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Pain Management FAQs

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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.

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.

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.

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 as is the case 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, you will be 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 decide 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).

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 decide to proceed with your 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.

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.

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.

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 the 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.

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.

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 in identifying the problem. It also helps us understand the impact pain has on your 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.

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, however 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, i.e. the treatment.


09 December 2022, Blog

I think a good way to start my blogging career is to quote a legendary person who, through dedication and perseverance, overcame illness, trauma, pain . He ended up participating in 50 Ironman races on 50 consecutive days in all 50 states, trying to raise awareness for his pet project, childhood obesity. As quoted in Men’s Fitness magazine:

Pain tip #1.
“When the pain becomes intolerable, I get through the moment by surviving to the next second. Once I do that, I try to survive another 60 seconds—I call these power minutes. The great thing about pain is that with pain comes struggle, and with struggle comes learning, and from learning comes growth.”

Pain tip #2.
“In my experience, most people quit when their bodies begin telling them to. But once we reach that built-in stopping point, we have at least 60% more to give. That’s why you learn the art of managing the pain and taking comfort in knowing that this is a new pain I have today—the pain I had yesterday is gone.”

Pain tip #3.
“Having one ‘why’ isn’t good enough. You need to have a whole bagful of whys. Whys keep you going and give you a reason to take the next step. For me, reconnecting with my family was enough, but if you’re going for 50 days and your first why isn’t big enough, you’ll stop.”

A lot of wisdom here. Sleep on it. Good night,

C. Savu, MD

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09 December 2022,
Pain center 2 21

“Take a breath”, “room to breathe”, “catching your breath”. Not just a manner of speech, but wise

words, rooted in ancestral knowledge of the miraculous benefits of the simplest medicine you never

knew you own. Slow, controlled breathing slows down your heart rate, lowers your blood pressure,

clears up the stress hormones from your bloodstream, nourishes your organs and clears your mind and


Try this: close your eyes while sitting in a safe, quiet, comfortable space. With the eyes of your mind,

for about two long seconds, follow a little particle of air as it starts its journey from the tip of your

nose, through your left nostril, to the back of your throat, down the windpipe, then descending to the

bottom of your lungs. Let it gift your body with its precious oxygen for a fraction of a moment, then

very slowly, over 4-5 seconds, let it flow out, without pushing it, like the air seeping out from the tiny

pinhole in a beach ball. Imagine all your pain, anxieties, worries, your anger, and resentment flowing out

like dark dust, leaving you soft, relaxed, light, and clean.

Try this for a minute, then next time maybe for 3, then 5. And whenever you feel overwhelmed, or your

batteries are empty, and there seems to be no hope in sight, remember about this secret weapon and

use it to cleanse and recharge. You are more powerful than you think.

Take good care of yourself.

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09 December 2022, Blog

A new study shows again what we pain sufferers have kinda felt all along: chronic pain consumes our energies, our patience, our strength and leaves us exhausted. Over time, our intellectual and emotional reserves become depleted. We are left defenseless against the challenges of our environment, our daily life. It can literally make us lose our minds.

It is another compelling argument to be as aggressive as possible in seeking the sources of our suffering and find solutions, even partial and temporary (but still, repeatable as needed).

In other words, every day without as much pain is a better day, and in the long run it will not tax our bodies and souls as badly.

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Disneyworld Days of Our Lives
09 December 2022,

Disneyworld day

Imagine every day as a day-trip to Disneyworld. You show up at the entrance, and get a painful, stinging

shock when you’re hit with the ticket price. Uncomfortably and reluctantly, you fork up the money. And

then you’re in, and now you are free to have fun and enjoy the rides.

Apply this method every day. You wake up, and you hurt and feel like you don’t want to do anything.

Your price of admission in the fun park of your life is a brief exercise routine that loosens you up, and

strengthens you just a little bit, and improves your balance and stability. And after 10-15 minutes (or

even 5), it feels just a little better. Your blood gets flowing, your muscles, ligaments, and tendons wake

up and you move a bit easier. And in the process, you will get better, and stronger, more flexible, and

perkier. Then, whenever the pain is becoming unbearable again, don’t give in. Add another 5 minutes.

