A Pain Procedure Is Proposed: Questions About Goals and Alternatives

By the Pain Care Questions Team

If a clinician has suggested a pain procedure, you’re at a decision point. Before you decide, it helps to get clear answers to three questions. What is this procedure meant to change for you? What are your other options, including waiting? How will you and your care team know if it’s working?

This guide gives you a short map of the decision, plain-language questions to ask, and a checklist you can print. It does not recommend for or against any procedure. That decision belongs to you and the licensed clinicians who know your history.

If this is urgent: If you have sudden, severe or new symptoms, or you think you may be having a medical emergency, call your local emergency number now. Don’t wait to work through a checklist.

A Quick Map of the Decision

Most shared decisions about a procedure follow the same basic path. You can use these steps to see where you are right now:

1. Understand the proposal. Get the procedure’s name, what it involves, and why it is being suggested now.
2. Name your goals. Decide what you most want to be different in your daily life.
3. Compare the options. Ask about alternatives, including not having a procedure right now.
4. Understand risks and unknowns. Ask what could go wrong and what is still uncertain for someone like you.
5. Agree on how to judge results. Decide together what “working” would look like and when you’ll check.
6. Decide, or ask for more time. You can ask for more time, more information, or a second opinion before you agree.

Questions About Your Goals

Why start with goals instead of the procedure?

The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

IASP also notes that “pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.” That means your goals may cover more than one thing. You might care most about walking farther, working, sleeping, or doing a hobby again. Naming these goals helps you and your clinician talk about what a procedure can and can’t be expected to address.

Questions to ask:

• What is this procedure meant to change: pain level, daily function, or both?
• Which of my goals do you think it could help with, and which would it probably not affect?
• Is it meant to help me take part in other care, like rehabilitation, or is it meant to stand on its own?

What would “success” look like?

People often mean different things by a procedure “working.” Agreeing on a definition up front makes the follow-up conversation easier.

• How much change would count as meaningful for me?
• When would we expect to notice a change, if one happens?
• How long might any change last, and what is still uncertain about that?
• How will we measure it: a pain rating, a daily activity, or something else?
• What is the plan if it doesn’t help, or helps only a little?

What kind of pain do you think I have?

IASP uses several terms to describe different ways pain can arise. You don’t need to diagnose yourself, but knowing the terms can help you follow your clinician’s reasoning:

• Nociceptive pain: “Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.” (Nociceptors are nerve endings that respond to possible harm.)
• Neuropathic pain: “Pain caused by a lesion or disease of the somatosensory nervous system.” (This is the part of the nervous system that handles touch, pain and body sensations.)
• Nociplastic pain: Pain that “arises from altered nociception” without clear evidence of tissue damage or nerve disease causing it. (Nociception is how the nervous system processes signals about possible harm.)

IASP also states that “pain and nociception are different phenomena” and that “a person’s report of an experience as pain should be respected.”

Questions to ask:

• Which type of pain do you think I have, and how sure are you?
• How does this procedure relate to that type of pain?
• How do my test or imaging results connect to what I’m feeling day to day?

Questions About Alternatives

A procedure is usually one option among several. Ask your clinician to walk you through the others, including what might happen if you wait or choose not to have it.

• What are my other options right now?
• What happens if I wait, or decide not to have this procedure?
• Could other approaches be used before, alongside, or instead of it?
• Why are you suggesting this option for me now instead of another one?

What the research says about complementary approaches

The National Center for Complementary and Integrative Health (NCCIH) is part of the U.S. National Institutes of Health. It has published an evidence summary on complementary approaches for chronic pain. NCCIH reports that about 20.4 percent of U.S. adults had chronic pain, which the survey defined as pain on most days or every day in the past 3 months. That figure comes from the 2019 National Health Interview Survey.

In NCCIH’s words, “a growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.”

Here is what NCCIH reports for specific conditions. These are general research findings, not advice for your situation:

• Back or neck pain: A large review found acupuncture was more effective than no treatment or sham (fake) acupuncture. Studies have found yoga helpful for low-back pain in the short and intermediate term. Tai chi, alone or with physical therapy, may decrease pain intensity and improve everyday function in people with low-back pain.
• Low-back pain guideline: The 2017 guideline from the American College of Physicians (ACP) includes spinal manipulation as an option for both acute and chronic low-back pain. It also recommends mindfulness-based stress reduction as an option for chronic low-back pain, based on moderate-quality evidence.
• Knee or hip osteoarthritis: A guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends tai chi for knee or hip osteoarthritis. Acupuncture may help knee pain from osteoarthritis. A limited amount of research suggests yoga may help pain, function and stiffness in knee osteoarthritis.
• Headaches: There’s moderate-quality evidence that acupuncture may reduce how often migraines happen, and moderate-to-low quality evidence that it may reduce how often tension headaches happen. Some studies of relaxation techniques have shown improvements, including fewer headaches. A small amount of research suggests yoga may reduce headache frequency, length and pain, mainly for tension headaches rather than migraines.
• Fibromyalgia: Low-to-moderate quality evidence suggests acupuncture helps with fibromyalgia pain. Several studies show massage therapy continued for 5 weeks or longer may reduce pain and other symptoms. A small amount of research suggests tai chi may help. There’s evidence that balneotherapy (bathing in mineral water) may help some symptoms.

