Chronic pain not improving What to re-check, and what to try next, when nothing seems to help

Many people with long-lasting pain reach a point where they have tried rest, pills, a few sessions of therapy and maybe an injection, and they still hurt. Chronic pain not improving after months of effort is frustrating, but it is also common, and it usually means the plan needs a different approach rather than that nothing can help. This post is about that moment. For the building blocks of a long-term plan, see our guide to chronic pain management.

Chronic pain not improving: common reasons

• The diagnosis is incomplete: two problems can overlap, such as a worn facet joint and an irritated nerve, and treating one leaves the other
• The treatment was too short or too passive: a handful of visits, or only heat and massage, rarely changes long-standing pain
• The “boom and bust” cycle: doing a lot on good days and paying for it for days afterward
• One treatment was expected to do everything: an injection can calm pain, but without exercise the problem tends to return
• Sleep, stress and mood: all three turn up how strongly the nervous system reacts to pain
• A sensitized nervous system: after months of pain, nerves can stay on alert even when the original injury has healed

Step 1: re-check the diagnosis

A fresh, thorough exam is the starting point. The physician asks where the pain is, what makes it better or worse, and what has and has not helped, then examines the joints, muscles and nerves. Imaging is repeated only when it would answer a specific question. If numbness, tingling or weakness are part of the picture, EMG and nerve conduction testing can show whether a nerve is involved. A test numbing block, guided by X-ray, can confirm whether a particular joint or nerve is the source. Our post on finding the cause of chronic pain walks through each step.

Step 2: check the plan, not just the pain

Many plans stall because the active part never got going. Exercise works for chronic pain, but it has to be regular, gradual and matched to you. Physical therapy at our Brooklyn and Staten Island offices sets a starting level you can repeat on bad days and builds from there (see what to expect at physical therapy). Pacing helps break the boom-and-bust cycle: split big tasks into smaller pieces, take planned breaks, and increase activity by small steps each week. Pain is tracked alongside what you can do, such as walking farther or sleeping through the night.

Step 3: treatments you may not have tried

Targeted injections and nerve treatments

When a specific source is found, an X-ray-guided treatment can be aimed right at it: an epidural steroid injection for an irritated nerve root, medial branch blocks and radiofrequency ablation for facet joint pain in the back or neck, or a genicular nerve block and radiofrequency ablation for long-standing knee pain. Fluoroscopy-guided injections use live X-ray to place the needle precisely. Pain procedures are performed at all three offices, and your physician explains where and when yours will be scheduled.

Focused shockwave for stubborn tendon and heel pain

The video shows focused high-energy shockwave on the heel, the kind of treatment used for plantar fasciitis that has not settled with stretching, footwear changes and time. Focused shockwave sends acoustic pulses into the painful tissue over a short series of sessions. At Precision Care Medical & Sports Performance it is used for back pain, muscle pain, plantar fasciitis and knee pain, and it is performed by a nurse practitioner and physician at our Brooklyn office only. Learn more about focused shockwave therapy.

Spinal cord stimulation for long-standing nerve pain

For a small group of people with nerve pain in the back or legs that has not responded to other care, a physician may discuss a spinal cord stimulation trial, a short test period with a temporary device that shows whether it helps before anything permanent is considered.

What you can do while the plan is adjusted

• Keep a simple pain and activity diary for two weeks and bring it to your visit
• Pick two or three goals that matter to you, such as walking the dog or sitting through a film
• Keep a steady sleep and wake time, even after a bad night
• Do your home exercises on bad days too, at an easier level
• Bring a list of every medicine and treatment you have tried, and how long you tried it

When to get help sooner

See a physician promptly if pain is steadily getting worse, wakes you every night, or comes with new numbness, weakness or weight loss you cannot explain. Go to an emergency room or call 911 for sudden weakness, loss of bladder or bowel control, or pain with fever. A pain management physician can also review whether the medicines you take are still helping and safe for you.

Related care at Precision Care Medical & Sports Performance

A pain management doctor near you

Searching for pain management near me, or a physician who will take a fresh look at long-standing pain? For a pain management doctor in Brooklyn, Ashley Marcus, MD sees patients at our Brooklyn pain management office on Shell Rd, a short trip from Sheepshead Bay, Midwood and Marine Park. Focused shockwave is offered only at the Brooklyn office. For pain management on Staten Island, Jake Stephen, DO sees patients at our Staten Island pain management office on Richmond Rd, convenient to New Dorp, Dongan Hills and Great Kills.

For a pain management doctor in Midtown East and uptown, Yuri Gordin, MD sees patients at the Precision Care Spine & Pain Center in Midtown Manhattan, 150 E 55th St, reached directly from Washington Heights, Spanish Harlem and Turtle Bay. Bring your imaging reports and a list of the treatments you have tried. Request an appointment or call the office closest to you.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common problems and treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

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