Pain Treatment

I am a specialist in anaesthesiology and reanimation, and I worked in a pain clinic during my specialty training. This page brings together the methods I use for pain in one place: occipital nerve block, acupuncture, knee-joint injections, and when each comes to the fore. Neural therapy has a separate informational article that introduces it as a method. The functional medicine assessment that addresses what triggers pain is also part of this plan.

Pain is a symptom, not a diagnosis. That is why I ask for a diagnosis before choosing a method; I do not plan injections for undiagnosed pain.

How I approach pain

At the first consultation we go through where the pain is, how long it has been there, what it feels like and what has been tried. If the pain is new, has changed character or comes with neurological signs, I ask for the relevant specialty’s opinion first — neurology, orthopaedics or physical medicine. An interventional procedure comes onto the agenda once the diagnosis is clear.

Then I ask three questions. Which structure is producing this pain? Is the goal short-term control or long-term protection? Does the patient want to reduce medication, or add something to existing treatment? The method follows the answers. The methods are not rivals; they are different answers to different questions.

Fewer procedures, more conversation. I do not recommend a procedure I do not consider necessary.

The methods I use

I do not rank these methods against each other. They can be planned in sequence or together in the same patient; that decision is made at consultation.

Headache and migraine

My interventional option for headache is the occipital nerve block. In chronic migraine, greater occipital nerve block has been shown in randomised trials to reduce attack frequency compared with placebo ². It is also used in cluster headache and occipital neuralgia. Acupuncture can have a place as support for preventive treatment in migraine and tension-type headache ¹.

When long-term preventive treatment for chronic migraine is on the agenda, migraine Botox comes in; I explain on the occipital nerve block page which of the two comes to the fore for which goal. The two can be planned together when needed.

Knee pain and osteoarthritis

In the knee, the first question is which phase the joint is in: active inflammation (pain, swelling, warmth), or a settled wear that causes friction and stiffness?

In the knee, the decision depends on the state of the joint: in the active phase, where pain and swelling are in the foreground, serum prepared from the patient’s own blood comes to the fore; once inflammation has settled and lubrication support is wanted, intra-articular hyaluronic acid does. The two are not given in the same session; they can be planned in sequence when needed. The final choice is made at consultation.

In knee osteoarthritis, intra-articular corticosteroid injection carries a strong recommendation in the current guideline; the same update recommends conditionally against intra-articular hyaluronic acid and strongly against PRP and stem cells ³. I set out my own position, and what I assess in which knee, on the Sanakin and hyaluronic acid pages. In advanced osteoarthritis I do not keep a patient who needs surgery waiting on injections; I assess injections in early and moderate stages. Intra-articular ozone is explained on the knee ozone therapy page.

Fibromyalgia and widespread pain

In fibromyalgia I do not expect a single injection to solve the problem; this picture needs sleep, the stress response and the musculoskeletal system to be addressed together. I plan acupuncture for general regulation and the pain threshold, and I assess sleep, nutrition and deficiencies at the functional medicine consultation. In a patient under rheumatology follow-up I run this plan alongside that follow-up, not in its place.

Being honest about the level of evidence

The methods on this page do not have equal levels of evidence. Occipital nerve block in chronic migraine, and acupuncture in chronic low back and neck pain, headache and knee osteoarthritis, have placebo-controlled trials; in acupuncture the difference between real and sham acupuncture has been found to be small, and I do not hide that ¹². For intra-articular hyaluronic acid the literature is contradictory; a large meta-analysis did not show a clinically meaningful benefit ⁴, and the current guideline recommends conditionally against it in the knee ³. The same guideline supports intra-articular corticosteroid with a strong recommendation and rates the certainty of evidence as low ³. Evidence is more limited for autologous serum and neural therapy; I write the evidence level of each method on its own page. I do not give unsourced percentages.

The procedure and pain management

Topical anaesthetic cream is standard. Because I am an anaesthesiologist, I treat pain management as a separate part of the procedure.

Acupuncture is an exception: the needles are far finer than injection needles and no cream is used. What you feel during each method is described on that method’s own page.

Aftercare

Aftercare advice is on the page for the relevant treatment.

Safety and anatomy

Because allergic reactions can occur rarely, treatments are carried out under medical supervision. The anatomical and safety limits of each method are explained on its own page.

Who is not suitable

Treatment is not performed, or is postponed, in the following situations:

• Active infection or inflammation in the treatment area
• Autoimmune disease in an active phase
• Pregnancy and breastfeeding
• Known hypersensitivity to the product components
• Uncontrolled chronic illness
• Untreated bleeding disorder or unregulated anticoagulant use

Method-specific additional situations are listed on the page for each treatment.