And keep going.

You’ll go to bed in better shape than when you woke up. And every day, your body will thrive, grow

healthier, and become more capable to serve you better. You need to be patient though. It will take a

while. Like anything worth something, you must pay a price. You may get a bit sore, and that’s ok. It is a

sign of our tissues waking up and shaking off our burdens. That is the discomfort described as the sound

of weakness leaving your body. Inside there is a kid covered in old man winter’s weight. You can slowly

dig yourself out. 

Take good care of yourself

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Dr Savu's Guide to Tolerating Uncomfortable Procedures & Stress
09 December 2022, Blog

Pain center 18

It is surprising how easy it sometimes is to do something good for our health.

Breathing, for example.

Today, I will walk you through a method I use frequently to help my patients relax and tolerate uncomfortable procedures with ease. If their usual response is a guide, you may benefit too, at any time, throughout the day, in any moment of stress, tension, anger, frustration, or even pain. 

With some variation in rates and duration, this method is used by world-class athletes and Special Forces warriors before they enter their competition or combat mission. It has been shown to abruptly lower heart rate, blood pressure, and decrease the stress hormones flooding our system when we’re under duress. 

The result: calm, serenity, clarity, increased attention, and focus, improved physical and mental performance, as well as tolerance to stressful and painful stimulation. 

Find a quiet comfortable area. Sit with a dignified posture, with your head up, with your ears lined up with the shoulders, and with your hands resting on your thighs, looking down about 6 feet in front of you.

Close your eyes. With the eyes of your imagination visualize a screen with counting numbers representing seconds. Inhale for 2 seconds, hold for the 3rd second, exhale for the 4th through the 10th, then pause at the bottom for 2 seconds (11, 12). Repeat. Focus on the count. Gently hush away all the thoughts, memories, and plans that will shower your mind continuously. Only the count exists. Live and enjoy each second like a refreshing potion healing your body and spirit (Because it really does).

It may be difficult at the beginning. Like with anything else, you will get better. And you will feel better. It may be one of the best medicines you’ll use. And it was really cheap…

Next time, we’ll try a different breathing method. Feel free to choose one or the other or combine them. 

Until then, take good care of yourself.

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Dr Savu's: Healthcare or Sickcare
09 December 2022, Blog

Pain center 25

Today we’ll talk about the state of your healthcare provider. Why am I named so? When did I last take care of your health? Wouldn’t you rather call me a sick-care worker? Because that would more precisely describe my job: to take care of you when you’re sick.

With rare exceptions, you are born and spend a long time in that state of physical and emotional balance that intelligent creation and millions of years of evolution have gifted you.  You are healthy.  Let’s call it normal bliss. That is your natural state. 

Then, a long destructive process starts, and the result takes you from being at ease in this world, into a state of dis-ease, pain, suffering, and anguish where everything seems to have turned against you.

The “healthcare” system will kick in once enough damage was done to your primordial state of happiness. We’ll sit tight until you are damaged enough to need us. That is our business. To give you the impression we are capable of repairing what damage you underwent before you came asking for salvation. Then we’ll give you band-aids so you can go back and keep doing what caused the damage in the first place.

We are the sickest, unhappiest generation in a very long time. We live in the most advanced, technologically enhanced, comfort-loaded society in the history of mankind, but the present generation is predicted to be sicker than any other before it. And that is despite us spending much more on sick care than any other country in the world.

So, what’s going on? 

In the next weeks, I’ll talk about the main actors of this play: you, the society (with plenty of contribution from the food, alcohol, and tobacco industries, media, the education establishment), the medical system supposedly keeping you healthy, and the government agencies supposedly keeping a watchful eye over the entire process.

It’s not going to be pretty, but it may show you a way to choose wiser.

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Dr Savu's: You Are What You Eat
09 December 2022, Blog

Pain center 21

We are what we eat. 

