Understanding Chronic Pain: Interview About Pain Management with Dr Diana Chan

A pain management specialist is a medical doctor who focuses on diagnosing and treating the nervous system’s pain signals directly. While primary care physicians (GPs) or surgical specialists typically treat structural damage, organs, or isolated injuries, a pain management specialist evaluates why the body’s neural alarm system fails to turn off. They focus specifically on the underlying mechanism and location of the pain to restore function and improve overall quality of life. A pain specialist also performs minimally invasive pain interventions on various painful areas which may avoid the need for surgeries.

A GP or surgeon primarily focuses on resolving underlying structural issues—such as repairing a damaged joint, removing a lesion, or prescribing general oral medications. However, pain often persists long after the structural damage has healed because the surrounding nerves become hyper-sensitised, remaining locked in an active “alarm” state.
Additionally, general oral painkillers frequently mask symptoms rather than targeting the source of neurological distress. Pain management specialists address this gap by treating the hyperactive nerves directly, working alongside a patient’s existing surgical or primary care team to tackle persistent pain from a neurological angle. Treatments may include medications, physical therapy and minimally invasive pain interventions.

Pain specialists treat both acute and chronic pain. Chronic pain is complex, long-term discomfort that has lasted for three months or more and impacts daily functioning. Common conditions include:
– Persistent lower back and neck pain (including disc degeneration, sciatica, and spinal stenosis)
– Chronic pelvic pain
– Joint and arthritic pain (such as knee, hip, or shoulder osteoarthritis)
– Post-surgical or post-traumatic nerve pain (where pain continues despite successful surgery)
– Neuropathic pain conditions (such as trigeminal neuralgia, postherpetic neuralgia, diabetic painful neuropathy, complex regional pain syndrome).

Both conservative and Interventional pain management utilises targeted, minimally invasive techniques designed to quiet hyperactive nerves and reduce localised inflammation:
– Medications and physical therapy
– Targeted Nerve Blocks & Injections: Delivering anti-inflammatory medication directly around specific nerves or joint spaces under live imaging guidance to disrupt pain transmission.
– Radiofrequency Ablation (RFA): Applying controlled thermal energy via fine needles to temporarily de-activate overactive pain-sensing nerves, providing sustained relief for months or years without open surgery.
– Targeted Disc Therapies: Utilising specialised radiofrequency techniques (such as biacuplasty) under live imaging to soothe hyperactive nerve fibers within damaged spinal discs.
– Neuromodulation: Implanting small devices that send gentle electrical pulses to the spinal cord or peripheral nerves to alter how pain signals are perceived by the brain.

Pain management procedures require extreme precision, often involving needle placements within millimetres of delicate nerve structures. Operating theatres provide access to advanced live imaging—such as fluoroscopy (live X-ray) or high-resolution ultrasound—allowing the specialist to visualise internal anatomy in real-time. Performing these interventions in a sterile operating theatre ensures maximum precision, safety, and effectiveness compared to a standard clinic consultation room.

Interventional pain treatment is designed as a long-term solution rather than a lifelong daily routine. Unlike oral medications that require continuous dosing to mask symptoms, a targeted procedure can reset hyperactive nerves and provide relief lasting from several months to years. This extended relief breaks the chronic pain cycle, enabling patients to participate effectively in physical rehabilitation and resume their normal daily activities comfortably.