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Center for Pain Management FAQ

Pain management is a comprehensive approach to diagnosing, treating, and controlling pain. It uses a multi-pronged and individualized treatment plan to coordinate safe and effective options that can address the physical, emotional, social, and psychological aspects of pain. In a balanced approach to pain management, people with pain, along with their family members and caregivers, learn to manage the pain in safe, effective, responsible, and healthy ways to improve or maintain their overall well-being.

Components of a balanced pain management plan may include:

• Minimally-invasive injection-based therapy
• Physical therapy and rehabilitation
• Psychological counseling
• Social support
• Medication
• Other complementary approaches

When medications are necessary, there must be full recognition of potential side effects and appropriate management of the medications.
It is important that individuals afflicted with pain know that they will have to be active participants in their journey from being a patient to a functional person — all with the assistance of their support network. Balanced pain management means a team approach to ensure that people with pain can improve their quality of life, increase function and reduce suffering.

A pain management doctor is a board-certified, fellowship-trained physician who is able to diagnose and treat acute and chronic pain conditions using a comprehensive, balanced approach.

At the Center for Pain Management, we build comprehensive, individualized care plans for each of our patients. These plans employ a variety of pain management strategies focused on the whole person — not just the pain.

Our physicians have more than 100 years of combined experience and are all board certified in pain management and anesthesiology. Our staff of nurse practitioners, nurses, and medical assistants are also highly educated and specialized in pain management.

Like other physicians, pain management specialists earn a college degree and then complete four years of medical school. They then spend four more years completing a residency in anesthesiology.

Our Center for Pain Management doctors continues their education to specialize in pain medicine by receiving an additional year of fellowship training to become a “subspecialist” or an expert in treating pain. Some go on to do research in addition to their clinical practice, and all of our physicians have special certifications in pain medicine through the American Board of Anesthesiology (ABA). The ABA is the only organization recognized by the American Board of Medical Specialties to offer special credentials in pain medicine.

People develop pain for many reasons. Pain from recent surgery, injury, or medical illness is called acute pain. In many cases, this pain can be managed immediately and will usually get better in just a short time. For more serious pain, however, your primary care doctor may ask a pain management doctor to help manage your pain while you are healing.

Back or neck pain that persists beyond six weeks may require further evaluation to accurately and quickly diagnose the cause and implement an effective treatment plan. In general, earlier evaluation of pain typically leads to greater diagnostic accuracy and faster relief.

If your pain persists after the healing process should be over, you might have what is called chronic pain. If the current treatment you are receiving stops working or your pain begins to get worse over time, your primary care doctor may suggest that you see a pain management doctor.

Cancer pain is another condition that can be managed by a pain medicine doctor while the patient continues to receive cancer treatment. The pain can be due to cancer surgery or treatment procedures, including radiation therapy and chemotherapy, or the tumor itself.

After completing a detailed history and a thorough physical exam, your pain management doctor may order additional tests such as radiographic images (including x-rays, MRIs, etc.) or blood tests. Chronic pain is a complex process that requires a combination of treatments in order to achieve the best results. A multi-pronged treatment plan tailored to the individual patient will be discussed and initiated that may include medications, possible minimally-invasive procedures, and/or physical therapy. Pain management requires an active joint effort from both the individual suffering from chronic pain and the healthcare team.

At the Center for Pain Management, we utilize interventional approaches (injections) when appropriate to diagnose and treat painful conditions. For a full list of the conditions we treat, please visit our Conditions We Treat section.

Diagnostic injections require precise placement of specific pain medications at the structures that are suspected of causing pain. These procedures require specialized techniques and imaging equipment to assure pinpoint accuracy and safety and are performed in state-of-the-art, sterile fluoroscopy suites to provide appropriate safeguards.

In addition, we provide surgical interventions if appropriate and indicated, such as spinal cord stimulators, percutaneous disc decompression, vertebral augmentation/kyphoplasty, and intrathecal pump therapy.

Our balanced approach also includes the use of medications, physical therapy, and self-management techniques with the goal of improving your function and quality of life as well as reducing your pain. Sometimes we may enlist the help of a pain psychologist to better assist with the psychological impacts of being in chronic pain.

It’s very common for people to be confused about the difference between physical dependence and addiction. The main difference is that addiction includes a psychological (or mental) craving for the medication that can lead to self-destructive behavior. Physical dependence only means that your body needs the medication, and you have symptoms when you do not take it. People become physically dependent on many kinds of medicines, including insulin, antidepressants, and others. It is a normal part of using some medications.

When you use pain medication, after a while, your body becomes used to having that chemical on a regular basis. Your body needs that medication to function normally. If you stop taking it or lower the dose, your body reacts badly, with physical withdrawal symptoms like headaches, nausea, shakes, and other more serious problems. This is physical dependence, and it is not at all the same as addiction.

Addiction is a psychological problem that causes people to lose control over their use of medication. People with this problem sometimes think the drug is the most important thing in their lives. They might raise their dosage or continue using the medication without their doctors’ permission, or seek other sources of medication that their doctors don’t know about. They take the medication even when they know it is not good for them, and they might do risky and irresponsible things to get the medication.

Addiction is avoidable. If you think that you might be taking a pain medication that you do not need for pain, talk to your doctor about safely reducing the dose. Also, if you become preoccupied with the medication, thinking about how soon you can take more or worrying excessively that you might run out, that can be a warning sign to talk to a health care professional about changing your treatment. The act of taking pain medications alone does not lead to addiction.

