Which of these is you?

Pain arrives by a handful of doors. Most people who find this page came through one of these.

• A line down the leg or the arm. Pain that leaves the spine and travels in a pattern you could trace with a finger, which is usually a nerve root problem, not a muscle one. Sciatica.
• A joint that has quietly become the center of your day. A knee, hip or shoulder that catches, aches on stairs, or has been called “arthritis” without anyone confirming which structure inside the joint is actually firing. Knee pain.
• Burning, numbness or a limb that overreacts. Nerve pain proper — feet that feel wrong at night, or a hand and arm that stayed swollen and strange long after a minor injury should have settled. Peripheral neuropathy.
• A crash, a fall, a shift injury. You were fine, then you were not, and now you are also managing an insurer, an employer or an attorney on top of your body. After a car accident.
• The operation happened and the pain came back, or never fully left. Hardware on the film, relief that did not match it. Failed back surgery syndrome.
• The injections used to work. Now they barely dent it. That is not you getting worse at responding to treatment. It is usually the treatment telling you something. When injections stop working.

Why a scan does not decide the diagnosis

An MRI shows structure. It does not show which structure is currently generating the signal you feel, and a large share of disc bulges, facet arthritis and rotator cuff fraying show up on scans of people who are not in pain at all. Treat the picture as the diagnosis and you will sometimes treat the wrong thing expertly.

Two things explain why imaging and pain diverge as often as they do. Mechanically, a structure can degrade slowly enough that the nervous system adapts around it, so the film looks alarming and the tissue is quiet. Biochemically, the inflammatory load circulating in a person’s blood changes how sensitized their nerves are at baseline, independent of what any picture shows — which is why two people with an identical scan can have opposite pain levels. And structurally, a fifteen-minute visit built around a radiology report is a poor incentive to keep examining a body once a film exists to point at. That is a system problem, not a judgment on the person doing the pointing.

Which is why the exam here starts before the images are pulled up, and why we will sometimes tell you the structure your scan blames is not the one causing your symptoms. What to expect at the first visit.

The toolkit is diagnostic before it is therapeutic

Most of what looks like a procedure list — blocks, injections, ablations, implants — is better understood as a set of tests. A medial branch block does not fix anything; it silences one specific nerve for a few hours and tells us, by whether your pain silences with it, whether that joint is the source. A diagnostic epidural is a question about a nerve root before it is treatment for one. The expensive, permanent step — radiofrequency ablation, a stimulator, an implant — comes after the question has an answer, not instead of asking it. Medial branch blocks.

The terrain underneath the structure

Pain is a signal, not a diagnosis, and the tissue where it hurts is rarely the whole story. Metabolic inflammation raises the baseline sensitivity of every nerve in the body, independent of what is torn or bulging. Chronically elevated blood sugar glycates the collagen in discs, tendons and joint capsules, stiffening the very structures we are trying to get to heal. And behind both of those sits a food supply, a work schedule and an economics of time that make sleep, movement and real food harder to come by the longer someone has been hurting — which is the social driver underneath the two biological ones.

Dr. Padda spent the first twenty years of his career telling patients their bloodwork was “not too bad” while their pain got worse. It was not bad by the reference range. It was bad by the standard that predicts who heals and who does not. That is why bloodwork happens at a pain visit here, not as an upsell afterward. The metabolic terrain and pain.

If an accident or an injury is part of this

An adjuster works on a timeline that assumes soft tissue heals in six weeks. Your nervous system does not read that file. If you are being treated as though you are exaggerating a slow recovery, the fix is not a louder complaint — it is a record, taken close to the event and repeated consistently, that survives a hostile reading later. After a car accident. Work injuries run on a parallel and different clock. Injured at work.

What actually gets examined

Facet joints, the sacroiliac joint, the nerve roots leaving the spine, the discs themselves, the canal they run through, the peripheral nerves further out, and the joints — knee, hip, shoulder — that get blamed on “age” before anyone has actually tested which structure inside them is firing. Each has its own physical exam findings and, where imaging alone cannot settle it, its own diagnostic block. Facet joint pain.

The physician

Dr. Gurpreet Singh Padda, MD, MBA, MHP is the medical director: a trauma-surgery-trained anesthesiologist and interventional pain physician, board certified across pain medicine, interventional pain management, addiction medicine and obesity medicine, who has run the Center for Interventional Pain Management since 2001. About Dr. Padda.

How to start

Call, text or book online. The first visit is a history and an exam, not a procedure — unless a diagnostic block is the entire point of the visit, you will not have anything done to you on day one. What to expect.

Common questions

Related reading

• About Dr. Padda
• What to expect at the first visit
• The metabolic terrain and pain
• Sleep, movement and behavior
• When it is an emergency