What is the difference between acute and chronic pain?

Acute pain is the result of trauma to your body, typically from an injury, surgery or illness. The sensation of acute pain is proportional to the trauma, and decreases as the injury improves and disappears when the injury completely heals. Chronic pain is an ongoing condition, and often persists even after an injury has healed.  Chronic pain can be experienced in your back, neck, joints, or any other part of your body.  Chronic pain should be treated as seriously as other chronic conditions, such as diabetes or high blood pressure, since it can have a significant impact on your quality of life. There are several types of chronic pain, such as neuropathic (nerve injury) pain, musculoskeletal pain, and pain related to cancer. Your physician may refer you to The Pain Clinic if your chronic pain condition has not responded to first-line therapies.

Treatments for acute and chronic pain are generally different. In some cases, acute and chronic pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain–such as cancer–cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychosocial and rehabilitation techniques.

What are the more common conditions that result in chronic pain?

While there are a multitude of conditions that may lead to chronic pain, we have found the following to be most prevalent in our patients:
Back pain
Neck pain
Muscle Pain and spasms
Nerve Pain/sciatica
Post Herpetic Neuralgia (Shingles)
Failed back surgery pain
Cancer-related pain

What is pain management?

Pain is a complex medical problem that can have profound effects on your physical and mental well-being. The goal of pain management is to help you decrease your level of pain and suffering, to return you to your maximum level of functioning and independence, and to help you restore your quality of life.

When should a person seek a pain management specialist?

Seek out a pain management specialist when pain does not respond to first-line therapies within a reasonable period of time.  Most primary care physicians in our area have considerable experience with these initial therapies, such as physical therapy and mild analgesics.  Unfortunately, people often wait to see pain management specialists until their pain becomes chronic.  Studies have shown the brain “remembers” pain signals, and the longer these pain signals are allowed to transmit to the brain, the more permanent they can become.  So it is crucial that patients get prompt treatment of their pain. Be aware of your body and take note when your pain does not improve. If your pain persists, do not hesitate to contact a board-certified pain management specialist immediately.

How does chronic pain affect one’s life?

Countless work days are lost as a result of acute and chronic pain, costing the economy billions of dollars every year.  Chronic pain can become so intense and overwhelm the body and mind to such a degree that it can affect all aspects of one’s life. People can become so debilitated that they cannot work. They have diminished appetite. Any kind of physical activity can be exhausting and exacerbate one’s pain. Often, people who suffer in pain will fall into a vicious cycle in which total preoccupation with pain leads to inactivity, irritability, anxiety, and depression, which in turn causes more pain. Insomnia is also a common byproduct of chronic pain.  Relationships are often affected as well.

At The Pain Clinic, Dr. Doraiswamy and his colleagues will work tirelessly with you to identify any of these issues and develop a treatment plan to help improve your quality of life.

What medications are most commonly used to manage pain?

Analgesic drug therapy should be tailored for each individual patient, based on their pain condition, medical problems, age, the severity of their pain, etc.  All pain medications, including over-the-counter drugs, have potential side effects, so the risks, benefits, and alternatives should be considered prior to starting any analgesic regimen.

Some of the more common are:

-Anti-inflammatory drugs to alleviate pain by reducing swelling and irritation.
-Adjuvant pain medications, including: antidepressants, anticonvulsants and muscle relaxers.
Opiates or “pain killers” used to treat acute pain or cancer-related pain, and often prescribed for chronic pain.

There are alternative delivery methods for medications. Common methods used at the office are oral medications, topical creams, sublingual medicines, nasal sprays, injections and patches.

What about the stories of addiction surrounding opiates? Is there a difference between physical dependence and addiction?

The practice of pain management involves the treatment to relieve or reduce pain. The truth regarding opioids, “narcotics” or “painkillers,” is simply that they all have the potential for serious adverse side effects, including addiction, even when monitored appropriately.

These side effects and adverse effects are explained in more detail in our opioid prescribing policy, and must be discussed prior to the initiation of any opioid regimen for the treatment of chronic pain of non-cancer origin. Remember, the most effective treatment plans don’t involve opioid medications by themselves. Patients and clinicians must work together using several treatment strategies along biological, psychological, and social areas to achieve stated goals prior to starting any treatment plan.

