What is pain medicine, and how does a pain physician differ from other doctors?

What is pain medicine?

Pain medicine is a branch of medicine that treats persistent pain as a clinical problem in its own right, using diagnosis, medication, image-guided procedures, and rehabilitation.

Physicians enter the field from a base specialty. In Thailand, physicians can complete subspecialty training in pain medicine after their main specialty. In practice, the work follows four steps:

1. Diagnose the source from the history, examination, and imaging, because an abnormal scan is not always the cause of pain.

2. Review medication, keeping what helps and reducing what carries long-term risk.

3. Perform image-guided procedures when they fit, such as a diagnostic nerve block or radiofrequency ablation. Most patients go home the same day.

4. Coordinate rehabilitation, because a procedure is designed to make exercise and daily activity easier, not to replace them.

For the procedures themselves, see our guide to interventional pain management.

What counts as acute pain and chronic pain?

Acute pain follows an injury, operation, or illness and usually settles as tissues heal. Chronic pain persists or recurs for longer than 3 months, according to the International Association for the Study of Pain (IASP).

Over time, nerves can become more sensitive, so pain may outlast healing. Guidance from the National Institute for Health and Care Excellence (NICE) separates chronic secondary pain, linked to a condition such as arthritis, from chronic primary pain, which has no clear underlying cause. The two are managed differently.

Pain physician vs orthopedic surgeon, rehabilitation, and neurology: who does what?

An orthopedic surgeon asks whether a structure needs repair; the pain physician asks a different question: which structure or nerve is producing the pain, and how can that signal be reduced without surgery?

The roles overlap, and each doctor refers to the others when needed.

When should you see a pain medicine doctor?

Consider a pain medicine doctor when pain has lasted about three months or keeps returning despite rest, medication, and physiotherapy. Common reasons include:

• persistent neck or back pain, with or without pain spreading into a limb
• a wish to understand non-surgical options before, or instead of, surgery
• pain that remains after spine or joint surgery, or nerve pain after shingles

If you are looking for a chronic pain doctor in Bangkok, our guide on how to choose a pain clinic may help.

How do the pain physician and the interventional radiologist work together at YOUNIFY Clinic?

At YOUNIFY Clinic, our pain medicine physician performs nerve and spine procedures, while our interventional radiologist performs embolization for selected joint and tendon pain. Complex cases are reviewed together.

Embolization works on blood flow rather than on a nerve: through a small puncture, a thin catheter is designed to reduce abnormal blood flow thought to feed inflammation around a joint or tendon. Examples are Genicular Artery Embolization (GAE) for knee osteoarthritis and Transarterial Microembolization (TAME) for frozen shoulder, tennis or golfer elbow, and plantar fasciitis. The Society of Interventional Radiology describes GAE for people who have not improved with conservative care. Evidence for TAME is still developing, and suitability is decided by our interventional radiologist after assessment.

As a guide, procedures range from dry needling, starting from THB 650, to epidural balloon neuroplasty, starting from THB 170,000. The full list is on the chronic pain service page.

When to see a doctor urgently

Go to an emergency department, not a clinic appointment, if pain comes with:

• new or worsening weakness in an arm or leg
• loss of bladder or bowel control
• numbness in the saddle area, between the legs
• fever with back pain
• severe pain after a major fall or accident
• unexplained weight loss

When we may advise against a procedure

Our physicians may advise against a procedure, or delay it, when:

• blood thinners have not yet been safely managed with the prescribing doctor
• there is an active infection, in the body or at the skin where the needle would go
• the patient is pregnant, for any procedure that uses X-ray guidance
• diabetes is not well controlled, for procedures that use a corticosteroid
• the pain source has not been confirmed
• the expectations are ones the procedure cannot meet

We explain why and suggest what can be done instead.

Physician perspective

[รอ approve] At our clinic, the first visit starts with what you want to get back to: sleeping through the night, walking to the BTS station, or sitting through a meeting. That goal shapes the plan more than the MRI does. We then work out whether the pain comes from a nerve, a joint or a tendon, and we review your medicines from the first visit, because some people take more than they need. When the source is unclear, we choose a small diagnostic block before a bigger step. When a joint or tendon problem may suit embolization, we plan it together with the interventional radiologist. If rehabilitation alone is the right answer, we say so.

What happens next

1. Send an X-ray or MRI report and a short history of your pain.

2. Our pain medicine physician reviews them, with our interventional radiologist where relevant.

3. You receive a written plan and a written quotation.

4. If a procedure is suitable, it is scheduled, and most patients go home the same day.

5. Follow-up checks how pain and daily function have changed.

We are at 2nd Floor, Room 214, United Center Building, 323 Silom Road, Silom, Bang Rak, Bangkok 10500, Thailand, a five-minute walk from BTS Sala Daeng, open every day from 11:00 to 20:00 Bangkok time.

To start, send your X-ray or MRI report and a short history for a physician review by WhatsApp +66 81 556 9696 or LINE.