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Bridging the Gap: How Orthopedic Surgeons Shaped My Approach to Pain Management

cassis101

Updated: Feb 3




Medicine is always evolving, and throughout my career, I’ve had the privilege of witnessing massive transformations in interventional pain management. What was once a field focused solely on temporary pain relief through injections has expanded into a true surgical subspecialty, incorporating restorative treatments and advanced interventions that change lives.

A key driver of this evolution? Orthopedic surgeons.

Early in my career, I had little interest in orthopedic surgery. As a medical student, I saw it as a rough, blood-soaked specialty filled with brash personalities that seemed nothing like me. There were no women in the field, and the operating room was often a "boys' club" where surgical bravado reigned.

But over time, I developed deep respect for orthopedic surgeons—not just for their technical skills, but for their impact on the development of pain management as a specialty.


Dr. Prithvi Raj: A Surgeon Who Transformed Pain Medicine

One of the greatest influences on my career was Dr. Prithvi Raj, a world-renowned anesthesiologist and interventional pain specialist who was one of my mentors during my pain fellowship at Texas Tech University.

What set Dr. Raj apart? He wasn’t just an expert in anesthesia and pain medicine—he was originally trained as an orthopedic surgeon in India before transitioning into interventional pain management. His surgical expertise transformed our field, elevating pain management from a specialty focused on temporary injections to one that incorporated true surgical interventions.

Dr. Raj pioneered techniques that are still widely used today.

His legacy continues to shape modern pain medicine, proving that the best solutions often come from merging disciplines—in this case, the precision of anesthesiology with the structural expertise of orthopedic surgery.


From Skepticism to Appreciation: My Journey with Orthopedic Surgeons

Even before my fellowship in Pain Management, I had a complicated relationship with orthopedic surgery.

As an anesthesiologist, I worked through countless grueling, bloody orthopedic surgeries, keeping patients alive while surgeons fractured and reconstructed bones with what seemed like brute force. I once had an orthopedic surgeon knock my endotracheal tube out mid-surgery, creating a moment of sheer panic as I scrambled to keep my patient stable.

The culture in orthopedic operating rooms was different—at times, it felt aggressive, hyper-masculine, and dismissive. I remember being so frustrated by a particularly boisterous and unfiltered OR environment that I once asked an orthopedic surgeon if he had been raised by a pack of wolves.

But not all orthopedic surgeons fit the stereotype.

When I transitioned into interventional pain medicine, I had an orthopedic surgery resident who took the time to teach me subcuticular closures—a skill that, while seemingly small, has remained valuable throughout my career.

And as I moved deeper into spine and musculoskeletal pain management, I found that orthopedic surgeons became some of my most valued colleagues.


The Evolution of Pain Management and Orthopedic Collaboration

For decades, the referral model was simple:

  • Primary care physicians sent patients with back or joint pain to orthopedic surgeons.

  • If surgery wasn’t immediately necessary, the patient was referred to physical therapy or interventional pain management for temporary relief.

  • If the pain persisted, surgery was often the final answer.

At the time, our interventional pain tools were limited to steroid injections and nerve ablation—treatments that provided relief but often destroyed important nerve pathways to supporting muscles in the process.


For example: We burned nerves leading to the facet joints (RFA) → Pain was reduced, but it also denervated key stabilizing muscles like the multifidus, leading to potential spinal instability and further degeneration.

Now, we have far better tools and knowledge:

✅ Regenerative medicine can repair soft tissue structures rather than just blocking pain.

✅ Advanced biologics (like PRP) help restore function instead of destroying nerve pathways.

✅ Minimally invasive procedures preserve spinal health rather than contributing to its decline.

Ironically, even as pain management has advanced, I now refer to orthopedic surgeons more than ever. Not every joint can be saved, and some structural damage is too severe for regenerative treatments alone.

I celebrate the progress of regenerative medicine—but I also celebrate the orthopedic surgeons who continue to be essential partners in musculoskeletal care.


The Future: Integrating the Best of Both Worlds

The best patient outcomes don’t come from choosing between pain management and surgery—they come from integrating the best of both disciplines.

I celebrate regenerative medicine for helping patients avoid unnecessary surgeries.

I celebrate pain specialists and interventionalists who continue to push the field forward, offering treatments that weren’t possible even a decade ago.

I celebrate orthopedic surgeons—who remain vital in cases where surgery is truly necessary and whose innovations have shaped the way we treat pain today.

Medicine is evolving, and the collaboration between pain management and orthopedic surgery is stronger than ever.

If you’re suffering from joint or spine pain and want a strategic, expert-driven approach that considers all options—both surgical and non-surgical—schedule a consultation today.

The best outcomes come from experience, collaboration, and expertise. Don’t settle for anything less.


Our tools have evolved. Our understanding of joint and spine health has expanded. But the need for highly trained specialists remains the same.

At Pain Experts, we don’t just mask pain—we take a strategic, long-term approach to musculoskeletal health. Whether through regenerative medicine, advanced interventions, or selective referrals to top orthopedic surgeons, we help patients get the right care at the right time.

Your pain deserves a comprehensive approach. Let’s find the best solution for you.


Schedule your consultation today.


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               Deborah Westergaard, MD

Pain Experts

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4708 Dexter Dr STE 300 Plano, TX 75093

Phone 214 750-6200

Fax 214 750-6203

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