New Approaches To Chronic Pain

Welcome to another edition of the Doctor's Note where we talk about what's on our minds when it comes to your health.

This week I had the privilege of sitting down with Dr. Michael Wilkinson, one of our region’s most esteemed pain specialists. We dove deep into the multifaceted world of chronic pain—especially spinal pain—and the importance of a “common sense” approach to both prevention and treatment. Dr. Wilkinson shared his remarkable journey from West Point to Yale and Johns Hopkins, explaining his return home to East Tennessee to make a meaningful difference in pain medicine, a specialty that’s faced its fair share of challenges, particularly amidst the opioid epidemic. His mission has always been to bring world-class care back to his community and offer patients alternatives that are not only effective but safer and less invasive than traditional surgery.

Our conversation really highlighted how the treatment of chronic pain is evolving. Instead of jumping straight to surgery or long-term opioid use, Dr. Wilkinson emphasized a layered, minimally invasive approach. From the critical role of physical therapy to next-level innovations like spinal cord stimulators and precision-guided ablations, he outlined how modern pain management offers hope for improved mobility and quality of life. Importantly, we discussed the value of prevention—exercise, weight management, and healthy lifestyle choices play a massive role in keeping pain at bay. As technology advances, so too does our ability to offer solutions that help people live well, stay active, and avoid unnecessary interventions.

PODCAST NOTES

• Chronic spinal pain is nearly universal with age, but Dr. Wilkinson reframes it as a “disease of a life well lived.” Instead of viewing this pain negatively, he highlights that wear and tear reflects activity and engagement with life over the years. Many people develop issues not only due to aging, but as a direct result of leading an active lifestyle, making movement and physical participation central to understanding the roots of discomfort.

• Physical therapy is the essential first line of defense for back pain. Dr. Wilkinson always investigates whether a patient has attempted therapy before proceeding with any medical interventions. In many cases, guided core strengthening and movement exercises resolve pain entirely, preventing the need for more invasive options or medications. This empowers patients to take charge of their recovery and avoids unnecessary medicalization.

• Surgery should be the final resort for managing spinal pain. Both Dr. Wilkinson and the local neurosurgeons he works with now only consider surgery after failing all non-invasive and minimally invasive treatments first. Patients are increasingly referred back from surgical consultation to pursue therapies such as medications, injections, and ablations before operating—a shift toward prioritizing patient safety and reducing unnecessary risk.

• Long-term opioid use is discouraged in chronic pain cases. While opioids are not inherently evil, Dr. Wilkinson emphasizes their significant drawbacks—including limited effectiveness for non-cancer pain, risk of tolerance, and potential for addiction. Other medications and interventional techniques offer more sustainable approaches. His practice minimizes opioid prescriptions and focuses on interventions that treat the root causes without introducing additional health risks.

• Spinal cord stimulation is a groundbreaking, minimally invasive procedure for patients with persistent, severe spinal pain that hasn’t responded to other treatments. This technology acts much like a pacemaker, using electrodes along the spine to alter pain signals and often delivering dramatic, lasting relief. Importantly, patients can trial these stimulators for a week before deciding on permanent implantation, ensuring significant benefit before committing to the procedure.

• Ablation procedures target pain originating from arthritic spinal joints. By identifying and using a prognostic nerve block, Dr. Wilkinson determines if ablating tiny nerve fibers that transmit pain will provide lasting relief—sometimes for months or years. This is particularly valuable for axial pain (pain that doesn’t radiate) and offers a safe, low-risk alternative to more aggressive treatments, often allowing patients to remain active and independent.

• Epidural steroid injections are best suited for pain that radiates down the arms or legs, such as sciatica. Performed under X-ray guidance, epidural injections reduce inflammation around irritated nerves and can provide significant, though temporary, relief lasting anywhere from six weeks to several months. By easing pain long enough for healing to occur or physical therapy to take effect, they may delay—or even eliminate—the need for surgery

• Prevention and lifestyle choices are foundational to avoiding chronic pain. Dr. Wilkinson stresses the roles of regular exercise, proper nutrition, weight management, and supplementation. Much of the pain he treats is linked to obesity and inactivity. He strongly advocates for preventive care—moving more, maintaining a healthy weight, and building good habits early—so patients can avoid entering the chronic pain cycle in the first place.

I want to reinforce how essential it is to stay proactive about your health. Chronic pain can steal so much joy from life, but the right approach—starting with prevention and embracing minimally invasive treatments—can bring real relief and restore your ability to do the things you love. 

If you’re dealing with pain or want to know how to keep yourself healthy as you age, don’t hesitate to reach out to us or connect with specialists like Dr. Wilkinson. Remember: prevention is always better than treatment, and together, we can help you age well and live your life fully.

Stay educated. Stay healthy. 

Till next week.