Pain Management and Pain Medication - Doctor Q&A

Pain affects more than just the body — it can influence our emotions, daily activities, relationships, and overall quality of life.

Current pain managment takes a holistic approach, recognising that pain is shaped by physical, psychological, and social factors.

Pain medications and different pain interventions work together to support better pain control within a “bio-psycho-social” pain management approach.

This includes:

• Self‑management strategies,
• Lifestyle and movement-based approaches,
• Psychological coping skills and non‑medication therapies,
• Alongside the safe and appropriate use of pain medications and interventions when needed.

By understanding these options and how they fit together, patients can be empowered to take an active role in managing pain in a way that is personalised, balanced, and sustainable.

In this 'Ask the Specialist' Q&A, don't miss this chance to ask Dr Leong any question you have about pain management and pain medication. This Q&A is for a limited time only!

Dr Adeline Leong is currently a Senior Consultant in Anaesthesia and Pain Management.

She was awarded the Ministry Of Health (MOH) Human Manpower Development Plan (HMDP) Scholarship in 2020 and completed her Pain Medicine HMDP in Australia. She was admitted to the Fellowship of the Faculty of Pain Medicine (FPM), Australian and New Zealand College of Anaesthetists (ANZCA) in October 2022, for which she was awarded the Merit Award in the FPM 2020 Examinations.

Dr Leong is the Director of Sengkang Hospital Pain Medicine from December 2020 till August 2025 and is the Head of Department of Pain Medicine, Singapore General Hospital since January 2025.

She practices anaesthesia and pain medicine in both Sengkang General Hospital (SKH) and Singapore General Hospital (SGH).

1. Question by Cindy

Dear Doctor

I would like to ask a few questions regarding after shingles recovery and why is it that my nerves continue to hurt. Sometimes is itchy and pain but bearable for me.

I am on lyrica 50 mg every night at 10.30pm. And I take antioxidants like pine bark and lingzhi every morning to boost my immune system. I am also on neurobion every afternoon.

May I know how to treat my nerves pain? And how long will I need to recover from this painful nerve. After taking lyrica to sleep at night, I will still wake up in the middle of the night because if the pain.

I had shingles in 29-11-2025 and had blisters in my right side of my lower shoulder blade and after one month the crust drop the scar remains there till now but some already disappeared and balance scars give me pain every days.

What can I do or what should I do? Please advise me and thank you very much in advance for your kind advice.

Answer by Dr Adeline Leong

Thank you for sharing your experience. What you are describing is very likely post‑herpetic neuralgia (PHN), which is nerve pain that can persist after shingles has healed.

This happens because the shingles virus can damage the nerves, leading to ongoing pain, burning, or itching sensations even after the skin has recovered.

Recovery time varies from person to person. Symptoms can improve over a wide range from days to months and even persist for years. The fact that your pain is still present several months after shingles is not uncommon.

You are currently taking pregabalin (Lyrica), which is a commonly used medication for nerve pain.

However, the dose you are on is relatively low, and waking up due to pain suggests that the pain is not yet optimally controlled. Sometimes, dose adjustments or additional medications such as topical treatments (e.g. medicated patches or creams) may help.

Non‑medication strategies such as good sleep routine, gentle stretching, stress management, and avoiding triggers to the affected area can also reduce flare‑ups. Supplements may help general health, but they are usually not sufficient alone to control nerve pain.

I would recommend seeing a pain specialist or neurologist for a review of your treatment plan. With proper adjustment, most patients experience improvement over time.

2. Question by Lucy

Hi Dr,

About a month ago I realise my last 3 toes on my right foot cramped when I walk. I wear socks and sneakers. I tried wearing opened toes socks. It helps. What can be the cause?

Appreciate your reply. Thank you.

Answer by Dr Adeline Leong

Toe cramping during walking can be caused by several factors. Common possibilities include muscle fatigue, footwear issues, nerve irritation, circulation problems, or electrolyte imbalance.

Since you noticed improvement when switching socks, friction or pressure on the toes may be contributing. However, persistent cramping could also suggest mild nerve compression or early foot mechanics issues, especially if it only affects one side.

I recommend ensuring that your shoes have adequate toe space and cushioning. Gentle stretching of the foot and calf muscles may help.

If the problem continues or worsens, you should consider a review by a podiatrist, orthopaedic doctor, or a neurologist for further assessment and management.

