A pain physician for chronic pain: what interventional algology is
Which conditions it treats, which tools it uses and when it makes sense to ask for an assessment with a pain specialist.
When pain persists for weeks, months or years —and painkillers, physical therapy or visits to other specialists have not provided a sufficient answer— a question usually arises: who else can I see? The answer, in many cases, is an interventional pain physician.
Algology is the medical specialty dedicated to the study, diagnosis and treatment of pain. It is not a subspecialty of neurology or rheumatology: it is a specialty in its own right, with specific training, independent certification and tools that other specialists do not usually have in their arsenal.
What makes it interventional is that, in addition to pharmacological management, it includes high-precision technical procedures —generally image-guided— designed to act directly on the source of the pain.
Clinical definition
Interventional algology diagnoses and treats chronic pain using minimally invasive techniques, often guided by fluoroscopy or ultrasound.
What sets a pain physician apart from other specialists?
It is a common question, and it makes sense to ask it: back pain can be seen by an orthopedic surgeon, headaches by a neurologist, joint pain by a rheumatologist. Why one more specialist?
The difference lies in the approach and the available tools. Each specialist treats pain from the perspective of their own organ or system. The pain physician treats pain as an entity in its own right, regardless of its origin, and has interventional techniques that are generally beyond the reach of other specialties:
This does not mean that a pain physician replaces other specialists. In many cases they work in a complementary way: the rheumatologist diagnoses, the pain physician manages the pain that diagnosis generates.
What conditions does an interventional pain physician treat?
The list is broad because chronic pain cuts across practically all medical specialties. Some of the most common conditions in an algology practice are:
Fibromyalgia
Widespread musculoskeletal pain with central sensitization
Ehlers-Danlos syndrome / hypermobility
Complex chronic pain associated with joint hypermobility
Chronic low back pain
Low back pain, facet, discogenic or persistent radicular pain
Sciatica
Radicular pain radiating down the leg or foot
Neuralgias
Trigeminal, postherpetic, intercostal and other neuralgias
Shoulder, knee and hip pain
When joint pain persists and limits function
Chronic postoperative pain
Pain that does not subside after surgery and affects recovery
Painful vertebral fracture
Compression fractures that cause disabling pain
Pain with no clear diagnosis
Patients who have been through multiple specialties without a definitive answer
What tools does it use?
This is where interventional algology stands apart in concrete terms. In addition to conventional pharmacological treatment, the specialist has access to image-guided procedures —fluoroscopy (real-time X-ray) and ultrasound— that make it possible to act with high precision on the source of the pain.
Some of the most common procedures include:
- Radiofrequency denervation — conventional, pulsed or cooled. It interrupts pain signals in the facet joints, knee, shoulder or sacroiliac joint.
- Nerve blocks — diagnostic or therapeutic, to identify and treat the specific source of the pain.
- Epidural neuroplasty — a procedure to treat adhesions and compressions in the spinal canal.
- Vertebroplasty and kyphoplasty — to stabilize vertebral compression fractures and relieve the pain they cause.
- Spinal cord stimulation — in selected cases, an implantable device that modulates pain signals at the level of the spinal cord.
- Cryoablation — a technique that uses extreme cold to temporarily interrupt the nerve conduction of pain.
Not all patients are candidates for every procedure. The selection depends on the diagnosis, the clinical history, prior imaging studies and the individualized evaluation at the first consultation.
When should you see a pain physician?
There is no need to wait years or to exhaust every option from other specialties. There are clear signs that an assessment with an interventional pain physician may be the right next step:
The pain persists for more than three months, regardless of the treatment received.
Painkillers or anti-inflammatories are no longer enough or cause significant side effects.
The pain limits everyday activities: work, sleep, movement, social life.
You have seen other specialists without reaching a clear diagnosis or an effective treatment.
You are looking for a non-surgical alternative or a second opinion before making a decision about surgery.
The pain is of unclear origin or has been diagnosed as fibromyalgia, neuropathy or hypermobility syndrome.
What is the first consultation like?
The first assessment is not a procedure: it is a complete clinical consultation. The history of the pain is reviewed —since when, how it started, what makes it better, what makes it worse, which treatments have been tried— along with imaging studies and prior records if they exist.
The goal of that first appointment is to reach an accurate diagnosis of the source of the pain and, from there, to outline a personalized management plan. It does not necessarily mean a procedure right away: in some cases the next step is to optimize the pharmacological treatment, in others it is to recommend an interventional procedure, and in others it is to refer or coordinate with another specialist.
What does stay constant: the starting point is always to validate the pain, understand its origin and offer a clear, evidence-based management pathway.
Clinical approach
The goal is not just to reduce pain: it is to regain function, comfort and quality of life with the most precise and least invasive management possible.
Frequently asked questions
Is interventional algology the same as a pain clinic?
Are interventional procedures safe?
Do I need a referral from another doctor to see a pain physician?
Is algology covered by major medical expense insurance?
Written by
Dra. Denise Vázquez
Interventional Pain Physician · Centro Médico ABC · Mexico City
Specialist in Anesthesiology and Algology · UNAM · Master's in Regional Anesthesia and Ultrasound-Guided Interventional Pain Management, University of Salamanca