Dr. Deacon Farrell, a board-certified anesthesiologist and interventional spine specialist based in Los Angeles and Beverly Hills, brings extensive experience in regenerative medicine, interventional pain management, and anesthetic innovation. As Director of Interventional Pain Medicine at Pacific Oaks Medical and Director of Anesthesiology at Southern California Hospitals Center, Dr. Farrell focuses on minimally invasive techniques that help patients restore mobility and reduce chronic pain. A recognized thought leader in healthcare technology, he has implemented AI-assisted surgical systems and authored research on anesthetic delivery, brain trauma, and space medicine. Dr. Farrell’s evidence-based approach emphasizes accurate diagnosis as the cornerstone of successful treatment. Here, Dr. Deacon Farrell discusses how a “diagnosis first” methodology provides a structured and effective path toward long-term pain management success.
Diagnosis First Offers A Structured Approach to Pain Management
Many people living with chronic pain assume that treatment starts with medication or a procedure. In reality, effective pain care begins with something less visible but far more decisive: pinpointing the trustworthy source of pain. Pain specialists follow a structured process to determine the origin of pain before selecting any intervention. That precision helps them avoid unnecessary procedures, reduce reliance on long-term medication, and match the right treatment to the right problem.
Clinicians usually begin with a thorough clinical history. They document the onset, duration, and quality of the pain, along with any factors that exacerbate or alleviate it. They also examine how pain affects daily activities and develop a timeline that informs their initial working hypotheses. This foundation guides decisions on what to examine next and whether imaging is needed.
The physical exam then tests these hypotheses through targeted maneuvers. Movements such as bending or rotating the spine can reveal whether structures like facet joints – small stabilizing joints in the spine – are involved. By observing how the body responds to specific movements, clinicians can narrow down the list of likely pain generators before proceeding.
Before ordering imaging, specialists apply red flag criteria to determine whether an MRI or CT scan is truly necessary. These criteria include signs of serious conditions such as fractures, malignancy, infection, or neurological compromise. Routine imaging without red flags often turns up incidental findings that don’t match symptoms and can lead to unnecessary interventions. Reserving imaging for cases that meet evidence-based thresholds ensures a sharp and clinically justified diagnostic process.
Imaging itself plays a supporting role. Many people have scan abnormalities that have nothing to do with their pain, so clinicians interpret results in context rather than relying solely on imaging. This balanced approach helps prevent overtreatment and keeps decisions rooted in clinical evidence.
When history, exam, and imaging point to a specific pain generator, specialists often use diagnostic nerve blocks to confirm their conclusions. A diagnostic nerve block involves a targeted injection that temporarily numbs a nerve to see if it’s the culprit. If the pain eases during the expected window, that structure is likely responsible. Repeating the block on another occasion can strengthen diagnostic certainty before moving to treatment.
For certain conditions, particularly facet joint pain, guidelines and payer policies require multi-step diagnostic block protocols before moving forward. Specialists may perform two diagnostic blocks on separate occasions, each producing significant pain relief, to verify that the targeted structure truly causes the pain. This evidence-based step improves diagnostic accuracy and ensures that only well-selected patients proceed to intervention.
Once the pain source has been confirmed, specialists can build a targeted treatment plan. Depending on the diagnosis, this may include radiofrequency ablation – a technique that uses controlled heat to disrupt pain signals – or other minimally invasive options backed by guidelines. This focused approach avoids unnecessary procedures and improves long-term outcomes.
Each step in this process builds on the last. History sets the direction, the exam tests hypotheses, red flag screening determines whether imaging is appropriate, imaging adds anatomical context, and diagnostic blocks provide final confirmation. Together, these steps ensure that treatment is guided by evidence rather than assumption, increasing the chances of real relief.
Diagnostic precision isn’t a formality; it’s the foundation of effective pain medicine. By anchoring interventions in a clear, methodical sequence, pain specialists can reduce unnecessary procedures and help patients regain function. This systematic, evidence-based approach defines high-quality pain care.
About Deacon Farrell
Dr. Deacon Farrell is a Los Angeles–based anesthesiologist and interventional pain specialist with expertise in regenerative medicine and spine care. He serves as Director of Interventional Pain Medicine at Pacific Oaks Medical and Director of Anesthesiology at Southern California Hospitals Center. Board-certified in anesthesiology and pain medicine, Dr. Farrell has led multiple clinical and research initiatives exploring AI-assisted surgical systems, anesthetic pharmacology, and pain diagnostics. His work emphasizes innovation, precision, and minimally invasive treatments that improve patient outcomes.