3. Question by Janet

Hi Dr,

I have needle and pins, numbness on my right foot big toe.

Sometimes when its serious it might affect the rest of the toes. Is this serious? At the moment I am taking Neuroforte B1, B6, B12.

Appreciate your advice.

Answer by Dr Adeline Leong

Pins‑and‑needles and numbness in the big toe are commonly related to nerve irritation or compression. There may be a wide variety of reasons that can cause this.

Taking vitamin B supplements can support nerve health, but they may not address the underlying cause. If symptoms are intermittent and mild, observation may be reasonable.

However, if numbness spreads or becomes persistent, further evaluation is needed.

I suggest consulting a neurologist or orthopaedic doctor for assessment. Early diagnosis is important to prevent progression.

4. Question by Andrew

Dear Dr Adeline Leong,

I am 58 years old and have a slip disc (L4/L5) problem almost 38 years ago. I opt for conservative treatment with physio and attended to TCM as well as chiropractor etc.

While the situation is better after the various treatments, the issue always came back not with sharp pain or unable to move, etc, but with aching pain along the lower back down to back of thigh and the calf area. The kind of "aching" pain (酸痛) can be unbearable especially when I am lying on the bed trying to sleep.

Like to seek your feedback how do I manage such aching pain, or how do I prevent such pain? Any medication you would recommend to relieve the pain as typical panadol does not help. Thank you.

Answer by Dr Adeline Leong

Your symptoms seem consistent with chronic nerve‑related pain from lumbar disc disease. The aching pain that radiates down your leg is a common feature of nerve‑related pain.

Paracetamol is often inadequate to help with this type of pain. Medications specifically targeting nerve pain, combined with targeted physiotherapy, posture optimisation, trigger identification, lifestyle changes, as well as strengthening exercises, may be more effective.

Pain management aims to reduce pain flare‑ups, improve sleep, and maintain function. A pain medicine specialist can evaluate whether medications, physical therapies, or interventional treatments may help control your symptoms and improve quality of life.

5. Question by CW Pun

Dear Dr,

I have cervical stenosis and lumbar stenosis. I feel pain in my neck, shoulders and upper back (I am a walker user) as well as pain all over my body sometimes (I am an osteoporosis sufferer). 

I was prescribed Gabapentin (300 mg) and subsequently Prebegalin (25 mg) since I was diagnosed with spinal stenosis in Feb 2024. I dare not take the aforesaid medication due to warnings on the side effects flagged out by search engines.

For your advice please.

Also, I feel ear pain as well as pressure in my neck and both ears, similar to when I’m in a plane during take-off.

Please advise which specialist department should I consult? Thank you.

Answer by Dr Adeline Leong

It is understandable to feel concerned after reading about medication side effects online. However, medications like gabapentin and pregabalin are commonly and safely prescribed when monitored correctly, especially for nerve pain due to spinal stenosis.

Not everyone experiences side effects, and many side effects are dose‑related and reversible. Starting at a low dose and adjusting gradually to the optimal dose appropriate for you is recommended for best effect.

Your ear pressure and neck symptoms may be related to cervical spine issues or ear issues and should be evaluated further.

I recommend consulting a Ear Nose Throat (ENT) specialist to exclude any ear issues first before consulting a pain management specialist or neurologist to review your symptoms holistically.

6. Question by MK Siew

Hi Dr,

I had the stroke two years ago. It was mild TIA in the beginning

Am on 60 mg of duloxetine and 225 mg oh pregabalin.

Pain is not reduced. Areas: neck, hip, just below rib, thumb, index and middle fingers, and can be anywhere on the palm. Pain is tingling on the fingers and hand.

Numbness in the face and tingling on the upper lip.

Muscle stiffness on the right side of upper torso and right arm.

Conditions keep on increasing overtime.

Medication doesn't seem to be working. Tends to flare up in the afternoon

What else can I do.? By the way, I did an infusion 6 months ago. Good but didn't last. Thank you for reading this.

Answer by Dr Adeline Leong

Your symptoms suggest a condition known as central post‑stroke pain, where the brain’s pain processing pathways are affected after a stroke. This type of pain can be widespread and difficult to control.

Medications such as duloxetine and pregabalin are commonly used, but not all patients respond well and may need to try other types of neuropathic medications.