There are certain factors that increase the possible risk of addiction when taking opioids. This includes a previous history of substance abuse, usage of psychiatric medications, depression, and in general, younger patients are at greater risk.

At the Center for Pain Medicine, pain medications are sometimes utilized as one component of a balanced, comprehensive plan for the management of your pain. On an initial visit, your physician will review your history, perform a physical exam, review imaging if available, and then come up with a plan tailored uniquely for you.

In addition, we will evaluate your list of medications during the initial visit and provide our recommendation to you and your primary doctor about continuing opioid therapy. We may recommend another course of treatment that does not include opioids. We do not always write a prescription for opioids, so please do not arrive with the expectation that we will automatically refill your prescription. If we opt to prescribe opioids as part of your care plan, we may adjust the medication to a more appropriate dose, a better dosing schedule, or a better medication.

There are always some risks associated with any invasive procedure. The most concerning complications associated with these procedures are related to bleeding or infection. Uncontrolled bleeding or infection within the spine can cause permanent paralysis if not quickly diagnosed or treated. The chances of these risks occurring are extremely rare and occur so infrequently that the percentage is difficult to qualify, possibly greater than 1:150,000.

Most commonly, patients have fears of nerve damage or paralysis with these procedures. With the utilization of live x-ray guidance — a standard of care for these procedures — the structures of the body can be visualized in real-time. The x-ray guidance facilitates accurate and safe needle placement. In addition, patients will never be placed under general anesthesia where they are unconscious and non-responsive. Even patients receiving sedation will be able to communicate if required — a very important safety feature.

Like every medication, steroid injections have some risks and side effects. Typically, any side effects from steroids are short-lived and usually resolve on their own with time. Patients who have diabetes may be at risk for a temporary rise in their blood sugars. Patients with high blood pressure may suffer from a transient rise in their blood pressure.

The most common complication that may warrant treatment is a post-dural puncture headache, commonly called a “spinal headache.” This occurs when an inadvertent puncture is made with a needle into the tissue sac in the spine called the dura. This slight leak of spinal fluid can cause a substantial headache. Although quite uncomfortable, this headache rarely causes any long-term issues and can readily be resolved through treatment. If you experience a headache after a procedure at the Center for Pain Management, please call our medical team at (321) 422-7111 to determine if your symptoms are due to postdural puncture.

Most minimally-invasive procedures performed in our clinics are quick, relatively painless, and require only local anesthesia. Your pain management physician will discuss each step in the procedure, including the anesthetics you’ll receive and any necessary fasting or preparation prior to your treatment. In certain circumstances, intravenous conscious sedation may be offered.

At the Center for Pain Management, Intravenous sedation is available for most but not all procedures. General anesthesia would have to be used to guarantee that you would sleep through your procedure. However, general anesthesia is not appropriate for injection procedures. Although intravenous conscious sedation will not guarantee that everyone will sleep through their procedure, it is adequate to provide comfort for treatments. In many situations, it is actually safest for the patient to not be asleep and to still be able to communicate. One of two options is available for anesthesia during these minimally-invasive procedures:

• Conscious Sedation: Administered via an intravenous (IV) needle and gives the feeling that is described as a light “twilight.” This is the same type of sedation used for patients having colonoscopies. This requires you to fast from midnight the night before your injection, and you must have a licensed driver over 18 years of age, to take you home after the injection. This is recommended for patients who are afraid of needles, are very anxious, or don’t tolerate pain well.
• Local: A small needle is used to numb the skin in the general area of the injection. This may feel like a bee sting for a few seconds and is similar to getting a shot. This is recommended for patients who do not have a driver and have at least a mild tolerance for pain. Some procedures require diagnostic feedback, and sedation may obscure the diagnostic feedback.

Some procedures may require sedation that prevents you from safely eating or drinking. Also, some procedures may inhibit movement in parts of your body that would make it difficult or unsafe for you to drive. Since we cannot be sure how the treatment will affect you, we require you to follow the instructions that are provided to you prior to your scheduled procedure.

“Minimally invasive” simply means that the majority of the procedures we perform (with few exceptions) are done percutaneously or through the skin. Percutaneous procedures involve the introduction of very small needles or needle-like instruments and do not require stitches afterward. This approach means that the risk of infection and complications, while still present, is minimized.

Yes, it is normal to have pain after the injection. Everybody works differently; some patients feel worse before they feel better, and others feel better right away. If pain persists, apply ice packs for 10-15 minutes every 4-6 hours. DO NOT use a heating pad for 3-4 days after your injection.

Call the office if you experience any of the following symptoms: fever, persistent headache, bowel/bladder issues, or weakness.

Most patients are referred to the Center for Pain Management by their primary doctor or their surgeon, but we also see “self-referrals” — all by appointment only. We do not see “walk-ins.”

Clinical evaluations and procedures to treat pain are covered by most insurers. We evaluate each policy to determine appropriate coverage before treatment is rendered.

It is imperative that your primary care doctor remain well informed regarding your plan of care. Establishing and localizing the cause of your pain is valuable information for your primary care doctor to have to help manage your overall health and well-being. In addition, it is important to keep your primary care physician informed of any treatments, medications, or therapies we initiate.

You might notice at times that you are in more pain than usual (such as at the end of a tiring day or as a result of certain activities). If you notice that certain activities contribute to your pain or that you feel worse at certain times of the day, medication can be taken prior to the activity (or time of day) to help prevent the pain from occurring. Always be sure to follow your doctor’s instructions.