An old saying, with very profound wisdom. What we put in our mouth gets transformed in complex ways into small particles that are, in the end, incorporated into our cells, tissues,

organs, and fluids. Would it make sense that different supplies create different products and results? Of

course. Good nutrients lead to good bodies. Bad ones lead to bad, aching, suffering ones.

And I am not only talking about what we put in our mouths. 

What goes into our eyes and ears is also food, for thought but also for bodies. For example, listening to the news about the war in Europe (so

far), the inflation without end in sight, the ruptured state of our society will create a real, measurable

effect in our bodies: similar to food-related toxins, bad news will trigger a stress response, with

adrenaline, cortisol, and other stress-related factors flooding our bodies, and causing a tightening of our

arteries, revving up of our immune cells to make them angry enough to attack our own tissues,

amplifying the production of juices that make us anxious, depressed, and angry.

Now imagine listening to a serene sermon, to your favorite tune, to the bubbly attempts for

conversation of your newborn, to your child or your best friend telling you how their day went and

asking you how you’re doing. Or watching a funny clip, or a travel documentary showing far, mysterious

lands. Your “happy” hormones are going through the roof, a sense of warmth and belonging engulfs

you. Even your joints feel a little better.

Positive information leads to good and healthy bodies. Bad info leads to bad, suffering ones.

And remember neither food companies nor newsgroups exist to protect you. That is not their job.

They want to make money by providing a product that sells well, which is ok.

So, whose responsibility is to make wise choices?

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Dr. Savu's: Portion Control
09 December 2022, Blog

Pain center 43

One of the most important contributors to the sickness epidemic is what we eat. The quality of food has

worsened, as producers have developed ways to create more that costs less.

 It’s a devil’s bargain that we accepted, and increasingly get a pass from so-called regulatory authorities. But today we‘ll talk

about the amount. Portion control is an essential tool to allow our bodies to be nourished but not

stuffed, supported, and not overwhelmed. Usually, hunger is regulated by hormonal factors: one tells us

we’re hungry (ghrelin), another that we’re full (leptin). We get hungry as ghrelin increases when we

don’t eat, and as we ingest our food, leptin starts rising, triggering a sense of satiety (fullness).

Unfortunately, leptin takes its time to signal our mind it’s time to put the fork down, so we keep eating,

well beyond the point of balance. As we overeat, leptin finally kicks in, too late to keep us balanced. We

already ate too much.

 I remember a trick the old rich and noble developed: build the kitchen a few

hundred yards away from their mansions. By the time their staff collected the flatware and silverware,

took them back to the kitchen, and brought back the next dish, leptin had enough time to rise and that

would limit their ongoing appetite. Voila! Automatic portion control. 

But you don’t have to buy a sprawling mansion to lose weight. Next time, try to eat a moderate amount of food. I usually fill a 12 oz

bowl with everything I want to eat (not necessarily mixing it), and after I’m finished eating it, I take a few

minutes. I can spend that time socializing, daydreaming, meditating, or simply drifting. When you come back,

you’ll notice hunger is mostly gone. Leptin is up, and you’re satisfied, but not bloated!

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Dr. Savu's: The 5 Why's
09 December 2022, Blog

Pain center 10

The 5 whys

The founder of Toyota Industries developed a method of analysis that goes to the root of any problems: ask “Why?” 5 times.

For example, I am seeing my medical provider for my annual check-up. I discover I have high blood pressure and high cholesterol.

Usually, due to time and insurance constraints, the visit will end with me walking out with a prescription for a bunch of pills and an appointment for a return visit in 2-3 months, but not with a lot of actionable information.

But wouldn’t it be better to start my conversation with my doctor by asking the first why:

Why do I have high blood pressure and cholesterol? Maybe because my vessels have hardened, and I have gained so much weight.

Why are my vessels hardened? Maybe because of ongoing stress I can’t seem to control.

Why did I gain so much weight? Maybe because my nutrition includes a lot of bad stuff.