Pain management for post‑stroke pain often requires a multidisciplinary biopsychosocial approach, including medication adjustments, physical therapy, psychological support, and sometimes interventional therapies.

I recommend assessment and follow‑up with a pain management specialist for comprehensive review and long‑term care planning.

7. Question by CK

Hi Dr,

I am a 74-year-old male citizen. Bottom of my feet (soles) will feel unbearable sharp pain and numbness if I stand still for more than 5 mins OR walk a distance more than 50 meters. Need to sit down for a few minutes to get over it.

Pathologist said is “nerve compression” and prescribed only pain killer and neurobion. Situation never resolved after months…

What should I do? Appreciate your advice and kind assistance. Thanks in advance!

Answer by Dr Adeline Leong

Your symptoms are in line with neurogenic claudication (nerve compression). While painkillers and vitamins may relieve symptoms temporarily, they do not address the root cause.

Further investigation is important. This may include imaging of the spine, nerve studies, or vascular assessment depending on clinical findings.

Please seek review by a pain specialist, neurologist, or orthopaedic surgeon for early management to improve mobility and prevent further deterioration.

8. Question by CP

Hi Dr. Leong,

I am 68 years old, male.  My whole body is aching - from neck to ankles.  I am not sure whether it is bone pain, joint pain or muscle pain.

What is the possible cause(s)?  Should I see an orthopaedic specialist or pain management specialist? Thanks.

Answer by Dr Adeline Leong

Generalised body pain can result from many conditions, including muscle tension, degenerative joint disease, metabolic issues, or chronic pain syndromes.

Differentiating whether the pain originates from muscles, joints, or nerves requires careful assessment. Blood tests or imaging may also be needed.

You may start with either an orthopaedic specialist (if its mainly movement‑related pain) or a pain management specialist, who can coordinate evaluation across multiple systems and guide appropriate treatment.

9. Question by YH Lim

Hi Dr,

May I know whether Fibromyalgia diagnosed by a General Practitioner is treatable at the Pains Management Centre? Thank you!

Answer by Dr Adeline Leong

Yes, fibromyalgia is managed at SGH Pain Management Centre, even if the condition was initially diagnosed by a general practitioner.

Fibromyalgia is a chronic condition characterised by increased sensitivity to pain in addition to other symptoms such as fatigue and “brain fog”. Management focuses on reducing pain, improving sleep quality, enhancing daily function, and identifying and managing stressors or triggers. Treatment is holistic and may include medications, exercise therapy, patient education, and lifestyle modifications.

At SGH Pain Management Centre, our doctors will first conduct a comprehensive assessment to evaluate your symptoms and confirm the diagnosis of fibromyalgia. We also offer pain management group programmes that bring together these treatment approaches in a supportive, multidisciplinary setting.

Early intervention and coordinated, multidisciplinary care are key to achieving better long‑term outcomes and improving quality of life.

10. Question by Howard

Hi Dr. Adeline Leong,

Recently, I have been hearing a lot about pain management. What is it about? Is it another option to consider instead of going under the knife to alleviate the pain by surgery.

Heard of friends going for surgery for back pain but not much improvement after the operation. Have also heard of people going through life and enduring the pain without going for an operation.

I am 69 years of age and having back pain for the past 5 years and bone spur on my right foot occasionally causing numbness to the toes. Should I proceed with an operation and relieve the pain or should I consider pain management with medication to go on with life?

Hope I can have some advice from you as I will be seeing an orthopaedic surgeon for a decision.

Thank you for your advice.

Answer by Dr Adeline Leong

Pain management is a medical specialty that focuses on relieving pain, improving function, and enhancing quality of life, especially when surgery is not clearly beneficial or carries significant risk.

It is not simply about medications, but includes a range of approaches such as targeted therapies, rehabilitation strategies, lifestyle guidance, and sometimes minimally invasive procedures.

Surgery can be helpful in many cases but may not guarantee pain relief depending on the specific condition. Many patients can benefit from pain management either before surgery, after surgery, or instead of surgery.

Given your long‑standing back pain and foot symptoms, it would be reasonable to consider a pain management consultation alongside your orthopaedic review. This allows you to make a well‑informed decision with a full understanding of all available options.

11. Question by GW

Dr Hi Dr, 

I experience chronic pain that is sharp at times and painless on others. This is felt at bedtime, middle of the night. To alleviate the pain I apply and that helps manage the pain.

