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 or neck surgery pain
Whiplash injury (often from car accidents)

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. They cannot sleep. 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 inflammation.
-Adjuvant pain medications, including: antidepressants, anticonvulsants and muscle relaxants.
-Opiates or “pain killers” used to treat acute pain or cancer-related pain, and often prescribed for chronic pain when more conservative therapies have not provided enough pain relief.

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.

Opiate side effects and adverse effects are explained in more detail in our “Risks, Benefits & Alternatives to Opioid Medications” form (that can be downloaded from the “Patient Forms & Reviews” section of this website), 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 a long period of time. This is usually less of an issue than was once suspected as long as activity levels are maintained. Benzodiazepines (sedatives) should not be taken daily along with opioids due to increased overdose potential. 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 “drug seeking” behavior because of inadequately treated pain. However, 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. We are contracted with the majority of insurance plans in the area. Please call our office for more information.

Do these procedures hurt?

Most procedures are minimally invasive with only needles entering the skin. However, if needles make you nervous, conscious sedation can also be provided.  During this type of anesthesia, patients are typically asleep and do not remember much during the procedure. Procedures can also be done in the office setting if you prefer. Dr. Doraiswamy does not rush his procedures, so the local anesthetic (“numbing medicine”) has more time to work, and patients are comfortable.

How long do most procedures take?

Most procedures take less than 15 minutes. With preparation time and recovery, expect to be in the office for about 30 minutes. When you get IV anesthesia, you should plan to wait for about two hours in the surgery center.

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?

If you have an HMO insurance plan that requires insurance authorizations, then yes, we will need a referral from your doctor. But if you have insurance that does not require authorization, then you can call us to schedule an appointment. Either way, 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 would be extremely helpful to bring any of your X-ray films, MRI films, CT films, CD/DVD’s with the radiology images, and/or radiology reports to your appointment. In addition, bring any other pertinent test results with you.

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.

Do you accept my insurance?

We are contracted with the majority of medical groups in the area, and accept most insurances. Please call our office for more information.

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 appointment.

What if my referral does not arrive by the time of my visit?

Unfortunately, your appointment would need to be rescheduled until we receive the referral authorization.

Do you accept Workers’ Compensation?

Yes. An authorization from your Workers’ Compensation carrier should be obtained. We would need the billing information so we can bill the appropriate insurance company. 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 providers, 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.