Tolerance, or loss of pain-relieving effects of pain medication may occur over long period of time. This is usually less of an issue than was once suspected as long as activity levels are maintained. Benzodiazepines (sedatives) are not concurrently administered along with opioids, and short-acting narcotics are not continued as “breakthrough” medication or the main treatment agent for chronic, benign pain. Withdrawal, or feelings of anxiety, nausea, increased pain, and/or sweating are expected from abruptly discontinuing any opioid, no matter what the substance or form it may come in. Addiction is defined as: impaired control over use of medication; craving, preoccupation with obtaining and using the drug; and continued use despite harm (physical, psychologic, social). If a patient has an issue with addiction to a controlled substance such as opioids, he or she will be referred to the appropriate specialist for treatment of this condition.

Pseudo-addiction is a condition that looks and acts like addiction. This means an individual with pain appears to have “seeking” behavior because of inadequately treated pain. The answer to this issue is not always more pain medication. Clinical experience and evidence shows that patients with legitimate pain are those who will work with their physician(s) to achieve pain relief.

Is pain management covered by health insurance?

Most policies provide for pain management. Please call our office for more information.

Do these procedures hurt?

Regional anesthetics or conscious sedation is available for procedures. Most procedures are minimally invasive with only a needle entering the skin.

How long do most procedures take?

Most procedures take less than 15 minutes. With preparation time and recovery, expect to be in the office 1-2 hours for a procedure.

When will I be able to return to work?

In most cases, if you were able to work before the procedure, you will be able to return to work the next day.

Do I need a referral from a doctor?

Yes, since we are a specialty practice, we work closely with your primary care physician and other treating providers to insure the best possible care.

Why must you have my information before my visit?

To simplify the registration process, we ask that new patients provide information in advance of their visit. This is so that we are able to verify your insurance information. Each insurance plan is different and this allows us to obtain the correct information prior to your arrival.

What should I bring with me to my appointment?

Please bring a valid copy of your driver’s license and current insurance card. It is extremely helpful to have any X-ray films, MRI films, and CT films or a CD/DVD with the images. In addition, bring any other pertinent test results with you.

What if I am late for my appointment?

If you are a new patient, we ask that you arrive 15 minutes prior to your scheduled appointment time, to fill out the necessary paperwork. If you are scheduled for a follow up appointment, and arrive greater than 15 minutes late, you will be rescheduled.

What should I do if I am unable to attend an appointment?

Please inform our office 24 hours before your scheduled appointment. We will be happy to reschedule you. By notifying us, we are able to provide another patient the opportunity to see the physician.

What is your policy regarding missed appointments?

If you miss your appointment, and did not provide us with a 24 hour notice, it will be considered a “No Show” unless your absence is due t o a serious emergency. After your second “No Show” a charge of $50 will be applied to your account. If you fail to contact our office a third time, a charge of $50 will be applied to your account, and you will be discharged from our practice. Your primary care physician will be notified of your dismissal. If you are scheduled for a procedure and do not notify us, a charge of $75 will be added to your account. If a second “No Show” occurs for a procedure, your $75 will be added to your account AND you will not be placed back on the Procedure Schedule.

Do you accept my insurance?

We accept most insurances; however, please call your carrier to verify that The Pain Clinic Specialists is a participating provider.

Do I need a referral from my insurance?

Most HMO’s/managed care programs require insurance authorization, which is generally obtained through your primary care physician. Without this, your insurance company will not pay for your visit, and unfortunately you will be responsible for the cost of your visit. It is ultimately the responsibility of the patient to make sure that insurance authorization is obtained if you have an HMO.

What if my referral does not arrive in time of my visit?

Your appointment will be rescheduled until we receive the referral authorization.

What is your policy regarding co-pays, co-insurances, and deductibles?

All co-pays, co-insurances and deductibles are required at the time services are rendered. If you are going to undergo a procedure at our office, we will calculate the amount owed by you prior to scheduling your appointment so that payment arrangement can be made.

Do you accept Workers’ Compensation?

Yes. An authorization from your Workers’ Compensation carrier must be obtained. All billing information must be provided to us so that we may bill the carrier. If you have a work related injury, and you have seen a Workers’ Compensation Provider, we cannot bill your private insurance unless the claim has been discharged from Workers’ Compensation.

Will my health information be kept confidential?

All personal health information will be kept in the strictest confidence. In all disclosures outside of The Pain Clinic Specialists, you will not be identified by name, social security number, address, telephone number, or any other direct personal identifier unless disclosure of the direct identifier is required by law.