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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.

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 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.

BLOG

ADVICE ON HANDLING PAIN
22 January 2020, Blog

Hello,
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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CHRONIC PAIN ASSOCIATED WITH INCREASED RISK OF POOR MEMORY, DEMENTIA
22 January 2020, 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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LEARN ABOUT YOUR PAIN
22 January 2020, 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.

Enjoy: learnaboutyourpain.com

C. Savu, MD

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MARIJUANA AND PAIN
22 January 2020, 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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MEDICINE BALL 200
22 January 2020, 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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REVIEW OF MARIJUANA THERAPY
22 January 2020, 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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SPINAL CORD STIMULATION
22 January 2020, 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!!!

https://www.bloomberg.com/news/articles/2017-12-26/spinal-cord-implants-to-numb-pain-emerge-as-alternative-to-pills

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TARGETED EXERCISES DECREASE PAIN
22 January 2020, 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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THE OPIOID CRISIS: DEFINING THE PROBLEM
22 January 2020, 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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WE’RE GETTING EDUCATED ON MEDICAL MARIJUANA!
22 January 2020, 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…

Autum

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WELCOME!
22 January 2020, Blog

Welcome to the jonesboropain.com 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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WHAT DO THESE DRUGS DO FOR/TO ME ANYWAY?
22 January 2020, 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!

Enjoy.

Have a wonderful, blessed, painless week.

C. Savu, MD

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