If treatment after treatment has not helped, the specialist you need is one who can prove where the pain is coming from before proposing what to do about it. That is the working definition of interventional pain management: image-guided testing that identifies the pain generator, followed by treatment aimed at that generator. The distinction is not a credential technicality. It is the difference between being tested and being cycled.
Chronic pain is common enough that this decision reaches a lot of people. In 2021, an estimated 20.9% of US adults had chronic pain and 6.9% — roughly one in fourteen — had high-impact chronic pain that limited daily life or work.1
Not every “pain doctor” does the same work
The title covers several different jobs. Some clinicians manage pain primarily with medication. Some deliver physical rehabilitation. Some perform image-guided diagnostic and therapeutic procedures. All are legitimate; they are not interchangeable when previous care has already failed.
The question worth asking at a first visit is simple: how will you establish where this pain is coming from? If the answer is a scan and a prescription, that is the same model that has not worked so far.
What separates diagnosis from labeling
Testing, not inference
Imaging shows structure. It does not establish that a visible finding is generating your symptoms — degenerative changes are common in people with no pain at all. A diagnostic block works differently: anesthetize a specific structure, and see whether the pain it is supposed to be producing goes away. That is a test with a result, not an interpretation.
Dr. Padda walks through what scans can and cannot establish in what imaging can and cannot show about pain, and the case where the MRI reads normal but the pain is real in deep low back pain with a normal MRI.
Procedural capability
A physician who can test can usually also treat what the test finds. That includes facet joint injections, radiofrequency ablation once a diagnostic response is confirmed, nerve blocks, and provocative discography where the disc is in question.
A model that accounts for the whole system
Pain that has persisted through several rounds of treatment is often no longer a purely peripheral problem. Central sensitization, sleep disruption, metabolic drivers and movement avoidance all sustain a pain state after the original injury has settled. A specialist working from a purely structural model will keep looking for a lesion to fix and will keep coming up short.
Normal imaging does not mean nothing is wrong
This is the most common reason patients arrive discouraged. A scan came back unremarkable and the conversation ended there.
Pain can persist through mechanisms that imaging does not photograph — altered central processing, motor control dysfunction, small-fiber involvement, or a structure that only hurts under load. The absence of a finding is a reason to test differently, not a reason to conclude the pain is not real.
Metabolic and nerve-related drivers
Nerve function depends on blood supply and glucose control. Diabetes, vascular disease and inflammatory states change how nerves behave and how well they recover, which is why metabolic assessment belongs in a pain work-up rather than in a separate silo. That reasoning is set out in diabetes and neuropathy.
“Neuropathy” itself is a category rather than a diagnosis — the useful question is always which nerve, and driven by what.
When the diagnosis is CRPS
Complex regional pain syndrome, still widely called reflex sympathetic dystrophy or RSD, is where a purely structural approach fails fastest. It involves central amplification, not just a peripheral injury, and it generally requires layered treatment rather than a single procedure.
Options include sympathetic blocks, functional restoration, and ketamine, which the practice delivers by intravenous infusion as well as by sublingual and topical routes. Whether ketamine’s benefit in this setting is primarily central or peripheral is still debated; the honest framing is an incompletely understood mechanism with an observable effect in selected patients. Details are on the CRPS and RSD treatment page.
Behavioral care belongs inside the treatment, not after it
A sensitized nervous system does not resolve through injections alone. Acceptance and Commitment Therapy is delivered in-house at Padda Institute by a licensed, pain-trained behavioral clinician, alongside interventional care rather than as a referral once procedures have run out. The goal is restored function and behavioral flexibility, not persuading anyone that their pain is imaginary.
What about medication?
If you are already taking opioids, the relevant question is how a practice plans to help you need less of them without putting you into withdrawal. Interventional treatment of the underlying generator is what makes a taper tolerable. The practice’s approach, including how it works with referring physicians and pharmacists, is described under opioid stewardship.
Being evaluated in St. Louis
Padda Institute Center for Interventional Pain Management is led by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and serves the St. Louis region across Missouri and Illinois. The main clinic is at 4477 Woodson Road, Suite 100, St. Louis, MO 63134, next to St. Louis Lambert International Airport, with a second location at 12174 Natural Bridge Road, Bridgeton, MO 63044.
Call (314) 481-5000 or text (314) 886-5902, Monday through Friday, 8:00 AM to 5:00 PM. You can review the full range of pain treatments, read about the pain management doctors in St. Louis, find both offices on the locations page, or request an appointment.
More explanation of how these decisions are made is on the practice’s YouTube channel, @paddainstitute.
Frequently asked questions
Which type of specialist should I see when other pain treatments have failed?
An interventional pain physician who performs image-guided diagnostics, so that the source of the pain is established before further treatment is chosen. The clinicians and their approach are described on the pain management doctors in St. Louis page.
Can a pain specialist help if my MRI is normal?
Yes. Normal imaging rules out some structural causes but cannot exclude pain arising from altered central processing, motor control problems, or structures that only hurt under load. See deep low back pain with a normal MRI.
What should a first visit actually involve?
A history, an examination, a review of prior imaging, and a plan for establishing the pain generator — often a diagnostic block. Imaging alone does not establish causation, as explained in what imaging can and cannot show.
I am already on opioids. Will a pain specialist simply stop them?
No. The aim is to treat the underlying pain generator so that less medication is needed, and to prevent withdrawal during any reduction. See opioid stewardship.
Is CRPS treated differently from other chronic pain?
Yes. CRPS, also called RSD, involves central amplification and typically requires layered treatment including sympathetic blocks, functional restoration and sometimes ketamine. See CRPS and RSD treatment.
Do you serve patients from Illinois?
Yes. The practice serves the St. Louis region across Missouri and Illinois, and Dr. Padda is licensed in both states. Both offices are listed on the locations page.
Sources
- Rikard SM, Strahan AE, Schmit KM, Guy GP. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morbidity and Mortality Weekly Report. 2023;72(15):379–385. CDC MMWR
Dr. Gurpreet Singh Padda, MD, MBA, MHP