Why am I eating a lot of bad stuff? Maybe because it tastes good and it comforts me many times when I am under stress, although I know this may not be good for me.

Why don’t I think about making better choices? And that’s where the real conversation starts.

Today we will start a weekly column with a specific education goal: to make you a knowledgeable owner of the most wonderful masterpiece that ever existed, the perfect result of creation and millions of years of evolution: your body.

We will also include commentaries on the state of the American Healthcare system, and the effects that its different structures, policies and arrangements have on your wellbeing (hint- they are huge!).

Hopefully, we will be able to help you navigate the complex maze of decisions that will affect your life and well-being, as well as that of your dear ones.

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Dr. Savu's: What is Pain Management? Part 1
09 December 2022, Blog

Pain center 33

Chronic pain conditions can be divided into 2 groups: those that are the result of problems that can be addressed and improved in dramatic ways and those for which a reasonable degree of relief is possible. There are really no conditions that cannot be improved upon.

Most of the time, we easily recover from injury. We are equipped with exquisite machinery that heals and repairs us on the go. But sometimes, when a condition has not resolved itself within a reasonable time (roughly 3-6 months), then we need to proceed with a different approach.

We use different methods to alleviate pain: one is the use of pain medications, and the other is a variety of nerve blocks.

Pain medications affect your body’s (effectively your brain) ability to experience pain by creating a chemical fog that blunts the reception of pain signals to the brain centers of pain reception and processing.

The nerve blocks temporarily interrupt the pathways pain uses to access those reception/processing centers.

None of those methods fixes the problem, the primary source of pain. 

“Fogging” the brain obviously does nothing to repair a displaced disk, an arthritic joint, an inflamed tendon, or a pinched nerve. It buys you a few hours of oblivion, and then you’re back to square one. Only a little bit older, and stiffer, and weaker. Because pain pills decrease your responsiveness and attention, they may make you less likely to engage in the efforts that would allow your body to repair itself.

Nerve blocks offer longer-term relief, without the drawback of slowing your strength and stamina. But they don’t make you better either. 

Both are only helpful in combination with training and rehabilitation specific for each chronic condition causing relentless pain.

Your body is an amazing masterpiece perfected by super-intelligent design and millions of years of evolution, which subconsciously (and frequently consciously) knows its problems, as well as its solutions. It only requires a free will to nudge it in the direction of repair, rebuilding, and improvement. Nobody is born an accomplished artist or athlete. It takes work and resilience but make no mistake: it always works. 

Athletes and artists get rewarded with riches and fame. Your prize is much bigger: you get your unique and wonderful life back.

Take good, loving care of yourself.

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Everybody Hurts
09 December 2022,

Everybody hurts

Everybody hurts. Not just an REM song (pretty good, actually). For those among us who suffer and have

a hard time doing anything and everything because of your pain, you are not alone. If you have that

particular type of pain, other people have it too. Some suffer more than others, some are more disabled

than others, some lives are affected more than others. In our clinic, we see those who are successful at

handling and managing their pain, and those who are not as fortunate. We apply not only our

knowledge of anatomy, and physiology, but also the lessons that we are taught by our patients. We

listen carefully to your story, and with each patient, we learn what works, what doesn’t, and what

makes the difference between a successful and a failed approach. When we give you advice, we are not

just quoting from textbooks and articles. We share with you the recipes discovered, adopted and proven

effective for other people, some just like you. 

We are working towards creating a space where you can

donate your advice, your wisdom and the fruits of your experience, hoping they will inspire those who

are about to lose their hopes and will to keep looking for solutions. Sometimes, it’s probably best to just

get out of the way and let you talk among yourselves. And we know we’ll listen too, because we’re in

this thing together (we hurt as well). 

Take good care of yourselves.

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09 December 2022, Blog

Good morning! I just came across a great website containing detailed and down-to-earth descriptions of most pain conditions that we encounter in our practice. See if you can find something that sounds familiar. Remember, all studies show a knowledgeable and involved patient who assumes some of the responsibilities for their well-being is the best suited to get better and stronger.


