For many adults living with ongoing pain, conservative treatments—such as physical therapy, medications, activity modification, bracing, chiropractic care, or basic injections—are the first steps toward relief. These approaches help a large percentage of individuals recover without invasive procedures. But what happens when you’ve “tried everything,” yet the pain continues to interfere with your work, sleep, mobility, and quality of life?
If conservative treatments haven’t provided meaningful relief, that doesn’t mean surgery is your only path forward. Modern interventional pain medicine offers a variety of minimally invasive, targeted procedures designed to address the source of your pain and help you regain function.
Below is a helpful guide to understanding your next steps and the advanced options available to you.
Why Conservative Care Sometimes Isn’t Enough
Conservative treatments are meant to calm symptoms while your body heals naturally. However, they may fall short when:
- Structural damage exceeds the body’s healing ability
- Pain originates from irritated, compressed, or damaged nerves
- Instability or degenerative changes remain uncorrected
- Inflammation is persistent and deep in the joint or spine
- Scar tissue, arthritis, or tendon degeneration has progressed
- The initial diagnosis didn’t fully capture the true pain generator
Persistent pain is often multifactorial, requiring a more precise treatment approach.
Advanced Diagnostic Testing: Identifying the Pain Source
When symptoms continue, the next step is clarity. Advanced diagnostics help pinpoint the exact pain generator, so treatment becomes more targeted and effective.
Common next-level diagnostics include:
- High-resolution MRI or specialized imaging
- Ultrasound evaluation for soft-tissue injuries
- Diagnostic nerve or joint blocks
- Electromyography (EMG) and nerve conduction studies
- Motion or weight-bearing imaging
- Fluoroscopic-guided assessment of spinal structures
Correct diagnosis is the gateway to better treatment decisions.
Minimally Invasive Interventional Options
When rest, physical therapy, and medications aren’t enough, interventional therapies can significantly reduce pain without open surgery.
Common next-step interventions include:
1. Image-Guided Injections
- Epidural steroid injections
- Facet joint injections
- Sacroiliac joint injections
- Peripheral joint injections
- Bursa or tendon sheath injections
These reduce inflammation and help restore mobility.
2. Radiofrequency Ablation (RFA)
Uses heat to quiet pain-generating nerves, often providing 6–18 months of relief for spine and joint pain.
3. Nerve Blocks
Diagnostic or therapeutic blocks temporarily interrupt pain signals and can guide long-term treatment planning.
4. Minimally Invasive Spine Procedures
For disc-related or nerve-related pain:
- Minimally invasive decompression
- Spinal cord stimulation
- Percutaneous discectomy
- Vertebral augmentation for compression fractures
These approaches aim to relieve pressure, restore stability, and reduce neuroinflammation—without traditional surgery.
When Is Surgery Considered?
Surgery is generally reserved for:
- Structural issues that cannot be repaired minimally invasively
- Progressive neurological deficits (weakness, loss of bowel/bladder control)
- Severe instability
- Fractures
- Tumors, infections, or advanced deformity
For most people, surgery becomes an option only after all other treatments have been exhausted and the diagnosis clearly indicates a surgical need.
Building a Personalized Treatment Plan
When conservative care doesn’t work, the goal is not simply to mask pain, but to:
- Identify the true pain generator
- Restore mobility, strength, and function
- Reduce inflammation
- Stabilize weakened or degenerated structures
- Support long-term recovery and prevent chronicity
A pain specialist will consider your unique anatomy, lifestyle, work demands, medical history, and imaging to build a customized plan focused on lasting relief.
Moving Forward: You Still Have Options
If you feel stuck or discouraged because conservative treatments have failed, you are not out of options. Modern interventional pain care offers a wide variety of solutions designed to relieve pain, support healing, and restore the activities you care about most.
You deserve a clear diagnosis, a thoughtful plan, and access to the full spectrum of care—not just the basics.