Without being a medical contraindication, I also consider expectation and treatment to be mismatched in these situations:

• People expecting a lasting result from a single session
• People with undiagnosed, new or changing pain — a diagnosis comes first
• People with advanced osteoarthritis who need surgery — an injection does not replace surgery

Suitability is determined by consultation in every case.

Where do ozone and IV treatments fit into this plan?

I plan ozone and IV treatments as support when needed; the main plan is the method that fits the diagnosis, oral supplementation and lifestyle adjustment. These treatments are explained on the ozone therapy and IV therapy pages.

Pricing

Under the applicable regulations, price information cannot be published on our website. The cost of a treatment depends on the product used, the technique chosen and the extent of the treatment. You can call the clinic for detailed information.

Frequently asked questions

Which methods do you use in pain treatment?

Occipital nerve block, acupuncture, autologous serum and hyaluronic acid injections into the knee joint, and a functional medicine assessment. Neural therapy is introduced as a method in a separate article. Which one is chosen depends on the diagnosis, the phase of the pain and the goal, and is decided at consultation.

How do you decide which method for pain is right for me?

With three questions: which structure is producing the pain, is the goal short-term control or long-term protection, and does the patient want to reduce medication. For headache the interventional option is the block; in the knee it is autologous serum or hyaluronic acid depending on the phase of the joint; in musculoskeletal and stress-related pain, acupuncture comes to the fore. Methods are planned in sequence when needed.

Why does an anaesthesiologist treat pain?

Pain treatment is one of the fields of anaesthesiology; nerve blocks are part of that training. I worked in a pain clinic during my specialty training and I perform interventional procedures within that framework.

Are the procedures used in pain treatment painful?

Topical anaesthetic cream is standard, and I treat pain management as a separate part of the procedure. Acupuncture is an exception; the needles are far finer than injection needles. What you feel with each method is described on its own page.

Do I need a neurology or orthopaedics opinion before pain treatment?

If the pain is new, has changed character or comes with neurological signs, yes: diagnosis first, procedure second. For a patient with a diagnosis and ongoing follow-up, I plan the procedure alongside that follow-up, not in its place.

Which method for migraine?

If the goal is pain control during an attack or in the short term, the occipital nerve block comes to the fore; if the goal is long-term prevention in chronic migraine, migraine Botox does. The two can be planned together. Acupuncture can have a place as support for preventive treatment.

Which method for knee pain?

In the active phase, where pain and swelling are in the foreground, serum prepared from the patient’s own blood comes to the fore; once inflammation has settled, intra-articular hyaluronic acid does. The two are not given in the same session. The current guideline gives intra-articular corticosteroid a strong recommendation and recommends conditionally against hyaluronic acid; I make the decision at consultation, discussing that framework. A patient who needs surgery in advanced disease is not kept waiting on injections.

What do you do in fibromyalgia?

I do not expect a single injection to work. I plan acupuncture for general regulation and the pain threshold, and the functional medicine consultation for sleep, the stress response and deficiencies; rheumatology follow-up continues.

Who is not suitable for pain treatment methods?

Active infection, autoimmune disease in an active phase, pregnancy, known hypersensitivity to the product components, uncontrolled chronic illness and unregulated blood thinner use are the main situations. With undiagnosed pain, a diagnosis is requested first. Suitability is determined at consultation.

Planning your visit

My clinic is in Nişantaşı, Şişli, on the European side of Istanbul, approximately 45 minutes from Istanbul Airport.

For pain treatments I suggest planning a stay of two to three days: arrival, consultation and treatment, and departure. Because these treatments may be planned as more than one session, they may require more than one visit. The first session takes place in Istanbul, and we plan the schedule of any following sessions together according to your travel arrangements, with remote follow-up in between. Flying is generally appropriate 24 hours after an injectable treatment.

Consultations are conducted in English. Follow-up after you return home is arranged remotely, and I remain reachable for any questions during the period in which the result develops.

Dr. Ömer Fatih Şahin — Specialist in Anaesthesiology and Reanimation Diploma Registration No: 113606

Published: 2026-09-21 · Last updated: 2026-09-28 This content has been medically reviewed by Dr. Ömer Fatih Şahin.

References

1. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455–474. https://pubmed.ncbi.nlm.nih.gov/29198932/
2. Inan LE, Inan N, Karadaş Ö, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand. 2015;132(4):270–277. https://pubmed.ncbi.nlm.nih.gov/25765043/
3. American College of Rheumatology. 2026 Update of the American College of Rheumatology Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (guideline summary). 14 September 2026. https://rheumatology.org/osteoarthritis-guideline
4. Pereira TV, Jüni P, Saadat P, et al. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ. 2022;378:e069722. https://pubmed.ncbi.nlm.nih.gov/36333100/