What is chronic pain?

Chronic pain is defined as pain lasting more than 3 months. It actually can be regarded also as any pain that lasts beyond what would be expected to be a reasonable healing period after injury, or surgery.

When any ongoing issues prevent the return to the normal state of the body, we have a process that may snowball to create other problems, including a gradual spread of discomfort to neighboring regions, the recruitment of other tissues (surrounding muscles, tendons, nerve fibers, etc). The progression of discomfort naturally triggers a sense of anxiety (why is this happening? Why doesn’t it get better in a timely manner?Is there anything more serious going on that may have been missed? When is this going to end? Am I going to be normal again?).

The inner turmoil may easily overwhelm us, creating a sense of insecurity and distrust in the future. Our preoccupation with this increasing problem seems to absorb all our thoughts and energies. We restrict our activity and try to minimize the damage. This leads to isolation and, not infrequently, a sense of desperation and hopelessness. There is also  gradual loss of fitness, strength and mobility, as well as progressive worsening of symptoms.

Therefore, most of the time, chronic pain is associated with severe deconditioning, depression, anxiety,  a sense of loss and loneliness, withdrawal from social and professional activities, and familial strain.

It is the typical presentation of our usual patients. You are not alone. And we are here to tell you that every day, somebody, maybe even worse off than you, turns things around, and together, we make a comeback.

Will I have the procedure the first time I see the pain specialist?

Usually, the first visit takes place in the Pain Clinic. You will undergo a typical office visit, where you will be greeted by our staff and get acquainted with our protocols. Dr. Calin Savu, MD or Nurse Amber Sloan, APN will provide the first assessment, based on information you will provide. Occasionally, if a need is identified, a procedure may be performed at the same time with the first visit. However, a lot of variables enter that decision, including your insurance carrier’s rules, or whether you are on blood thinners that you may need to stop prior to a treatment. While a number of interventions may be done with ultrasound guidance, which is available in the clinic, others require x-ray  (fluoroscopic) guidance. That is available only in the Pain Center, a free standing ambulatory surgical facility, which is located 1 floor below, and for which you need to be scheduled. We continuously strive to minimize the waiting times between appointments and provide timely relief.

Who will perform the procedure?

The procedures will be performed by Dr. Calin Savu, a pain medicine specialist trained in chronic pain therapy, with more than 20 years of experience in such treatments. His pledge is to offer the most up-to-date, proven and effective forms of care, matching or surpassing the care available at the largest pain centers in the US. He is assisted by a team of thoroughly trained and vetted clinicians, who will provide you the highest quality of care, with compassion and respect.

How long does the visit take?

While it may take very little time for the actual procedure to be completed, there are a number of steps that add a fair amount of time to the process, is is usually the case with most medical and surgical interventions. It’s not unusual to occasionally spend a bit over a couple of hours in our facility.

After registration, your are going through an admission process which determines the present status of your general health, as well as the specific character, location and intensity of your particular pain.

While it may sound that you are going to be asked the same questions repeatedly, and by different staff members, you should consider this as a feature, not a bug. Many times, essential details provide us information that continuously shapes our thought process, our diagnostic and therapeutic protocols, and our final decision making. Be patient and help us understand your problem.

After treatment, a thorough assessment is essential to determine your immediate response. When the nursing staff decided it is safe to release you, a hand-over to the person accompanying you may include important information about the next stages of monitoring and treatment( self-assessment of pain for diagnostic blocks, information regarding the next appointment, referral to other departments-PT, OT, Medicine).

What should I expect?

After initial registration, you will be prepped and taken to a pre-procedure room. A nurse review of your general health status and specific pain details will follow. Once we decided to proceed with our treatment, a light anesthetic cream will be applied to the area to be targeted. you will be positioned lying on your stomach on your stretcher and get transferred to the procedure room.

Once there, after another verification of your identity and pain problem, the target area will be cleansed with a sterile solution. We use extremely thin and flexible instruments to minimize discomfort. Many describe a burning or stinging sensation for a few seconds, followed by a growing pressure as we approach the intended structure, using continuous x-ray monitoring . Use of x-ray (fluoroscopy) guidance maximizes precision and minimizes the chances of mishap, that are overwhelmingly reported when poor techniques and inappropriate/insufficient use of x-ray technology is used. When the desired area has been located and reached,  a small amount of contrast dye will be injected to obtain further confirmation of ideal placement; the targeted structure will be then  bathed in a combination of diagnostic or therapeutic substances, depending on your particular procedure.

