Comprehensive Pain Management

Complementary Medicine, Pharmacological Options, and Interventional Procedures for All Types of Pain, Including Back Pain

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Chronic pain can keep you up at night, make it difficult to focus on simple, daily tasks, and zap your energy and your joy for life. The key to lasting relief is finding the source of your pain and learning how to manage it so that it doesn’t control your life. That’s the goal of the comprehensive pain management specialists at Duke. We use a team approach to diagnose your pain and involve the right specialists to ensure you get the care you need. We recommend a series of treatment options to help you return to living with less pain and distress.

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Understanding Pain

Possible Pain Sources
Pain is your body’s way of telling you something is wrong. It can result from an injury to an organ or tissue such as a torn ligament or muscle, a disease such as arthritis or cancer, or damage to a nerve from injury, aging, disease (like diabetes), compression, or inflammation. Pain can result from a psychological condition. It can also be a disease – not just a symptom -- that can occur when nerve cells are out of whack.

Acute Pain vs. Chronic Pain
Pain that occurs suddenly and is short-lived – days to weeks -- is called acute pain. Persistent pain that lasts for three to six months or longer is chronic pain. It can come in intermittent waves or be a constant presence. No matter where it occurs in your body, pain can be debilitating, physically and psychologically, especially when the cause is unknown.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Where to Get Help

Pain-Specific Clinics
Duke maintains several clinics and specialists who provide care for people with pain in specific areas of the body such as facial and jaw pain, back pain, and chronic headaches. They offer treatment options tailored to specific sources and sites of pain.

Comprehensive Pain Management Clinics
Often, however, the source of your pain isn’t that clear. For example, while it may reside in your back, other factors may be at play. Duke comprehensive pain management clinics are staffed by specialists who can determine the source of your pain, assess your needs, and connect you with the resources you need to feel better faster.

A Team Approach to Managing Your Pain
Our team specializes in the disease of pain and includes anesthesiologists, physiatrists (physical medicine and rehabilitation specialists), neurologists, physical therapists, behavioral health specialists, and more. We work with you to create a personalized pain management plan.

Researching New Ways to Treat and Manage Pain
Because we are part of an academic medical center, our pain management specialists are involved in research to better understand how and why pain develops and are studying new, personalized therapies to treat pain. As a Duke patient, you may have access to these therapies through our clinical trials before they are widely available.

Proactive Pain Management
In addition to providing the full spectrum of treatment options, our comprehensive pain management clinics can help you be proactive about your pain management. That’s important if you’ve had pain episodes in the past and want to prevent them from recurring.

Pre- and Post-Surgical Pain Management
If you have an upcoming surgery, our specialists work with you to identify your pain management needs before and after your surgery and to reduce your risk of developing persistent post-surgical pain.

Diagnosing Pain

The first step to finding relief is a comprehensive evaluation. Your doctor will spend time asking questions to understand the type and location of your pain, how long you've experienced it, its intensity, and how it affects your life. Your answers may determine which tests they will prescribe. They will also conduct a thorough physical exam.


Tests to diagnose pain may include:

  • Blood and urine tests to look for diseases
  • Imaging tests such as X-rays, CT scans, and MRI
  • Nerve conduction tests to look for nerve damage
  • An electromyogram (EMG) to assess your muscle function

Armed with the results of these tests, knowledge about your condition, and other factors such as your age and overall health, your doctor will have a better understanding of your pain and how to treat it. Often, more than one of the following types of treatment will be part of your personalized plan.

Complementary Pain Treatments

A comprehensive pain management plan will often include a variety of therapies. The right combination will depend on the source and severity of your pain. Complementary therapies are often the first step.


Acupuncture involves the strategic placement of fine needles in your skin to relieve pain.

Behavioral Health

Behavioral health specialists may use cognitive therapy and other forms of counseling to help you manage depression, anxiety, and the emotional side effects that can coincide with chronic pain. Behavioral health can also help you learn breathing exercises, muscle relaxation techniques, pain coping skills, and methods to manage stress.