What is this condition and if medical attention is required, can you provide me with a referral letter to see a GP from the polyclinic?

Answer by Dr Adeline Leong

Thank you for sharing your experience.

Many patients experience heightened pain sensitivity at night, when distractions reduce and the nervous system becomes more aware of bodily sensations.

It is encouraging that topical applications help, suggesting a local or musculoskeletal component.

Medical attention is recommended if:

• The pain is persistent, worsening, or disturbing sleep regularly
• There is numbness, weakness, or pain radiating to an arm or leg
• Pain is associated with fever, unintentional weight loss, or trauma

You can start by visiting your GP or polyclinic doctor, who can assess and decide if further imaging, physiotherapy, or specialist referral is needed. A referral letter is typically issued by the GP/polyclinic doctor to the required specialist.

In the meantime, attention to sleep posture, gentle stretching, pacing activities, and stress regulation can help reduce night-time pain sensitivity.

12. Question by Micky

Hi Doctor,

I would like your specialist opinion about dealing with pain.

I have a continuous disturbing pain in my inner ear and have visited my doctor for treatment. I was diagnosed with pain caused by ear wax buildup. They tried flushing the stubborn ear wax with water but failed and now redirected to specialist for further treatment.

Unfortunately the first available appointed date is a month (public government hospital).

Meanwhile the pain is still causing much discomfort and affecting my sleep as well. I was prescribed with Ibuprofen for the discomfort till the scheduled Specialist appointment (month) to remove the clogged ear condition professionally.

My question, is it wise to take the pain killer continuously till my scheduled (month) appointment and tried to bear with the discomfort/pain instead.

Please advise. Thank you.

Answer by Dr Adeline Leong

Short-term use of ibuprofen for pain relief while waiting for your specialist appointment is generally safe for most people, provided that:

• You take the lowest effective dose
• You take it with food
• You do not have a history of stomach ulcers, kidney disease, uncontrolled high blood pressure, or heart disease

However, continuous daily use over several weeks may increase the risk of:

• Gastric irritation or ulcers
• Kidney injury
• Cardiovascular complications

If the pain is tolerable without medication, it would be reasonable to use ibuprofen only when necessary rather than on a regular, around-the-clock basis.

Additional supportive measures include:

• Avoiding insertion of any objects into the ear
• Keeping the ear dry

Ultimately, identifying and treating the underlying cause is most important. Review by an ENT specialist will be key, as appropriate treatment is likely to resolve the pain.

If the pain becomes more severe or is associated with symptoms such as hearing loss, dizziness, ear discharge, or fever, you should seek earlier medical attention — either by requesting an earlier appointment or presenting to emergency services if needed.

13. Question by SH Lim

Hello Dr Leong, I hope my message finds you well.

I have a lower back budged disc and nerve compression issue for almost 8 years. My bone test done late last year was osteopenia stage.

I am currently undergoing physio. I have very bad cramps whenever I flip myself on one side while sleeping (around ankle, hamstring, knee areas), tingling and numbness on a daily basis either on feet, legs or arms.

If I stand too long, the pain will start from buttocks area. If worse, pain will travel down to my feet.

My LDL is on a high side, and HDL is also on a high side. Ratio is within range.

I am trying to manage my pain and discomfort by doing stretching and beginners reformer pilates at least 2 times a week. I think it helps a little.

I would like to seek your kind and honest opinion on what better I could be doing, and is there any supplements I should be taking. Thank you so much!

Answer by Dr Adeline Leong

You have clearly been very proactive and thoughtful in managing your condition, which is commendable.

What you are already doing well:

✅ Physiotherapy
✅ Consistent stretching
✅ Beginner reformer Pilates (excellent for core control and spinal support)

While no supplement can directly “fix” nerve compression, some may support overall musculoskeletal health.

• Additional considerations include:
• Optimising sleep posture
• Pacing activities to avoid prolonged periods of standing
• Maintaining a balanced, nutrient-rich and non-inflammatory diet
• Regarding supplements: calcium and vitamin D may be helpful for bone health if dietary intake is insufficient
• If pain is affecting your sleep or daily function, a low-dose neuropathic medication can be considered to help manage symptoms safely

Most importantly, pain management should focus on maintaining function and building confidence in movement, rather than aiming to eliminate all pain entirely.

