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Treatments & procedures
Not everyone needs a procedure. When one is suitable, it is one part of a wider plan. Choose a procedure to read about it and see the one-page flyer. Your doctor will explain what applies to you.
Most people with persistent pain are best helped by a combination of approaches. Procedures are considered only when they are likely to help as part of a wider plan, and not every procedure is suitable for everyone.
About the evidence. The strength of scientific evidence differs between procedures and between conditions. Some treatments are well established for carefully selected patients. Others, such as pulsed radiofrequency, have more limited or mixed evidence. Your doctor will explain the expected benefits, limitations, risks and alternatives for your situation.
1. Medication and multidisciplinary care
Persistent pain is influenced by physical, psychological and social factors, so care usually involves more than one approach:
- Medication review: checking which medicines help, reducing those that are not helping or that cause side effects, and using medicines safely.
- Physical rehabilitation: graded exercise and activity with a physiotherapist or exercise physiologist to improve strength and function.
- Psychological therapies: approaches such as pain-focused cognitive behavioural therapy to help with the impact of pain on mood, sleep and daily life.
- Functional restoration: setting practical goals, such as returning to work, sport or hobbies, and working towards them step by step.
- Multidisciplinary care: coordination with your GP, physiotherapist, psychologist and other specialists so everyone works to the same plan.
Detailed page in preparation
2. Spinal interventions
Procedures for pain arising from the spine, the spinal nerves and the sacroiliac joints.
- Radiofrequency DenervationRadiofrequency denervation uses a thin needle placed next to a small nerve that carries pain signals.Read more
- Thermal & Pulsed RadiofrequencyRadiofrequency energy can be used in two ways. Thermal radiofrequency uses controlled heat to make a tiny lesion that interrupts pain signals from a nerve.Read more
- Epidural & Nerve Root InjectionsA small amount of local anaesthetic and steroid medicine is injected, using X-ray guidance, into the space around the spinal nerves (the epidural space) or next to a particular nerve root.Read more
- Facet Joint & Radiofrequency ProceduresFacet joints are small joints at the back of the spine in the neck, mid back and lower back.Read more
- Sacroiliac Joint ProceduresThe sacroiliac (SI) joints connect the base of your spine to your pelvis.Read more
In preparation: lumbar and cervical medial branch blocks (currently covered on the facet joint page) and pulsed radiofrequency of the dorsal root ganglion.
Back to top ↑3. Joint and peripheral nerve interventions
Procedures targeting nerves outside the spine, including those supplying the knee, shoulder and head.
- Knee & Genicular Nerve ProceduresThe genicular nerves carry pain signals from the knee joint. A test injection of local anaesthetic can be placed next to these nerves to see whether it eases your knee pain.Read more
- Shoulder Nerve ProceduresSeveral nerves, including the suprascapular and axillary nerves, supply sensation to the shoulder joint.Read more
- Peripheral Nerve Blocks & RadiofrequencyPeripheral nerves are the nerves outside your brain and spinal cord. If a particular nerve is causing pain, for example because it is trapped, injured or irritated after surgery, local anaesthetic (sometimes with steroid) can be placed next to it.Read more
- Headache & Occipital Nerve ProceduresThe occipital nerves run from the top of the spine up the back of the head.Read more
- Sympathetic Blocks for CRPSThe sympathetic nerves help control blood flow, sweating and temperature.Read more
- Ultrasound-Guided Pain ProceduresUltrasound uses sound waves to show nerves, muscles, tendons and joints on a screen in real time.Read more
4. Neuromodulation
Devices that use gentle electrical pulses to change pain signals, usually after a trial period.
- Peripheral Nerve StimulationPeripheral nerve stimulation places a thin wire (lead) near a nerve that is causing pain.Read more
- Spinal Cord StimulationSpinal cord stimulation uses mild electrical pulses to change how pain signals travel along the spinal cord to the brain.Read more