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According to the Centers for Disease Control and Prevention (CDC), approximately 60 million American adults live with chronic pain, and 21 million experience pain that frequently limits their daily or work activities. Pain can be exhausting, frustrating and isolating — and “I’ve tried everything” is something clinicians hear often.
Yet comprehensive, evidence‑based treatment is available. Pain management procedures can reduce pain, improve movement and support patients’ functional goals, especially when paired with rehabilitation.
In this Q&A, Karina Bouffard, MD, MPH, an attending physician who is double board‑certified in Physical Medicine and Rehabilitation and Pain Medicine at Shirley Ryan AbilityLab’s Pain Management Center, explains how pain procedures work and how an interdisciplinary approach helps patients restore function and reclaim meaningful activities.
What are the different types of pain management procedures available to patients?
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There are many types of procedures — injections, epidural steroid injections, nerve blocks, radiofrequency ablation and neuromodulation, among others. The key is matching the right procedure to the right patient at the right time.
Examples include:
- Injections: Deliver medication directly to the area contributing to pain, targeting a nerve, joint or the spine.
- Epidural steroid injections: Deliver anti-inflammatory medication into the epidural space around the spinal nerves to help reduce irritation and inflammation that can contribute to neck, back, arm or leg pain.
- Nerve blocks: Temporarily interrupt pain signals from a specific nerve or group of nerves. They can also help identify a patient’s “pain generator.”
- Radiofrequency ablation: Uses targeted heat to quiet specific nerves that are sending pain signals, which may help provide longer-lasting relief for some patients.
- Neuromodulation: Includes spinal cord stimulation and peripheral nerve stimulation, using implanted or temporary devices to send small electrical pulses that modify how pain signals are processed.
How do these interventions complement rehabilitation and other therapies?
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Our goal is functional restoration. Helping patients move, participate and return to meaningful activities—that is our philosophy in our interdisciplinary chronic pain program at Shirley Ryan AbilityLab.
Pain procedures and rehabilitation work together hand in hand as they address different aspects of the patient’s pain experience. A procedure may decrease pain intensity, while physical and occupational therapy improve strength, mobility, endurance and flexibility.
Many patients also experience kinesiophobia, or fear of movement due to pain. When pain is reduced, confidence improves, making it easier for patients to engage in therapy and daily activities.
How do these procedures differ from pain medications?
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Pain medications can play an important role in managing symptoms, but they affect the entire body and may cause side effects. With chronic pain, long-term reliance on opioids can also carry additional concerns, including tolerance, dependence, sedation, constipation, hormonal changes, increased sensitivity to pain and impact on daily function.
Pain procedures are different because they are targeted. When we can identify a specific pain generator — such as a joint, nerve or area of the spine — we can deliver treatment closer to the source of pain. The goal is not simply to reduce pain, but to help patients move better, participate more fully in rehabilitation and, when possible, reduce the need for systemic medications over time.
Can pain procedures help patients with subacute or intermittent pain?
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Pain procedures are not limited to patients with chronic pain. We also see a whole range of patients with acute and subacute pain (lasting 4 to 12 weeks). Different procedures are appropriate for different subsets of patients.
More important than considering how long or how often a patient has pain is to understand what’s causing the pain and how it affects the patient’s daily life. From there, we can determine what procedure is best to alleviate symptoms.
Are pain injections or nerve blocks painful?
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These procedures may cause temporary discomfort, but we take several steps to maximize comfort. We begin with a local anesthetic, so patients may feel only a pinch or a burn. Patients remain awake and can provide feedback throughout the procedure.
How soon might a patient notice pain reduction, and how long can relief last?
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It varies:
- Diagnostic blocks: Relief may last minutes to an hour.
- Epidurals: Often take effect within 2-14 days and may last weeks to months.
- Radiofrequency ablation: Relief may take up to six weeks and typically lasts 6-12 months.
- Peripheral nerve stimulation: May provide relief for 12-18 months.
- Basivertebral ablation (for lower-back pain): For some patients, pain may not return; repeat procedures are uncommon.
Why are movement and exercise still important after a pain procedure?
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A pain procedure creates an opportunity to move — not a reason to stop. Reduced pain allows patients to participate more fully in therapy. We encourage patients to use this window to build strength, mobility and flexibility.
What are common misconceptions about pain procedures?
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Living with pain does not mean you have to give up on living well. I always tell my patients we may not completely eliminate your pain, but we definitely can help you improve your function and support your goals so you can enjoy a meaningful life.
One common misconception is that pain procedures mask pain and gloss over the core problem. It’s important for patients and clinicians to realize pain is complex, and procedures are one aspect of comprehensive treatment to address pain. Procedures really work best with broader treatment — and in addition to exercise, rehabilitation, behavioral strategies, sleep optimization and lifestyle changes.
Another misconception is that one procedure will “solve” pain. It’s natural to hope for immediate relief, especially after years of discomfort, but patients often discover that a sustained, individualized treatment plan offers more reliable improvement and helps them stay engaged in the activities they enjoy.
What would you tell someone who has lived with pain for years and feels they’ve tried everything?
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The first thing I tell my patients is that: I believe you. Chronic pain affects every part of life — work, family, social connections.
I encourage reframing: instead of “There’s nothing left to do,” remember that pain is complex, functional restoration is possible, and sometimes a fresh start with a new perspective can make a meaningful difference.
What sets the Pain Management Center at Shirley Ryan AbilityLab apart?
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We incorporate all different disciplines under one house — evaluation with a pain physician, physical therapy, occupational therapy, pain psychology, education and more. Our fellowship-trained, board-certified pain physiatrists offer a full range of interventional procedures.
Patients in our chronic pain program also benefit from a supportive cohort, gaining community, validation and new perspectives.
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