From Symptoms to Solutions: Rethinking Pain Care

What if the symptom you see isn’t the real problem?

In pain care, this happens more often than people realize. Patients often arrive with one diagnosis, but a careful evaluation may reveal two or even three causes of pain, each needing a different treatment. That’s why accurate diagnosis matters. When we identify all the causes of a patient’s pain, we can create a treatment plan that targets the whole problem—and that’s when healing begins.

Let me share an example.

Bill’s Story

(This is a fictional patient story based on multiple patients I’ve treated, used to illustrate a clinical lesson.)

Bill was a 36-year-old X-ray technologist who came to see me with right arm pain that had lasted six months. The pain began the day after he used his right arm to stop a patient from falling during a transfer. Since then, he had burning and tingling pain that started in his shoulder, traveled down the front of his arm, and reached his thumb and index finger. Over time, the pain worsened. He used his arm less and less and noticed swelling in his wrist and fingers. Simple tasks—like lifting a coffee mug—caused severe pain, weakness, and burning.

Because the injury happened at work, a workers’ compensation adjuster joined the visit. She explained that he had already tried months of physical therapy, but his pain got worse. An MRI of his neck showed a disc bulge at the C5–6 level, mostly on the left side. A spine surgeon told him surgery might be an option if things didn’t improve. The patient didn’t want surgery—he just wanted to feel better. The pain was limiting his job and his daily life.

“They told me the pain is coming from my neck,” Bill said. “But I don’t want surgery. Is there anything else we can do?”

I asked a few more questions. What made the pain worse?

“Any time I reach overhead, my arm goes numb, and I have to drop it,” he said.

“What about pushing or pulling?” I asked.

“I can’t grip things well enough,” he replied. “I’m afraid I’ll drop them.”

After examining both arms, I asked if he had noticed any changes in his skin, hair, or nails.

“Now that you mention it,” he said, “the nails on my right hand grow much faster. I have to cut them twice a week.”

I also noticed that the hair on his right forearm was thinner than on his left.

One Complaint, Multiple Causes

After asking more questions, I realized Bill didn’t have just one cause of his arm pain—he had multiple.

The main cause was a condition called complex regional pain syndrome (CRPS). This can happen after an injury, when the nerves in the arm “rewire” themselves in response to trauma, causing chaos in that body part. The result is severe pain, along with changes in skin color, temperature, swelling, and hair or nail growth.

The secondary cause was less obvious but just as important: thoracic outlet syndrome. This occurs when nerves or blood vessels are squeezed as they travel from the neck into the arm. This pressure can cause pain, numbness, and tingling in the arm and hand. This helped explain why his symptoms worsened when he raised his arm or tried to use it.

There may have also been a third contributor to Bill’s pain—the disc bulge at C5–6—but it was less likely to be the main cause. The MRI showed a larger disc bulge on the left, while his pain was on the right. This is an important reminder that imaging can offer helpful clues, but it must always be interpreted alongside the full clinical picture. 

Which Cause do we Treat First?

When more than one problem is causing pain, deciding where to start can be tricky. In Targeted Pain Treatment, I focus first on the problem that limits function the most. 

In Bill’s case, his hand weakness and constant forearm pain were the biggest barriers. The pain was always there and got worse when he raised his arm overhead. The goal was to reduce his pain at rest first. Once that improved, we could then focus on pain with movement.

I decided to treat the CRPS first. To do this, I used numbing medicine to help reset the nerves in his neck that had been sending the wrong signals since his injury. This was done with a procedure called a stellate ganglion block.

After the first treatment, Bill returned excited. He showed me that he could make a stronger fist and that his wrist pain had improved. Then we moved on to treating the thoracic outlet syndrome pain.

Why Does This Matter?

Too often, both patients and clinicians feel discouraged when pain treatments don’t work. But many times, the problem isn’t that the treatment failed—it’s that the wrong problem was treated. I’ve seen this countless times when patients, like Bill, come in having had neck injections for a problem that wasn’t actually coming from their neck. 

What matters most is getting the diagnosis right. Pain often has more than one cause. When we identify all the factors contributing to a patient’s pain, we can create a plan that targets each one in a way that is specific, strategic and safe. The Targeted Pain Treatment approach breaks this process down to help us, as clinicians, ensure we’re not missing important clues to the underlying causes of pain. 

To help others apply this approach, I’ve created a free toolkit that shares lessons and methods I’ve learned over years of practice. It’s designed to support both clinicians and patients in using best practices to diagnose and treat pain more effectively.

Accurate diagnosis is the key to effective, targeted treatment.If the symptom you see isn’t the real problem, then treating symptoms alone will never be enough. Real healing begins when we look deeper, identify the true causes, and focus on restoring function.

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To Learn More

If you’re a clinician interested in caring for patients with complex or overlapping causes of pain, I invite you to join me at the 2026 Targeted Pain Treatment Conference: Paradigm Shift, on February 28, 2026, in Knoxville, Tennessee. I’ll be joined by expert colleagues to explore how focusing on function—and not just symptoms—can change outcomes in pain care.