Frequently Asked Questions

Opioids are often essential for treating severe, acute pain but rarely effective for chronic pain. Unfortunately, long-term use of opioids too often leads to addiction and other complications. As such, we prescribe opioids very sparingly in accordance with government and professional society guidelines. We generally will not take on responsibility for prescribing opioids from another doctor for any condition other than cancer pain. But with an appropriate referral from your doctor, we do offer consultation and treatment by other means even if you are taking opioids. In addition, for selected patients we will safely wean off opioids while initiating other treatment modalities.

Pain Management Specialists is not licensed or staffed to treat drug addiction, and that includes weaning patients who have been identified as having a substance dependency. We do not prescribe buprenorphine (Suboxone and others). To find a treatement center near you, call 1-800-662-HELP or follow this link: SAMHSA.

We are happy to evaluate most patients with chronic pain, but there are some conditions which either are not amenable to the interventional therapies that we offer, or which we do not have the training and experience to handle. Some examples include primary headache syndromes and fibromyalgia. These and other conditions are best managed with your primary care doctor or another specialist.

Certain procedures are performed in an ambulatory surgery center or hospital. When this occurs, a bill for the doctor’s services will be submitted in the name of Pain Management Specialists and a second “facility fee” bill will be submitted by the hospital or ambulatory surgery center. Since our Rockville office is immediately adjacent to Comprehensive Pain Management Center, a licensed ambulatory surgery center, often patients assume that their procedure was performed in a medical office when it was not.

Patients having spinal injection procedures need a driver to take them to and from their appointment. It is best to have an adult driver who can also look after you for a short time after the injection, rather than a stranger like a taxi driver. There is at least a small possiblity of leg or arm numbness after spinal injection procedures, potentially impairing your ablity to drive yourself. If a sedative is used, driving is dangerous due to mental impairment caused by the sedative.

Patients often use blood-thinning medications due to a previous stroke, heart ailments, severe vascular disease or blood clots. These medications often must be temporarily discontinue to prevent serious bleeding complications when receiving injection procedures. Pain Management Specialists follows guidelines set forth by the American Society of Regional Anesthesia(ASRA) to reduce risk of bleeding when performing procedures for patients on these medications. It is very important to bring a list of medications to your doctor, so that appropriate medications can be discontinued prior to any invasive procedure. We will consult with the doctor prescribing your blood thinner before telling you to discontinue these medications. For detailed information please visit ASRA.

Obesity is epidemic in the Western world, particularly in America. And while obesity does not cause pain directly, obese persons are much more likely to have chronic back and joint pain. This is both because of the obvious increase in mechanical forces on the affected body parts caused by obesity, and perhaps also because of mild systemic inflammation seen in obese persons. Unfortunately, being obese and in pain is a difficult situation. Exercise is needed to help with weight loss, but it is difficult when you have severe pain. If you are obese and in pain, talk to your doctor about exercises you might tolerate. And speak with your primary care doctor about a diet you can stick with.

Pain is ordinarily a signal to our bodies that injury has occurred. Naturally, we seek to protect our bodies from further injury when we feel pain. It is appropriate, for example, to rest a sprained ankle. But chronic pain is like a false alarm. Due to changes in the nervous system, chronic pain persists long after tissue injury has healed. So it is not necessary to rest or protect the chronically painful body part. In fact, activity avoidance leads to progressive weakness, muscle spasm, further nervous system changes and disability, thereby worsening chronic pain. Physical inactivity may also lead to or exacerbate mood disorders such as depression and anxiety. Numerous clinical studies have demonstrated the beneficial effects of exercise on chronic pain due to arthritis, fibromyalgia, migraine, back conditions and others. While tailored exercise under supervision is best, especially if you are not accustomed to exercising, the most important thing is just to start moving. It is normal to feel more pain when starting a new exercise regimen, so don’t stop simply because you feel worse. It will be necessary, however, to pace yourself and to initially avoid specific activities that make your symptoms worse.

Chronic insomnia is present in the majority of patients with chronic pain. There are numerous possible causes and contributors to insomnia, starting with the pain itself. In addition, patients whose chronic pain keeps them physically idle often take naps during the day, which makes it harder to feel tired at night. Other causes are eating, smoking, exercising and drinking alcohol too close to bed time, and the regular use of habituating sleep aids. Once those issues have been addressed through education and behavior changes, psychological causes, such as depression and anxiety, should be considered. Opioid pain medications can also interfere with normal brain wave patterns and breathing during sleep – another reason we try to avoid opioid use for chronic pain. Effective treatment of these conditions, possibly including the use of sedating antidepressants and relaxation techniques, may greatly improve sleep. Your pain doctor may refer you to a sleep specialist if a medical cause is suspected. It is particularly important to obtain this evaluation because some breathing disorders can lead to chronic heart and lung problems. When sleep problems are corrected, patients often feel more energetic and better able to engage in healthy, productive activity during the day.

The choice to prescribe opioid analagesics must be made with great caution. We consider the likelihood that you have or will develop addiction, and whether the medication is more likely to help than to hurt you. Since opioids are rarely helpful in the long run, opioid-based pain treatment is a last resort for carefully-selected patients, and therefore is not an appropriate choice for most. It is imporant to distinguish between opioid addiction and physical dependency. In the latter, persons taking opioid pain relievers have uncomfortable symptoms of withdrawal if they stop their medication too quickly. Addiction, on the other hand, is characterized by the repeated, compulsive use of a substance for something other than a legitimate medical purpose. Not counting tobacco abuse, over 6% of Americans are thought to have substance abuse disorders, and the rate appears higher in chronic pain patients. Still, the majority of patients with chronic pain do not abuse pain medication when it is prescribed. For those patients other concerns, especially whether the medication will produce the desired pain-relieving effect, are more important. If we decide that opioids are worth a try for you, we will fully inform you of the expectations, side effects and consequences of opioid use, and will monitor you closely to ensure that the benefits of opioid treatment outweigh the risks.

In the last 15 years, the rate of prescription drug abuse has skyrocketed. Since opioid analgesics are habit forming, it is essential that pain doctors take special care to avoid feeding the addiction epidemic. In fact, the Drug Enforcement Administration has mandated that we work to identify addicted patients and minimize the risk of pain medication abuse and diversion. In addition to identifying patients who are at increased risk for addiction, we must monitor patients for proper medication use. For those patients being prescribed opioid analgesics, we use urine testing to detect the appropriate levels of pain medications and any non-prescribed medications or illegal drugs that may be present. When we identify a patient who is at risk for or may be abusing pain medication, we make a referral to an addiction specialist for further evaluation and recommendations/treatment. In most cases of illegal drug use and when we strongly suspect that the medication we are prescribing is not being used safely or appropriately, we discontinue therapy with all habituating medications.