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Rethinking the Treatment of Pain

Dr. Pavan Dalal, Pain Management Specialist

September 10, 2019

Rethinking the Treatment of Pain

Patients today have options for finding relief to back and joint pain.

Getting to the source of pain can be complicated. The pain in your hip could be caused by a nerve in your back. The pain in your neck could be radiating from your shoulder. That’s why the most effective treatment often involves a combination of different therapies, especially for chronic pain that lasts longer than 12 weeks and doesn’t resolve on its own. The good news is that doctors are constantly refining approaches to treating orthopedic pain, whether in the lower back, knee, hips or other part of the body -- affecting most people at some point in their lives.

Here’s some of the new thinking around pain:

Targeted steroids

Systemic steroids like prednisone help to reduce inflammation, but often produce other undesirable side effects and aren’t designed to be taken long-term. In epidural steroid injections, we’ll inject a steroid like cortisone locally around nerves, using guided imaging to target the exact spot of inflammation and irritated nerves. In some cases, relief will last for months, and some patients will never need another injection.

Radiofrequency Ablation

In this procedure, effective for spine related joint pain, we burn sections of small nerves that sense pain in the joints causing the trouble. Doctors have been refining the combination of duration and temperature used for maximum effectiveness. For instance, studies have shown that burning over a minute and a half doesn’t add much in terms of long-term benefit. And anything over 80 degrees Celsius doesn’t impact results, either. So there’s been a lot of narrowing recently in terms of defining a standard of care for nerve ablation.


There’s a big movement away toward non-narcotic options available for pain management. Adjuvant medications target nerve related pain while muscle relaxants can take aim at muscle related causes. Some anti-depressants, which work on pathways of the brain that control mood and arousal, have also been shown to be effective for nerve pain. Prescribed non-steroidal anti-inflammatories are effective in treating pain caused by inflammatory conditions like rheumatoid and osteo arthritis. The medications are stronger, and have a different timing for release in the body than ibuprofen or naproxen, allowing patients to take fewer pills each day and sometimes with fewer side effects.

My best tip for back pain prevention? Core strengthening. There’s a lot of core muscle weakness in today’s population due to work and lifestyle habits. Any kind of training in a supervised setting by a trainer or physical therapist to ensure that you are strengthening these muscles correctly without causing harm is something can go long way to preventing back pain as well as treating it.

Dr. Pavan Dalal

Dr. Dalal is the Director of Pain Management at White Plains Hospital and treats patients at several of our White Plains Hospital Physician Associates locations around Westchester. To make an appointment, call (914) 849-7900.