C. Savu, MD

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09 December 2022, Blog

Good morning,
For better or worse, it appears marijuana is here to stay.
By now everybody is aware of this powerful current streaming through our nation. Marijuana is pushing hard to sit at the table of legitimate pain relief modalities.

Our clinic is responding. We weren’t on board with it simply because the evidence supporting it was, in general, scant and of dubious quality. As its use has increased exponentially, the number of case studies is expected to grow and, hopefully, provide us with better data.

During the next few months, we will undertake the project of becoming educated on the subject. After assessing the benefits and risks of treatment, we will draw conclusions. And we will make a decision about possibly offering it for patients whose type of pain and situation suits this type of treatment.

We promise to be diligent, careful and open with the process and its conclusions. But we try to find the best options available, including those with a shadier past!

Stay tuned…

Calin Savu, MD

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09 December 2022, Blog

MB 200 is supposedly one of the training routines used by the North Carolina Tar Heels. Hey, they’re champions, so I presume they know a thing or two about training that works!

Our routine includes 10 exercises, each with 20 repetitions (reps, in short), therefore the name (10×20).

It should be done in the following manner:

A full set of 200, allowing a brief pause between each of the 10 exercises; if a true beginner, take time to catch your breath. But you should perceive each exercise as hard enough to push you a bit; if there is one exercise you can not do for 20 reps, remember that number and try to beat it each time you train again.
At its completion, rest, walk around, shake arms and legs for a couple of minutes.
Repeat the full set of 200.
Hit the shower.
Repeat every other day; you have to give your body time to recover and repair. We grow stronger through a cycle which goes like this: stress, recover, adapt. Give your body time to recover and you will adapt at a slightly higher level of fitness each time.

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NSAIDs In Acute Pain
09 December 2022,

Nsaids in acute pain

Non-steroidal anti-inflammatory drugs (Advil, Naprosyn, and the large over-the-counter, so-called NSAID

family) are probably the top category of drugs used in the US.

There is a problem with that. I’ll address the short-term use today and I’ll return for a second shot at its

long-term (mis)use.

A study investigating NSAIDs for acute pain showed a surprising increase in the percentage of patients

who progress to develop chronic pain when compared to those who didn’t receive this treatment. But it

makes sense. Any acute injury to our body (especially trauma and surgery), will trigger inborn

mechanisms of defense and repair that are truly amazing in their complexity and elegance. We are made

to heal, repair, and recover. In short, we are born survivors. Inside us, we have the best doctor,

therapist, and coach we’ll ever encounter.

The initial injury creates an acute inflammation, which is an immediate and positive reaction mobilizing

armies of cells acting as defenders, soldiers, EMTs, scientists, and planners who set up to repair the

injured part right away. In a way, there is no chance of repair without the initial step of inflammation.

Unfortunately, widely used NSAIDs are powerful inhibitors of this process, and while they prevent the

acute inflammatory process, little is known of their limited power to promote healing (probably

minimal). It is possible that an incomplete repair process may start a chain of events leading to the

development of chronic pain. Maybe at this point, all we need is to get out of the way, rest a bit, and

allow the miracle of creation end evolution to take its course. Tolerating some degree of pain and

understanding it is a signal our bodies are starting to work should be the initial step in the recovery

process. Acetaminophen (Tylenol), ice, a short period of rest, and limited, carefully monitored use of

minimal doses of opioids (none of which interferes with the repair process), just enough to allow

progressive return to activity (which turbo-charges healing) may be a wiser solution if the rules of this

process are thoroughly discussed and agreed upon with patients before its initiation.

Take good care of yourself!

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09 December 2022, Blog

A new review of studies investigating the effects of marijuana has been published.
It undertook the large task of critically looking at a large number of studies investigating this option over the last 20 years

It focuses on effects on chronic pain and PTSD.

It appears pot does little to help with PTSD.

When it comes to chronic pain, well… it’s complicated.

