The honest answer depends on which structure is causing it. Here is how to tell.

AM I A CANDIDATE?

The honest answer depends on which structure is generating your pain, which is a question most people arrive without an answer to. Here is how to tell whether this is worth your time.

You are probably in the right place if

• Your neck pain has lasted more than six weeks and has not responded to the obvious first steps.
• You have pain traveling into the shoulder, arm or hand and nobody has mapped the distribution properly.
• You have had a scan that was reported as showing degenerative change, and treatment aimed at that has not helped.
• You have a headache that starts at the back of the neck and nobody has examined your upper cervical spine.
• You have had neck surgery and the pain is still there, or a new problem has appeared since.
• You have been offered an operation and want the diagnosis confirmed before agreeing to it.
• Your imaging is normal and you have been told there is nothing wrong.

You need somewhere else first if

You have signs the spinal cord is involved — clumsy hands, difficulty with buttons or coins, dropping things, a change in walking, or bladder disturbance. Progressive weakness rather than painful weakness. Fever with neck pain. Unexplained weight loss. A history of cancer with new neck pain. Recent significant trauma.

Those are on the urgent page and they need assessment now rather than an outpatient appointment in a few weeks. Saying so plainly is more useful than booking you in.

What being a candidate actually means

It does not mean you are a candidate for a procedure. It means you are a candidate for an evaluation that will establish which structure is responsible, after which the treatment follows from the diagnosis rather than from what happens to be available.

A meaningful proportion of people who come through this door are treated without any injection at all — because the answer turned out to be muscular, postural, load-related, or a peripheral entrapment that responds to a splint. That is a good outcome, not a wasted appointment.

Age, and whether it rules anything out

It does not, by itself. Degenerative change is more common with age and so is the assumption that nothing can be done about it, which is a separate thing and a wrong one. Diagnostic blocks, radiofrequency treatment and nerve studies are not age-limited procedures.

What changes with age is the differential — giant cell arteritis enters it over fifty, and it is one of the few things on this website that is genuinely time-critical.

If you have already been told nothing more can be done

That statement is almost always about a specific treatment pathway rather than about your neck. It usually means surgery is not indicated, or that one service has run out of options within its own scope. Neither is the same as the pain being untreatable.

The most common finding in people arriving with that sentence is that a structure was never tested. Facet-mediated pain in particular goes years without anybody putting the question to a diagnostic block, because it does not show on imaging and there is no blood test for it.

What we can treat, listed plainly

Facet-mediated neck pain, tested with a diagnostic block and treated with radiofrequency ablation. Cervical radiculopathy, treated medically and, where it is not settling, with a targeted epidural steroid injection at the confirmed level.

Cervicogenic headache and occipital neuralgia. Myofascial pain and trigger points. CRPS, including stellate ganglion blocks and, in refractory cases, spinal cord stimulation. Carpal tunnel hydrodissection. Botulinum toxin for cervical dystonia and chronic migraine.

What we assess even when we are not the ones who treat it

Shoulder pathology, jaw involvement, peripheral entrapments at the wrist and elbow, and the vestibular contribution to unsteadiness after neck surgery. Those are assessed because they change the diagnosis, and identifying one of them is frequently the most valuable thing that happens at the appointment.

Where the answer lies with another service, you leave with a diagnosis and a specific destination rather than a general referral. That is the difference between being passed on and being directed.

How to decide whether to book

If you can name the structure that is causing your pain and the treatment aimed at it has been tried properly and failed, another opinion may not add much. If you cannot — if what you have been given is a category, a scan finding, or nothing at all — then the diagnostic step has not happened yet, and it is the step everything else depends on.

That is the whole basis on which this practice is worth your time. Not a procedure you have not tried, but a question nobody has asked yet.

If you are deciding between opinions

Ask each service which structure they identified and how they tested for it. A named structure with a test behind it is a diagnosis. A scan finding, a category, or a treatment offered without either is not, however senior the person offering it.

That one question sorts most of the confusion people arrive carrying, and it is worth asking of us as readily as of anybody else.

If you are traveling from outside the metro

We see patients from across the St. Louis region and from Illinois, and a first appointment is built to be worth a single trip: history, full examination of the neck, shoulder and arm, and a working diagnosis on the day rather than after a sequence of visits.

Where a nerve study or a diagnostic block is needed it is arranged promptly, and where possible it is coordinated so that a longer journey is made once rather than three times.

What a wasted appointment would look like

Being told your imaging explains your pain without an examination that supports it. Being given a category rather than a structure. Or being routed onward without anybody having tested the thing that is testable.

Those are the three failures this practice is organized around avoiding, and they are reasonable things to hold us to.

What people ask before booking

Do I need a referral?

No. Bring your imaging, prior test results and a list of what has already been tried. What the first visit covers.

What if I do not want any injections?

That is a legitimate position and it does not disqualify you. The evaluation still tells you what the problem is, and a good share of what we find is managed without procedures. How treatment gets paid for.

I have had three opinions already. Will this be a fourth of the same?

It is worth asking each previous service which structure they identified. If the answer was a category rather than a structure, this is a different exercise. How the medial branch block is performed and read.

Is it worth coming if my pain is mild?

If it is mild and improving, patience is reasonable. If it is mild and has been there for a year, the question is why, and that is answerable. Why a normal MRI does not close the question.

Do you see Illinois patients?

Yes. The practice is licensed in Missouri and Illinois. What the first visit covers.

Related reading

• What to expect at your first visit
• About this practice
• When a neck problem is urgent
• Why your MRI does not explain it
• Neck pain doctor in St. Louis
• Connect with us

Candidacy and cost are separate questions. The second is answered on how treatment gets paid for.

If an operation has been raised, these are the three questions worth asking first.