Epidural. Nerve block. Steroid injection. If you have had chronic spinal or joint pain for any length of time, you have probably been offered at least two of these. It is worth noticing what they have in common.
They are all designed to do one thing: block the signal.
Your pain is a message, not a malfunction
The framing matters more than it might seem. If pain is a malfunction — a wire misfiring, a system erroring out — then silencing it is a repair.
But pain is not a malfunction. It is a message. It is the output of a system reporting that something in your body requires attention. Suppressing the report does not change the condition being reported on.
And when a system silences the messenger without ever asking what the message means, you do not get healed. You get scheduled for the next procedure. That is the structure of symptom masking: each intervention buys an interval, the interval expires, and the interval’s expiration becomes the indication for the next intervention. It is a loop that is stable, billable, and repeatable — which is precisely why it persists.
None of this is an indictment of the physicians performing these procedures. It is an observation about what the model is built to do. A system organized around procedures will reliably produce procedures.
The imaging trap
There is a second structural problem, and it sits upstream of the injections.
In spinal pain, imaging is notoriously unreliable as a pain generator. That abnormality on your MRI — the bulge, the degeneration, the finding that was circled and explained to you — is not a reliable explanation for what you feel. Plenty of people who feel absolutely fine have one too. They have never had a symptom and never will.
This creates a trap with three steps. A structural finding is identified. It is assumed to be the cause. An intervention is aimed at it.
When the intervention does not produce durable relief, the conclusion drawn is usually that the wrong level was targeted, or that a bigger procedure is needed — rather than that the finding may never have been the pain generator in the first place. So the chase continues, aimed at a target that may have been incidental all along, while the actual driver goes unexamined.
The fire nobody measured
Drawing on Hotamisligil’s landmark 2006 work on meta-inflammation, Dr. Padda connects a piece the assembly line does not: your pain signal is often downstream of a systemic metabolic fire that nobody measured.
That reframes the entire sequence. If the signal originates from a systemic inflammatory and metabolic state, then the local finding on your scan is not the source, and the local block is aimed at the wrong level of the problem entirely. Silencing the alarm does not put out the fire. It just means you find out about the fire later, and by a less convenient route.
It also explains something you have probably experienced: the diminishing returns. The first block worked well, the second less so, the third barely. That pattern is what you would expect from a local intervention applied to a systemic driver — the driver keeps producing signal, and the local suppression keeps getting outpaced.
Dr. Padda has spent more than thirty years across anesthesia, interventional pain, and metabolic health. He also owns clinics, which is why the critique here is specific rather than vague: he knows exactly why the assembly line is built the way it is, because he has operated inside the same economics.
Audit first, then intervene
The alternative is not to reject needles. It is to change what the needle is for and when it comes.
At Regen.MD, the needle is not the therapy. It is the final, localized step in a much larger biological strategy. The sequence runs in a deliberate order: first we audit, then we restore the terrain, then we intervene.
The audit exists to answer the question the imaging cannot — what is actually generating this signal, and what systemic conditions are sustaining it. Restoring the terrain addresses the metabolic and inflammatory environment before anything local is attempted. Only then does a targeted intervention make sense, because only then is it being delivered into a system capable of responding to it.
If you have had a series of blocks with fading returns, the useful next question is not which level to inject next. It is whether anyone has measured the fire.
Frequently asked questions
Are epidurals and nerve blocks always the wrong choice?
No. These are legitimate tools with real indications, and there are situations where blocking a signal is exactly the right thing to do. The concern raised here is about a specific pattern: repeated signal-blocking as an ongoing strategy, aimed at an imaging finding that may not be the pain generator, while the systemic driver is never assessed.
Should I cancel my scheduled injection?
No. Do not start, stop, or change any treatment without consulting your physician. If this article raises questions for you, bring them to the physician who knows your case, or seek a formal second evaluation before your date. Nothing here is a directive to abandon care that has been recommended to you.
My MRI showed a real abnormality. Does this mean it is irrelevant?
Not necessarily — it means the finding cannot be assumed to be the cause without further evidence. Imaging is unreliable as a pain generator in spinal pain, and people without any symptoms frequently have similar findings. Establishing whether your finding is generating your pain requires clinical correlation, not the image alone.
Why do the blocks work less well each time?
That pattern is consistent with a local intervention being applied to a systemically driven problem. If the underlying driver continues unaddressed, each round of local suppression is working against an input that has not diminished. It is a reason to widen the assessment rather than to escalate the same approach.
Key takeaways
- Epidurals, nerve blocks, and steroid injections share a single mechanism: blocking the signal.
- Pain is a message, and silencing the messenger schedules the next procedure rather than resolving the problem.
- In spinal pain, imaging is notoriously unreliable as a pain generator — asymptomatic people commonly have the same findings.
- Drawing on Hotamisligil’s 2006 work on meta-inflammation, the pain signal is often downstream of an unmeasured systemic metabolic fire.
- At Regen.MD the needle is the last step, not the therapy: audit first, restore the terrain, then intervene.
Medically reviewed by Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed July 2026.
This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary, and not every patient is a candidate for the therapies described. Do not start, stop, or change any treatment without consulting your physician.
Find out what is actually driving your pain
Regen.MD begins with a physician-led Clinical Evaluation — a review of your history, imaging, and metabolic data, and a written terrain roadmap. Evaluation is contingent upon review of your data.
Questions? Call (314) 668-1525 or text (314) 886-5902.
Leave a Reply