14. Question by Faith

Hi Dr Leong,

I have been having this numbness (pins and needles) perpetually since Sept 2025.

On good days, the intensity can be at its lowest level of 1 and on not so good days, it can be at 9.5.

Some days i do experience lower back pain and I have noticed that my immunity is weaker now since Nov/Dec 2025.

There’s a suspected electrophysiology evidence of bilateral S1 radiculopathy.

I would like to ask pls:

a) With the above, what could be the cause of this?

b) Do you suspect that it could be autoimmune disorder (i.e. MS)?

c) How to deal/cope with the sensation?

Thank you for your advice.

Answer by Dr Adeline Leong

Based on the information you have shared:

Electrophysiological findings of bilateral S1 radiculopathy suggest irritation or compression of the S1 nerve roots.

This pattern is more commonly associated with structural causes, such as intervertebral disc pathology or degenerative spinal changes, rather than autoimmune conditions.

A definitive diagnosis will require a more comprehensive assessment, including detailed history-taking, physical examination, and full review of your investigations.

Based on the current information, the following considerations may be relevant:

a) A likely underlying cause is mechanical nerve root irritation, such as lumbar spinal stenosis — particularly if this is associated with lower back pain.

b) Demyelinating conditions such as multiple sclerosis typically present with different clinical patterns (e.g. visual disturbances, coordination or balance difficulties, and other central nervous system features). Based on your description, this appears less likely.

c) Supportive management strategies may include:

• Maintaining gentle, regular movement (while avoiding prolonged inactivity)
• Preserving consistent sleep routines
• Addressing fear-driven avoidance behaviours (recognising that pain does not necessarily indicate harm)
• Incorporating mind–body approaches (e.g. breathing exercises, mindfulness)
• Considering medications for neuropathic pain if symptoms significantly impact function

15. Question by BR

Hi Dr,

The top side of my feet always feel burning, pain and tingling. What causes this and how do I get rid of it? Thank you.

Answer by Dr Adeline Leong

Burning and tingling sensations over the top of the feet are most commonly neuropathic (nerve-related) in origin. Potential causes include:

• Peripheral nerve irritation or entrapment
• Lumbar spine nerve involvement (e.g. radiculopathy)
• External compression, such as from tight or stiff footwear
• Metabolic factors, including diabetes or vitamin deficiencies

Practical steps to consider:

• Review footwear—avoid tight laces, narrow toe boxes, or rigid uppers
• Monitor whether symptoms are triggered or worsened by walking, prolonged standing, or certain positions
• Seek medical assessment if symptoms persist, progress, or extend to other areas
• Management focuses on addressing and treating the underlying cause, as well as reducing nerve sensitivity. This may include:
  • Medications for neuropathic pain
  • Topical treatments (e.g. patches or creams)
  • Desensitisation approaches to gradually reduce nerve hypersensitivity

16. Question by Michael

Hi Dr,

Is it true that if we take Panadol and Oxycodone daily for control of pain after a neck surgery can be harmful to our kidney and liver.

Also, does taking oxycodone interfere with selegiline for treatment of Parkinson Disease. Thanks.

Answer by Dr Adeline Leong

Thank you for your question and for being mindful about your medications.

Paracetamol (Panadol) is generally safe for the kidneys when taken within recommended doses.

Oxycodone, when prescribed and used appropriately for acute pain, does not directly harm the liver or kidneys. However, longer-term use may be associated with side effects such as:

• Constipation
• Drowsiness or cognitive slowing
• Dependence
• Tolerance (reduced effectiveness over time)
• Possible effects on the immune system

Regarding selegiline:

There can be interactions between opioids and certain Parkinson’s medications, including increased sedation and, rarely, serotonin-related effects

This combination should be used under medical supervision, with appropriate monitoring.

Principles of long-term pain management include:

✅ Using the lowest effective dose
✅ Combining medications with rehabilitation and self-management strategies
✅ Regular reassessment, rather than assuming the need for lifelong therapy

17. Question by Alarice

Dear Dr,

My question is as follows:

Pain is extremely qualitative, but can be quantified with pain scales. However, it is still subjective to every individual.

How do doctors decide how much pain medication to give patients, and when do they suggest self-management treatment (e.g. lifestyle and psychological coping)?

Additionally, since there is a limit to how much medication can be given to stop the pain, what happens when the patient’s tolerance has already reached its limit? What is the right approach if the patient still feels pain?