There seems to be a small, but clear benefit for its use in cases of neuropathic pain, caused by actual nerve injuries. Those may stem from direct trauma, inflammation or metabolic disturbances (diabetes). It also seems to have some effect alleviating anxiety and tension, relieving insomnia and overall, improving quality of life in the short term.

On the other hand, it does not appear to have an effect on other types of pain, originating in other tissues (muscles, joints, bones, ligaments and tendons, internal organs).

Furthermore, counterbalancing the positives, there is a definite number of side effects, both immediate and long-term; car accidents, episodes of psychosis, manias, cognitive impairment seem to crop up soon after its use. The long term effect, whether related to development of dependence or not, results in different but clear degrees of mental impairment and disability. Say what you may about opioids, but blaming them for similar (irreversible) results has proven much more difficult.

As promised, we embarked on a search for the truth in service to our patients. We are still on the sidelines, but we are getting educated. And we will come to a conclusion regarding the careful use of marijuana in selected cases.

But if you choose to use it before we can become good stewards of your trust, ask about the dark side. Providing it just because we can (and it’s good business) may be good in a lot of other commercial areas but not medicine.

Thank you for your patience.

C. Savu, MD

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09 December 2022, Blog

After a series of studies were recently published about the benefits of this new technology, the mainstream media has picked up the story. I think it does a very good job at presenting it in a realistic light. But, buyer beware, as it is not a miracle cure. Patients need to be presented the subtle nuances of such therapy. Make sure you understand how the technology works, what are its limitations and how it fits in with the rest of pain relieving modalities.

Oh, and Happy New Year to all our patients!!!

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09 December 2022, Blog

A new study investigates “lumbo-sacral stabilization training” exercises. They decrease pain in a manner similar to pain pills. When performed regularly, they decreased pain and sensitivity to heat and pressure, which were used as measures of spontaneous and triggered discomfort. So, as we frequently tell our patients, exercises is just like a pain pill. But without negative side-effects, and with many added advantages (mobility, strength, stamina, mood, happiness).

We are developing a new set of exercises along this particular profile. Until then, stay warm and active!

Calin Savu, MD

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Test Blog
09 December 2022, Blog

Ths is a test blog.

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The House Hold Assassin: Fentanyl
09 December 2022,

Pain center 2 18

Do you know there is an assassin in our house that has killed more Americans than entire Vietnam

War? And it is only warming up? Fentanyl-related deaths have grown 10-fold in the last year. And

Fentanyl has become the leading cause of death by overdose (it is hard not to overdose, as it is

enormously powerful). It is coming for us, or for someone dear to us. One way or another, many of us

will be badly hurt, unless we do something. And right now, we are not very well prepared.

As a pain specialist and anesthesiologist, I was awed by the power of this super-drug, created to blunt

the worst pains possible (as in being cut wide-open during surgery). It is an amazing product, that

revolutionized our field. But in the operating room, we have the supporting and monitoring systems that

would allow us to safely drive you back to a pleasant, albeit fuzzy-headed awakening.

Imagine boarding an airplane, strapping yourself in for turbulence, taxiing, taking off, and flying at 32000

feet, then, gently descending to the ground for a precise and timely arrival, under the care of a

competent, caring staff.

Outside the OR, at a party, at home chilling, or vacationing in paradise, you have no such protection.

Imagine being launched from a cannon at 32ooo feet. What are you going to do? Same path, not the

same outcome.

Fentanyl is a fine powder, 100 times stronger than Morphine, cheap to create, and extremely easy to

conceal for transport. It has been used to spike, lace, and adulterate every form of legal and illegal drug

(sedatives like Xanax, antidepressants like Prozac, other narcotics like heroin, Percocet, Hydrocodone,

stimulants like crystal meth, Adderall, MDMA). The presumption should be that any drug coming from a

person you know may have passed through 2-3 more pairs of hands that you will never know. Reassured


And while kids and other vulnerable people (along with a sizable number of innocent bystanders) die all

around us die every day, it is comforting to hear that the CDC, the elite forum of experts and policymakers

tasked with our safety and well-being, finally decided to call an emergency. For moneypox.