Safety limits: NCCIH says the approaches studied for chronic pain “have good safety records,” but “that doesn’t mean that they’re risk-free for everyone.” It adds that “people with medical conditions and people who are pregnant may need to modify or avoid some of these practices,” and that “some dietary supplements may have side effects and may interact with medications.”

NCCIH also advises: “Don’t use an unproven product or practice to postpone seeing a health care provider about chronic pain or any other health problem.” It suggests telling the providers you see for chronic pain about any product or practice you’re considering.

Questions About Risks, Recovery and Unknowns

Every procedure has its own risks and recovery. Only your clinician can explain how they apply to you. Ask them directly:

• What are the common risks, and what are the rare but serious ones, for someone with my health history?
• What does preparation involve? Will I need to change any medicine beforehand? (Don’t start, stop or change any medicine unless your prescriber tells you to.)
• What will recovery look like, and how long might I need help at home or time off work?
• Which warning signs after the procedure mean I should call you or get emergency care?
• Might this need to be repeated? If so, how would we decide whether to repeat it?
• What is still unknown about this procedure for people in my situation?
• Can you show me the evidence, or the written information, behind this recommendation?

Questions about cost and coverage vary by plan and procedure. Ask your insurer and the facility’s billing office for details in writing before you decide.

Printable Checklist: Before You Decide

Print this or copy it into your phone’s notes app. Bring it to your appointment, and consider bringing someone you trust to help take notes.

Before the appointment

• ☐ I wrote down the exact name of the proposed procedure.
• ☐ I listed my top three goals (for example, a daily activity I want to get back to).
• ☐ I listed every medicine and supplement I take, plus any complementary approaches I use or am considering.
• ☐ I wrote down what I have already tried and how it went.
• ☐ I picked the five questions from this guide that matter most to me.

During the appointment

• ☐ I understand what the procedure is meant to change for me.
• ☐ We agreed on what “success” would look like and when we’ll check.
• ☐ I heard about at least one alternative, including waiting or not having the procedure.
• ☐ I asked about common and serious risks for someone like me.
• ☐ I know whether I need to change any medicine, and I will follow only my prescriber’s instructions.
• ☐ I know which warning signs after the procedure mean I should call or get emergency care.
• ☐ I asked for written information I can review at home.

After the appointment

• ☐ I reviewed my notes with someone I trust.
• ☐ I wrote down any questions that came up later and know how to reach the care team.
• ☐ I decided whether I want more time, more information, or a second opinion.
• ☐ If I have coverage questions, I asked my insurer for answers in writing.

My goals worksheet

• The one thing I most want to be able to do again: ____________
• A change that would feel meaningful to me: ____________
• When I’d like to check whether things have changed: ____________
• What I’d want to try next if this doesn’t help: ____________

What This Guide Can’t Tell You

The sources behind this page define pain terms and summarize research on complementary approaches. They do not rate the procedure you’ve been offered. They also can’t tell you whether it fits your body, history or goals. Research findings describe groups of people, and your results may differ. Your licensed clinicians are the right people to weigh those details with you.

Where to Go Next on This Site

• New to this site? Visit our Start Here page.
• Want to know how we choose and check evidence? Read how we research and use sources.

Sources

• International Association for the Study of Pain: Terminology. Source for the definitions of pain, nociception, and nociceptive, neuropathic and nociplastic pain, and the notes on pain as a personal experience.
• National Center for Complementary and Integrative Health: Chronic Pain and Complementary Health Approaches: Usefulness and Safety (last updated January 2023). Source for the research findings by condition, the guideline references, the safety statements, the chronic pain figure, and the advice not to delay seeing a provider.

About This Page

Medical information disclaimer: This article is general health education only. It is not medical advice, a diagnosis, or a treatment recommendation, and it does not replace a conversation with a licensed clinician who knows your history. Do not start, stop or change any medicine or treatment based on this page.

About Pain Care Questions: Pain Care Questions is an independent educational publication. It is not a pain clinic, treatment center, health care provider or referral service. It does not offer appointments or care, and it is not a successor to any business that previously used this web address. This page contains no product promotions, affiliate links or sponsored content.