The answer is absolutely yes! The health questionnaire that we ask you to complete gives us a very good look at you from your own personal perspective. When you share with us your story of pain and any treatments or medications you have experienced in your search for pain relief, we can start our relationship from a place of understanding and knowledge. Your truthful answers are critical for the plan that we develop together.
Medications often can work against each other so a urine sample gives the physician information on what is already in the patient’s system. This information is key in order to avoid drug conflicts such as additional side effects or overall ineffectiveness. The likelihood of drug interactions increases as the number of drugs being taken increases. A urine sample is not judgemental, however, it is required before any medications are prescribed by PCA.
Our Agreement for Opioid Maintenance Therapy is necessary for PCA to safely prescribe narcotics and/or controlled substances for pain that is difficult to manage with standard medical care, also known as intractable pain. The agreement outlines all of the safety and regulatory issues regarding the proper use of controlled substitutes. Among our expectations, we stress the need to use one pharmacy and one physician for all of your pain medicine prescriptions. In the agreement, PCA requires you to take your pain medications as prescribed and submit a urine specimen for testing regularly. The agreement also covers not using other intoxicating substances including alcohol, marijuana or other unprescribed substances. Due to the impairment effects of some pain medications, you must not drive or operate machinery. Your medications are for you alone, so you are restricted from giving or selling them to others, and you also are not allowed to take anyone else’s medications. The agreement is focused 100 percent on your health and safety.
The use of controlled substances requires careful monitoring for the health and safety of every patient. The Opioid Maintenance Therapy Agreement states very clearly that regular office visits are required in order to review your response to the overall pain management program, including prescriptions. When we meet during your office visit, there may be a need to change or adjust your medication, and discuss other therapies or new treatments. Note that PCA will not call in medications in between your office visits.
It is imperative that you keep all medications safe and PCA recommends a lockbox. The Opioid Maintenance Therapy Agreement states that “you agree to take reasonable safeguards to protect medications from theft including lock and key.” When you travel, you should keep your medications on you at all times and do not check them with your luggage when flying.
No. Why? Because you must take your medications as prescribed. We stress in your treatment agreement that you will not use up or run out of medication early. You will not allow medication to be lost, stolen, ruined, misplaced, or left behind. You understand that medications will not be replaced or filled early. You will take reasonable safeguards to protect medications from theft, including lock and key. Be aware that most insurance companies will not allow you to fill your medications early. In the occasional situation where travel out of town is required, your insurance company may allow an earlier fill. However, subsequent fills will be back “on schedule” and travel is not an excuse for deviating from your prescription directions.
An epidural steroid injection (ESI) can treat sciatica or other intense pain in the arm, neck, lower back, and down into the legs. An ESI is an injection of a small amount of a powerful anti-inflammatory steroid around the spinal nerves to provide quick pain relief by reducing the swelling or inflammation of the nerve roots as they leave the spine.
All PCA treatment options are designed to reduce or remove pain, so a concern about pain during a procedure is understandable. However, with the use of a local anesthesia, most patients find the majority of procedures easily tolerated and a sedative is rarely needed. If a patient is extremely anxious or extremely fearful of needles, the PCA physician can administer a sedative to help the patient relax during the procedure.
Before you leave our office after an injection, a PCA nurse will provide you with complete instructions related to your particular injection. In general, we advise rest and very limited physical activity for the remainder of that day. Patients often may return to their baseline activity 24 to 48 hours after the procedure.
There is not a singular answer, as relief varies for each patient and there is not a definitive way to predict a response to treatment. Most patients do well and can experience long term complete pain resolution, although patients with severe conditions may not see much pain relief. But the consultative nature of the PCA relationship means we will work together on the plan and work towards any changes needed to find the right solution.
Yes, X-ray guidance is an important part of administering an ESI precisely in order to reduce or remove the pain a patient is experiencing. The advanced technology found in the PCA interventional suites gives our physicians what they need right here in the office to perform procedures safely.
The term “steroids” is often associated with a performance-enhancing anabolic steroid sometimes found in the sports industry. However, Cortisone is the steroid used in pain treatment such as in an ESI. In this situation, problems with steroids used in pain treatment are very rare unless the steroids are used chronically for problems such as asthma or rheumatoid arthritis.
There is nothing in the steroid Cortisone that causes you to be unaware of your surroundings, so injury due to Cortisone is nothing to worry about.
Epidural Steroid Injections are often performed as a series of two to three injections over several weeks. If the problem returns in the future or later in life, this series of injections can be repeated.
Some people become nauseous due to anxiety or general discomfort and IV sedation can increase the risk for vomiting and aspiration. Because of this risk, an empty stomach is required for the procedure. You may continue to take your medications using just small sips of water.