Upon completion, you will be rolled back to the pre-procedure area, where a brief period of observation will allow us to assess your immediate response, answer any questions from you or your company, and get a set of departing instructions.

May I eat or drink prior to my procedure?

Eating a light breakfast or lunch is usually permitted. However, our staff will instruct you regarding your specific procedure. It is essential for patients with metabolic conditions (diabetes) to continue their daily habits without any changes.

How should I prepare for the intervention?

In the morning of the procedure, it is suggested to take a shower using an anti-microbial soap (Dial) and a washcloth or a sponge and gently rub the general area to be treated for a few minutes.

ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver;

Notify the nurse if you are taking any  blood thinner,  or have an infection or are sick;  Stop taking  anti-inflammatories  (Advil, Naprosyn, Mobic, etc) for 7 days;  we will provide you a list for blood-thinner stoppage durations during your first visit. For patients receiving coumadin, blood will need to be drawn prior to procedure to make sure it is not too thin.

IF YOU ARE SCHEDULED FOR A DIAGNOSTIC TEST, DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE. You have to continue  your routine medication on the day of the procedure (heart, diabetes, blood pressure)

If these recommendations are not followed carefully, we may have to cancel the procedure, causing a delay in treating your pain.

Expect to be at our facility one to three hours. This includes registration, paperwork, review of consent, procedure, recovery and review of discharge instructions.

What to do if I think I have an adverse effect from the treatment?

If you experience severe back pain, new or progressive numbness or weakness of your legs, dizziness, nausea or vomiting, or if you or someone else notice signs of infection in the area of the injection, you should call The Pain Center immediately at (870) 972-0411 during office hours or go to the nearest emergency room.  If these symptoms progress over more than a couple of hours, and are unable to travel safely to the closest ER facility, call 911 and request a team to come in and evaluate you; explain you had a recent procedure in your back/neck/ extremity and it was upon our advice you are calling to request assistance. Our office hours are 7:45 a.m. to 4:45 p.m. Monday through Thursday and 7:45 a.m. to 12:00 p.m. on Friday, except holidays.

What is Pain Medicine?

Pain Medicine is a branch of Medicine which is made of many disciplines. Pain doctors  have to draw their knowledge from Internal Medicine, Orthopedic (bone and joint) medicine, Neurology (nervous system), Rehabilitation, Anesthesiology, Radiology, Pharmacology and Psychiatry.

The Pain Medicine professionals have to make sense of your general medical, as well as the specific pain(s) history.

A thorough exam is necessary to identify problems and hints that may help identifying the problem. It also helps us understand the impact pain has on you present physical state and your ability to function, be productive and enjoy life.

Based on this information, we can then  develop a plan to identify the elusive causes of your pain and suffering, however subtle or frequently overlooked they may be; we then can finally put together a plan towards recovery of function, abilities and quality of life; in the process, a lot of time needs to be spent on gradually promoting good long term habits that would improve the odds of success.

It is essential to understand that we don’t fix problems, as if we replace a broken part and we’re back in business at 100%. We develop a collaborative plan between the pain specialists and the patients, where each party has to understand and accept their tasks and responsibilities.

Frequently, chronic pain is the result of chronic conditions (diabetes, degenerative arthritis, neuropathies) which cannot be cured. But even then, we strive to find solutions, tools that empower the pain patient to withstand some degree of discomfort, and handle it  in a confident and knowledgeable fashion, leading to a successful and enjoyable life.

What is a diagnostic block/injection?

While MRIs and CT scans may be helpful to identify potential sources of pain, they rarely determine a precise cause for chronic pain. Consider them a screening tool which may narrow the search for an answer. But they do not pinpoint the true pain source, or generator. The reason is the large discrepancy between MRI findings and true painful structures.

While some areas look “bad” on an MRI, they may be quiet and cause very little discomfort. Others may look fair on MRI but go through a powerful inflammatory process; this is actually a chemical reaction that can not be pictured on a screen, howevewr advanced is the camera.

A more effective and elegant way is to instill a potential antidote within the painful inflammatory “soup” developed at the suspected site. If our suspicion is correct, the antidote (in the form of local anesthetic) will provide dramatic relief, at least for the life duration of the anesthetic agent-usually a few hours.

A dramatic improvement in the pain level and the ability to function following such a block is the hallmark for a “positive test” and gets us one critical step closer to providing the appropriate solution, ie the treatment