Biofeedback helps to train your body’s functions, including your body’s automatic responses to pain. These include muscle tension, physical expressions, fast breathing, and rapid heart rate. There are different types of biofeedback, but in general, electrodes are attached to sites on your body to measure your body’s responses, such as your brain waves, heart rate, and muscle contractions. Over time, biofeedback helps you understand what causes these body changes and trains you to better control them.

Electrical Stimulation

A TENS (transcutaneous electrical nerve stimulator) unit can be used in your doctor’s office or at home. A portable version is small enough to hold in your hand. When you are experiencing pain, you place reusable electrodes on your back and attach them with wires to the TENS device. Then you turn on the device to deliver mild electricity (it should not hurt) through your skin for 15 to 30 minutes. This stimulates your nerves and interferes with pain receptors in the brain.

Lifestyle Changes

Changes to your diet, exercise routine, and sleep habits may be discussed to promote your overall health, decrease inflammation, and manage stress.

Massage Therapy

Massage manipulates muscles to relax them, ease tension, and improve blood flow and circulation.


Learning to focus your attention on one thing will quiet your mind and help it release endorphins, which are the body’s own natural pain relievers. It also reduces the release of stress hormones, which can cause inflammation and trigger pain.

Physical Therapy

An exercise routine that improves flexibility and strength may be prescribed to help relieve stress and alleviate pain.

Pharmacological Options

Nerve Pain Medications

A variety of drugs may be prescribed to treat pain that results from nerve damage or injury. They include anticonvulsants, antidepressants, and gabapentinoids. When taken under a pain doctor’s supervision, they can be effective in helping to manage pain that originates in the nerves.

Anti-Inflammatory Medications

Non-steroidal anti-inflammatory (NSAID) medicines can range from over-the-counter to prescription-strength drugs. If those are unsuccessful, prescription medications including steroids and muscle relaxers may also be prescribed.


Opioids block pain messages but do not correct the problems causing your pain. They can be highly addictive and are only prescribed under strict supervision.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Interventional Procedures

In some cases, one of the following interventional procedures may be recommended.

Nerve Blocks and Injections

Medication can be injected on or near the nerves that are the source of pain. This numbs the nerves and blocks pain signals. Steroid injections may offer relief for pain caused by inflamed nerves. Botox injections, trigger point injections, and joint injections may also be prescribed, as needed.

Intrathecal Pump Therapy

A surgically implanted pump releases low doses of medication into the space around the spine to reduce pain signals. This minimizes the side effects of high-dose medications and results in better pain control.

Spinal Cord Stimulation

Electrodes are implanted on your spinal cord, and a generator is implanted under the skin on the abdomen or buttocks. The generator sends electrical impulses that travel through the electrodes to block pain signals.

Peripheral Nerve Stimulation (PNS)

Small electrodes are implanted next to a peripheral nerve outside the brain or spinal cord, and a generator is implanted under the skin. Electricity from the generator travels to the electrode to block pain signals sent by the peripheral nerve.

Radiofrequency Ablation

When pain radiates from the spine to other areas of the body -- including the legs, arms, and head -- this procedure blocks the source of those pain signals. Using X-ray guidance, a heat source is inserted into the appropriate nerve to prevent the pain signal from traveling to the brain.


During this minimally invasive procedure, bone cement is inserted in the spine to stabilize spinal fractures which are a common cause of back pain.

Percutaneous Decompression

This procedure removes a damaged herniated disc through a needle rather than an open incision.

Sacroiliac Joint Fusion

This procedure may be performed to relieve pain in the lower back and buttocks when injury or damage has affected the sacroiliac joint, located between the spine and the hip. It may be recommended when other options have failed. Screws, rods, and bone grafts are implanted to eliminate movement of the joint, which can be the source of the pain.

This page was medically reviewed on 12/02/2021 by