22 Oct What to Expect at Your First Pain Management Consultation
Taking the step to visit a pain management specialist in North Dallas, whether in Carrollton or Denton, is an important milestone. If you’ve been living with chronic back, neck, or nerve pain, it’s normal to feel nervous about what happens next. The goal of this first appointment is simple — to stop guessing and start identifying the actual cause of your pain.
At Principal Spine & Pain Management Consultants, Dr. Paul Kurian uses a detailed, four-step process — from hearing your story to confirming your diagnosis — to create a clear plan for meaningful, long-term relief.
1. Why This Appointment Is Different
Many patients come to a pain management specialist after trying treatments that only provided short-term relief, such as medications, general physical therapy, or basic injections. At a specialized clinic, the goal is not to mask your symptoms but to identify the underlying cause of your pain and address it directly.
Your doctor will work to determine:
- Is your pain coming from a pinched nerve, such as sciatica?
- Is it related to an inflamed joint, like the facet or SI joint?
- Could it be caused by a disc problem or another structural issue?
Once the source of pain is identified, your doctor can recommend targeted, interventional treatments that help you move toward lasting comfort and improved mobility.
2. Step 1: Your Story Is the Best Diagnostic Tool
The most important part of your first visit is the conversation. The way your pain behaves, when it starts, where it travels, and what makes it better or worse, provides critical clues to its cause.
You can expect your doctor to ask questions like:
- Pain Description: Where exactly does it hurt? Is it sharp, dull, burning, or like an electric shock?
- Triggers: What makes it worse — sitting, standing, bending, or walking?
- Pain that worsens with sitting often points to a pinched nerve or disc issue.
- Pain that worsens with standing or walking may indicate spinal stenosis (narrowing of the spinal canal).
- Pain that worsens when bending backward or twisting can suggest facet joint inflammation.
- Relief: What makes it better — sitting, lying down, or leaning forward?
- Timeline: When did the pain begin? Was it gradual or caused by an injury?
- Previous Treatments: What have you tried (physical therapy, chiropractic care, medications, etc.), and did it help?
To make the most of your appointment, bring:
- A list of all medications and supplements you currently take.
- Copies of any imaging (X-rays, MRIs, or CT scans) related to your pain.
- A short list of your top questions or concerns.
3. Step 2: The Physical Examination
After discussing your history, your doctor will perform a physical exam to confirm the clues from your conversation.
During the exam, your doctor may check:
- Range of Motion: You’ll be asked to bend, twist, or move your spine in different directions to see which motions trigger pain.
- Nerve Function: The doctor will check your reflexes, muscle strength, and sensation to see if a nerve is compressed. If you have numbness or tingling, they’ll compare symptoms from one side of the body to the other.
- Pain Location: Gentle pressure may be applied to different areas of the back or pelvis (such as the SI joint) to help pinpoint the exact source of pain.
This physical assessment, combined with your pain history, gives your specialist a clear idea of where the problem lies.
4. Step 3: Confirming the Diagnosis
Sometimes, your doctor can confirm a diagnosis based on your exam and imaging. In other cases, additional testing helps ensure precision.
Imaging Review:
Your doctor will review your existing scans (X-ray, MRI, or CT) to assess for disc herniations, arthritis, or joint wear and tear — and to rule out other possible causes.
Diagnostic Nerve or Joint Blocks:
If your doctor suspects that a specific nerve or joint — such as a facet joint or the sacroiliac joint — is the pain source, they may recommend a diagnostic block.
- This is a brief, minimally invasive injection of numbing medication near the suspected nerve or joint.
- If your pain temporarily improves, it confirms the correct source.
- This precise approach ensures that future treatments target the right area and have the best chance of success.
5. Step 4: Building Your Personalized Treatment Plan
Once the cause of your pain is confirmed, your doctor will create a custom treatment plan focused on achieving long-term relief and helping you regain function — not just masking symptoms.
Your plan may include:
- For Nerve Pain (Sciatica, Pinched Nerves):
- Epidural Steroid Injections (ESI) may be recommended to reduce inflammation and calm irritated nerves. Advanced techniques like the transforaminal approach allow medication to reach the precise area causing pain.
- For Joint Pain (Facet or SI Joints):
- If a diagnostic block confirms the joint as the pain source, your next step may be Radiofrequency Ablation (RFA), also called Rhizotomy. This minimally invasive procedure uses heat to quiet the nerves that send pain signals from the joint, offering longer-lasting relief.
- For Chronic or Complex Pain:
- For pain that hasn’t improved with traditional treatments, advanced options like Spinal Cord Stimulation (SCS)may be discussed. This therapy helps interrupt pain signals and reduce the need for medication.
- Regenerative Options:
- Your doctor may also review advanced therapies such as Platelet-Rich Plasma (PRP) if appropriate for your condition.
Your first consultation isn’t the end of your pain journey — it’s the beginning of a clear, evidence-based plan designed to guide you toward lasting improvement with expert care.