These are not serious people. While Fentanyl floods us through our porous borders, there is minimal

leadership and guidance from Washington, which is too busy with its own self-serving interests taking

center stage in this busy election season. This time bomb is left for the local leaders of communities like

ours to try to defuse and develop defensive systems.

As an initial kit of simple advice, I would humbly suggest:

-Narcan (a reversing and temporary antidote) stations backed by Narcan-specific trained people

everywhere drug use can take place (which means everywhere). Note: a single dose of Narcan will not

last too long, but only be able to buy the time needed to call first responders, who will continue the

necessary treatment.

-Fentanyl-testing strips that can identify its presence in other pills, powders, and liquids to be made

available in a similar manner.

-if you take drugs, do not do that alone; have a designated guardian everywhere you decide to use.

-if you receive your fix from anywhere else than a medical facility or pharmacy, understand that there is

a chance in 3 it will be contaminated with Fentanyl.

-dust from contaminated drugs can linger or float around and be ingested or inhaled, with dire

consequences, especially for the frail or very young; so, best not bring it in your house.

It is beyond my set of skills to devise a policy and its mechanisms. A nimble and rapidly responding blue-

ribbon group of healthcare and other first-responders, school administrators, local industry, and civic

leaders, as well as any others with experience, deemed useful would be a good start. I will contact the

City Hall, as well as the 2 great hospitals we are fortunate to have and ask for guidance.

I also would appreciate your thoughts, advice, and input at

I hope you will hear from us soon. Until then, be safe and take good care of yourselves. God Bless.

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09 December 2022, Blog

As we are all aware, there has been an onslaught of rules, regulations, directives, guidelines and outright impositions regarding the prescription of opioid medications in the United States. The roots of this forceful push are real.

According to statistics, between 100 to 150 patients on prescription opioids die every day in the US. While the immediate cause may be acute intoxication/overdose, this already horrible number fails to take into consideration the more subtle, shadowy underbelly of the same beast. Some of those overlooked but equally deadly contributors?

1.Impairment of reaction times (leading to traffic accidents),

2.impairment of balance (with an increased risk of falls),

3.decreased attention span and focus (creating the opportunity for work or household accidents),

4.chronic, slowly developing immunity impairments (possibly contributing to infections and facilitating the development of cancers), likely adding an untold number of victims to the tragic tally.

Why is this happening? Because these drugs are very good at what they do, at a cost. They can take away your pain. Physical, but also mental and emotional. They give us elation, and forgetfulness. They make us feel at ease. But when the effect is gone, they leave us with nothing. Or maybe worse. Now we’re 6 hours older, weaker and stiffer. And then we crave what we just had, and lost: the good feeling of comfort and warmth that came and left with them. And we want more of this. We like to go back to that place of lightness and freedom, to get up and do stuff. We like to be pain free. But free we’re not, anymore.

Come back next week for part 2: What do these drugs do to me, after all?

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The Sunshine Drug
09 December 2022,

So we hunker down in our dark, protective caves and shield our faces like Dracula’s disciples (I’m from Romania, I know the feeling!) But is this all we can do? It turns out there’s some ray of hope out there.

Researchers have suggested that Vitamin D may play a beneficial role in strengthening our immune response, which helps us fight back against aggressors (infection, inflammation, cancer).

Did you know some studies estimate Vitamin D deficiency can affect almost 50% of the world population? Yes, you read that right. In my calculation, it would be the most pervasive health issue by far!

We can eat more stuff containing it (salmon, egg yolk). But it turns out the richest source is closer than you’d expect. Just look in the mirror.

Our skin contains large amounts of such ammunition, in inactive form. All we need to unleash its healing powers is a little bit of sunshine. Yes, you’re a sunflower.

Even moderate sun exposure energizes large amounts of life-enhancing, tiny miraculous molecules ready to spread into all our nooks and crannies with their healing and strengthening effects.

