When Pain Medication Stops Working
What Comes After Medication
The Step-Up Approach
When medication alone isn't enough, these options are available:
Nerve Block Injections
Injections are often the next step after medication:
| Type | What it does | How long it lasts |
|---|---|---|
| Epidural block | Reduces inflammation inside the spinal canal | Days to weeks |
| Nerve root block | Targets the specific compressed nerve directly | Days to months |
| Caudal block | Delivers medication through the base of the spine | Days to weeks |
Nerve block injections serve a dual purpose: treatment and diagnosis. If an injection brings relief, it confirms which nerve is the source of the problem — which helps guide future treatment decisions.
[!info] Learn more Nerve Block Injections explains the types, effectiveness, and limitations in detail.
Surgery
When conservative treatment and injections aren't providing adequate relief, surgery may be considered:
| Surgery type | Best for | Key feature |
|---|---|---|
| Decompression | Stenosis at a clearly identified location | Relatively low physical burden |
| Fusion | Spinal instability or multi-level stenosis | Higher physical burden |
[!info] Learn more Surgery covers the types of surgery and their risks.
SCS (Spinal Cord Stimulation)
For people who feel "medication isn't enough" but "major surgery feels like too much", SCS is an important option to consider.
| SCS feature | What it means for you |
|---|---|
| Low physical burden | Can be performed under local anesthesia |
| Trial period available | Test it for one week before committing |
| Reversible | The device can be removed if it doesn't help |
| May reduce medication needs | If SCS controls the pain, your medication dose may be lowered |
SCS is especially worth considering when:
- Conservative treatment (medication, injections) hasn't provided enough relief
- Neuropathic pain is the primary issue — and surgery is unlikely to address it
- Multi-level fusion would be needed, but the physical burden is a concern
- Pain persists even after previous surgery
[!info] Learn more Spinal Cord Stimulation (SCS) explains how it works and who it's suited for.