Still in pain after six months of rehabilitation, but the doctor says no surgery is needed? First, go back and find the root cause of the pain.

Conversations like this are common in outpatient clinics: "It's been hurting for nearly a year. I've done physical therapy for half a year, and followed all instructions for hot compresses, electrotherapy, stretching, acupotomy, and physical therapy. The doctor said surgery isn't necessary. While I feel great about not needing surgery, what now? Nothing happened after that. I keep taking the medicine, keep doing the physical therapy, and the pain is still very severe."

In fact, many people have their treatment phase stalled here. This article discusses what should be done at this stage: instead of switching to yet another treatment, go back and find out the exact cause.

Why do patients get stuck in a state of "no surgery needed, but unable to get better"?

Because "no surgery needed" answers a different question.

No surgery needed means: there are no structural problems on the images that require surgical treatment, and no obvious compression, tears, or unstable bone structures. This is the result of the elimination method and is an important step in treatment. However, ruling out the reasons for surgery does not mean finding the cause of your pain. There is a connection between the two.

Most medical processes stop once "no surgery needed" is reached. What follows is pain relievers and rehabilitation. If they work, that's great; but if it still hurts after half a year, the problem is usually not a lack of effort in treatment, but rather the need for more patience to work with the doctor to find the real cause of the pain.

When pain persists and the cause cannot be found, where does the problem usually lie?

The most common issue: the location of the pain is not necessarily the location of the problem.

Referred pain is typical. A problem with the cervical nerve root causes pain on the outer side of the elbow; a hip joint problem causes pain in the knee; deep gluteal muscles pressing on the sciatic nerve cause pain down the entire leg. If you only check the painful spot, the source will always remain outside the scope of the examination.

Next are sources that do not show up on imaging. Tension imbalance in deep myofascia, nerve compression in specific channels (such as the radial tunnel in the forearm), and abnormally proliferating microvessels and nerve endings in chronically inflamed tissues. This information is not obvious on general imaging, but it will continue to send pain signals. A normal MRI does not mean there is no cause; this topic is fully explained in "Why does it still hurt when the MRI check is normal? Four pain sources that imaging cannot capture".

Another type is vascular pain. In addition to nerves and musculoskeletal issues, pain in the lower limbs can also come from blood vessels. A pattern of pain when walking and improvement with rest particularly requires a detailed diagnosis. This requires a vascular-side assessment, which uses a different examination logic than orthopedic rehabilitation.

To find the cause again, how is it actually found?

Check them one by one, in the following order.

The doctor will first conduct a detailed inquiry and discussion of the medical history. For example, how long has it hurt, what movements cause pain, does it hurt at night, what treatments have been done, and how was the response to each at the time. These answers themselves will rule out some possible causes. Then comes the physical examination—posture, joint range of motion, muscle strength, and neurological reflexes—using the body's actual responses to find the answer.

Next is imaging. Ultrasound looks at the actual state of soft tissues and tendons, and X-rays look at bone structure and alignment; an MRI is arranged if necessary, or further evaluation is done for vascular pain symptoms. The initial pain clinic consultation at See-Health includes these four items: detailed history taking, physical examination, advanced ultrasound imaging, and X-rays. This is because finding the cause is something that should cover the basics all at once, rather than being split into four separate appointments.

What must be honestly said here is: not every cause can be found. But with the right checking order, at least we know what has been ruled out and what the remaining possibilities are. Only then is there a basis for the next step of treatment, rather than taking turns to try different things and starting all over again in the next clinic room.

What should be prepared before the consultation to save the most time?

Four things; bringing them all usually saves a trip.

Previous imaging data, either on a CD or via a cloud link, along with reports. Treatment records, especially what injections were given, how many times, whether they were effective at the time, and how long the effect lasted. This information is extremely useful for doctors to judge the source of pain. Many people cannot remember clearly, so it is recommended to recall and write it down before leaving home. The current medication list, including chronic disease medications. Finally, the record of the pain itself: when does it hurt, what movements trigger it, and does it wake you up at night.

The value of this information in the consultation room is more valuable than doing an extra test.

Once the cause is found, what is the next step?

It depends on the cause determined by the doctor.

For overall treatment options and order, please see "What treatment options are available for chronic pain?". For specific parts, please see "Why does tennis elbow never seem to get better?", and for frozen shoulder, please see "What to do when frozen shoulder rehabilitation never seems to get better?".

Want an evaluation?

If your pain has lasted for more than half a year, and the effects of rehabilitation, injections, physical therapy, acupotomy, and medication are limited, you can first undergo a pre-evaluation via LINE, and bring all four of the above materials with you during your consultation.
For information on what materials to prepare before the first consultation, the consultation process on the day, and fees, please see "What to prepare for your first pain clinic visit"
See-Health Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City, and operates entirely on an appointment basis. Phone: (02) 2366-0186.

Author: Dr. Ping-Sheng Lu

Last updated: August 16, 2026

Disclaimer: This article is for educational purposes and cannot replace medical diagnosis and treatment advice. The suitability of any treatment should be evaluated and decided by a doctor.

Yuji Okuno Transcatheter Arterial Embolization Research References:
Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995-1002. doi:10.1016/j.jvir.2017.02.033