Activated vitamin D (D3 or cholecalciferol) fights cancer, heart disease, hypertension, obesity, depression, dementia, diabetes, Parkinson’s disease, fractures and falls, autoimmune disorders, macular degeneration, infectious diseases. Pretty impressive, huh? How come you didn’t know all of this? Well, not many will invest in a study that would show results they cannot sell, right? Here, all you need is step out into the fresh air and light, while they’re still free.

I continue to advocate social separation, and minimizing the time spent in public places, for now. But it’s getting stuffy inside.

So drag a lounge chair into the back yard, or launch a boat onto a lake, spread a little sunscreen and enjoy the sun, with moderation. Heed its gentle call to shield ourselves against the shadows circling around, with weapons that an infinite wisdom endowed us with.

Open a book, listen to some good music, squeeze an orange, bite an apple, and close your eyes…Yes, you are hard at work.


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09 December 2022, Blog

At the Pain Center, we are committed to offering our patients relief from their pain through a multidisciplinary approach that includes interventional treatments as well as physical rehabilitative therapy and medication. Additionally, we are constantly researching new and innovative treatment options that might better help our patients. This weekend, Amber Sloan, APRN, will travel to Orlando, FL, to attend the American Medical Marijuana Physicians Association 2017 Conference. While there, she will have the opportunity to attend multiple educational presentations and discussion panels and network with experts in the medical marijuana industry. Some of the presentation topics include:

Cannabinoids and Dependency
Medical Cannabis Dosing and Formulation Strategies
Complications and Adverse Side Effects of Medical Cannabis
Chronic Pain and Medical Cannabis
Autoimmune Diseases and Medical Cannabis

Right now we are just doing our research on medical marijuana: how it can be used, what the laws and prescribing guidelines are for our state, how it will fit into our current treatment regimens. Once we feel we have done our due diligence on the matter, our practice will decide what role medical marijuana will play in our clinic.

Continue to follow us on here and on Facebook for the latest updates…


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09 December 2022, Blog

Welcome to the blog
We intend to make it a home for all those who suffer from relentless pain and are looking for solutions.

Our team will try to make this website a valuable resource for information regarding modalities of relief, ideas for coping, as well as advice for those who are confused and support for those who feel hopeless.

We strongly believe everybody can get better! Moreover, we know so…

Staff members will post information regarding studies and research investigating painful conditions, diagnostics and treatment.

We will add inspirational stories from the web or magazines that cross our desk. And frequently, we will publish stories written by our own patients. They will describe their own ordeal and struggles, and yes, their achievements.

Because whatever you suffer from, you can be sure someone like you suffered too, and succeeded!

So, we are looking forward to have you on board.

We’re in this together,

Calin Savu, MD

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09 December 2022, Blog

Welcome back
First, the good news.Opioids, deriving from the poppy seeds, have been identified many thousands years ago to help the wounded hunters, the stumbling clumsies, the sick and the elders with their pain. They probably helped, if not saved, many millions of people, from the caves to the huts, and the villages, and the towns and the cities that sheltered humankind over its evolution. I would think only the discovery of antibiotics offered a more revolutionary medical tool. Over time, opioid use has been refined to include natural, partially processed (semi-synthetic) and fully engineered (synthetic) brethren. Of note, in this context, “natural” has no advantage whatsoever over the other products. Equally useful, and risky.

Once they enter our bodies, they attach to little sites on the surface of different cells and activate pathways leading to different effects: in the brain and spine, they prevent the creation, transport and effect of other substances (neuro-transmitters) that send pain signals to the main receiving area-the cortex. But pain pathways end up in other areas of the brain, where emotion, hope, happiness, self-confidence, and our inner sense of security and comfort are nested. It’s easy to understand now why pain is not only a sensation, but also a feeling, a state of mind that affect negatively our deeper selves. Preventing the changes creating this widespread damage is what makes these opioids so effective and appreciated.

Next week, something about the dark side..

But until then, something to think about: Exercise makes us younger!


Have a wonderful, blessed, painless week.

C. Savu, MD

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