Thank you so much for taking my question.

Answer by Dr Adeline Leong

This is an excellent and highly thoughtful question.

When assessing pain, doctors consider several key factors:

• The nature and cause of pain (acute vs. chronic; tissue-related vs. nerve-related)
• Its impact on function and daily activities
• Individual health risks
• Response to prior treatments

While pain scales are helpful, clinical decisions are guided even more by function and overall quality of life.

Self-management strategies should always complement, not replace, appropriate medication use.

When tolerance develops:

• Simply increasing medication is rarely the optimal solution; medication rotation may be considered.
• More importantly, the focus shifts toward:
  • Non-pharmacological approaches
  • Recalibrating the nervous system
  • Building psychological resilience
  • Restoring physical function

It is also important to recognise that pain does not always equate to harm. In chronic conditions, pain often reflects a sensitised nervous system—one that can improve with the right, holistic approach.

18. Question by Betty

Greetings Dr Adeline Leong.

May I have your advice on how to manage lower back pain?

I am a 73-year-old female not on any medication but have been having chronic back pain for the past few months since I had dengue fever on 8 December last year.

I am not sure if this is post-dengue back pain or chronic back pain as we age and degeneration sets in. The back pain is worse upon waking up from sleep in the morning and getting up from the bed.

The pain becomes less after some stretching movements. However, the pain would not go away!

Appreciate your advice, please. Thank you!

Answer by Dr Adeline Leong

Post-viral pain can persist for months in some individuals, including after dengue fever. However, in people aged over 70, age-related degenerative changes may coexist.

Your pattern — worse on waking, improves with movement — suggests a mechanical or inflammatory component.

Helpful strategies include:

• Gentle morning mobility routines
• Regular low-impact physical activity
• Strengthening of hip and trunk muscles
• Avoiding prolonged rest

Pain that improves with movement is often manageable and not harmful, even though it is uncomfortable.

If pain remains persistent, a GP or physiotherapist review may help guide further care.

19. Question by Mdm Tan

Dear Dr Adeline Leong

I had shingles last year on my right neck, my right cheek and the back of my head on the right side.

The shingles affected the muscle or nerves on the right side of my face resulting in my right jaw unable to close properly affecting my chewing during meals & unable to open my right eye fully.

After some acupuncture sessions and self-massage for the past 1 year, it has improved about 50%.

Nonetheless, my right eye is still partially closed and my lips lopsided whenever I smile. Whenever I'm stretching or trying to perform yoga, my right jaw, right arm & right leg will shake which can be quite painful especially at my jaw area.

Please advise is there any medication to cure my situation? Or can you please advise the type of doctor that I should consult to try to fix my issue. Many thanks.

Answer by Dr Adeline Leong

Your symptoms may be consistent with post-herpetic nerve injury.

Unfortunately, there is no single medication that can completely reverse nerve damage. However, gradual improvement can occur over time, sometimes continuing for years. Studies suggest a generally favourable prognosis, with more than 50% of patients recovering full motor function and a further one-third experiencing significant improvement.

Specialists who may be helpful to involve include:

• Neurologists
• Rehabilitation medicine physicians
• Pain specialists

Management typically focuses on:

• Reducing nerve sensitivity and pain
• Supporting functional recovery
• Preventing secondary complications

Your progress so far is encouraging, even if recovery feels slow. Continued improvement remains possible with a comprehensive and consistent approach.

20. Question by Healey

Dear Dr,

As recent visit to the polyclinic for a x-ray scan for my prolong neck and shoulder pain, doctor found the C3 to C7 Degenerative due to old age and have referred me to physiotherapy.

My issues are whole day the pain will surface at my neck area and if I do walking or out to run errands, after 2-3 hours my whole back area will be numb and hard.

Please advise should I go see a pain specialist or do further MRI or CT Scan?

Thank you for your advice.

Answer by Dr Adeline Leong

Degenerative changes from C3 to C7 are very common and may not automatically require surgery or advanced imaging.

• Physiotherapy is an appropriate first step.
• Further imaging (MRI or CT) or pain specialist referral may be considered if:
• You develop progressive weakness or numbness
• Pain does not improve after adequate conservative treatment
• There are red flag symptoms (e.g. fever, weight loss, trauma)

Seeing a pain specialist is reasonable if pain continues to limit function despite initial treatment.

Ref: F26