pinched spinal nerve can cause burning pain, numbness, or weakness in an arm or leg. A nerve specialist can usually identify the affected nerve. Radiofrequency ablation uses controlled heat to disrupt the nerve’s pain signal. Some patients with facet-related back or neck pain have reported pain relief of six months or more with this procedure. Spinal cord stimulation is only indicated in a very select group of patients whose neuropathic pain has failed to respond to all other forms of treatment. 

What an Interventional Evaluation Involves 

It starts with your history and physical exam. Imaging is then selected based on your symptoms. That’s crucial because imaging alone can be very deceptive. An MRI can show disc changes in perfectly healthy adults with no back pain. Your nerve specialist should treat the person, not the picture. 

When Surgery May Still Be the Right Choice 

Some situations will require surgical intervention. You should present to A&E if you develop new leg weakness, groin numbness, or loss of bladder/bowel control, as these are potentially significant signs of nerve compression. Surgery is indicated where there is a clear structural problem and non-operative management has failed. A nerve specialist can advise which scenario applies. Even when surgery is indicated, pain management without surgery is often an important part of the picture both pre- and post-op. 

Take the Next Step with Dr. Rodolfo Gari 

Living with pain doesn’t necessarily mean you go for surgery. Dr. Gari is a knowledgeable pain management doctor who will take the time to review all your options with you. If you have a long-standing back problem with chronic pain or have a specific pain issue involving a nerve, he’ll go through the non-surgical pain management options and the risks of surgery. He can advise you on which of the interventional pain treatments are appropriate for you and when it would be sensible to go down the route of muscle pain medication or muscle pain relief. His approach to alternatives to surgery for chronic pain is very simple. You start with the safest and most effective step and then you modify as you respond. Book in for a consultation at rodolfogarimd.com to find out which route is right for you. 

Frequently Asked Questions 

Can chronic pain be treated without surgery? 

Yes, most people do improve with exercise therapy, medication or a specific procedure. Your doctor will be able to put together a chronic pain management plan for you and set realistic pain relief goals. 

What are the best non-surgical treatments for chronic pain? 

Good options would be supervised exercise, short term muscle pain medication or image guided injections. The non-surgical pain treatment options will work best if they’re tailored to your diagnosis and a chronic nerve problem may well require some form of interventional pain treatment. 

When should you consider alternative pain treatments instead of surgery? 

Consider them first in the absence of any emergency warning signs (sudden weakness, loss of bladder control etc). If the symptoms are stable, then alternatives to surgery for chronic pain are a reasonable proposition so pain management without surgery for weeks or months would be a sensible thing to do while progress is monitored. 

How do I know whether I need surgery or alternative pain treatment? 

A nerve specialist can look at you, match your scan to your symptoms and tell you the likely benefit of each pathway. A pain management doctor can also advise when a surgical referral would be appropriate.