FAQ

Pain management is a comprehensive approach to diagnosing, treating and controlling pain. It encompasses an individualized treatment plan to coordinate safe and effective options that can address the physical, emotional, social, and psychological aspects of pain. In a balanced approach to pain management, people with pain, along with their family members and caregivers, learn to manage the pain in safe, effective, responsible and healthy ways to improve or maintain their overall well-being.

Components of a balanced pain management plan may include:

• Physical therapy and rehabilitation
• Medications
• Minimally-invasive injection-based therapy
• Psychological counseling
• Social support
• Other complementary approaches

Successful pain management relies on teamwork.  Moving from patient to a functional person with reduced suffering depends on the active involvement of the patient and the assistance of the support network. Multidisciplinary approach to pain management means a team approach to ensure that people with pain can improve their quality of life, increase function and reduce suffering.

A pain management doctor is a board-certified physician who is able to diagnose and treat acute and chronic pain conditions using a comprehensive treatment approach.

At Spine & Pain Associates, PLLC, we build comprehensive, individualized treatment plans for each patient. These plans employ a variety of pain management strategies focused on the whole person — not just the pain.

People develop pain for many reasons. Pain from a recent surgery, injury or medical illness is called acute pain. In many cases, this pain can be managed immediately and will usually get better within a short time.  If your pain persists after the healing process should be over, you might have what is called chronic pain. If the current treatment you are receiving stops working or your pain begins to get worse over time, your primary care doctor may suggest that you see a pain management doctor.

Pain that remains persistent may require further evaluation to accurately diagnose the cause and implement an effective treatment plan. In general, earlier evaluation of pain typically leads to greater diagnostic accuracy and faster relief.

Cancer pain is another condition that can be managed by a pain medicine doctor while the patient continues to receive cancer treatment. The pain may be due to cancer surgery or treatment procedures, including radiation therapy and chemotherapy, or the tumor itself.

By definition pain is considered to be chronic when it lasts more than 3-6 months, has significant psychological /emotional effects and limits an individual’s ability to fully function.  Chronic pain may result in sleep disturbances, lack of energy and depression. In chronic pain conditions the pain persists beyond the usual course of an acute disease or healing of an injury.

We do appreciate referrals from a wide variety of physicians and other professionals, but a physician referral is NOT necessary. If your insurance company requires a referral, please obtain it from your primary care or referring physician prior to making an appointment.

At your first appointment, you can expect a thorough evaluation by one of our expert doctors. Dr. Bhat and Dr. Dhaliwal specialize in identifying the source of the painful condition and in designing a comprehensive and personalized treatment plan to alleviate symptoms and improve function.  Your pain management doctor may order additional tests such as radiographic images (including x-rays, CT scan, bone scan, MRIs, etc.) or blood tests.  A multi-modal treatment plan tailored to the individual patient will be discussed and initiated that may include medications, possible minimally-invasive procedures and/or physical therapy.

Insurance cards and picture I.D. are required. Any type of prior evaluation material such as medical records, reports and/or images of x-rays, MRI, CT, bone scans, and nerve conduction studies are useful.

Spine & Pain Associates, PLLC accepts most insurance plans, including government-sponsored plans and private commercial insurances.

Spine & Pain Associates, PLLC is an in-network provider with the following insurance plans.  Check with your insurance carrier and your employer to see if special restrictions apply.

• Aetna/Coventry
• Blue Cross Blue Shield of NC
• Cigna
• Humana
• MedCost
• Medicaid
• Medicare
• Tricare
• United

If we are not a network provider for your insurance carrier, we will be happy to file a claim as a non-network provider.  If your insurance carrier is not listed above, please contact our office, as the list may change.

Our physicians focus on advanced interventional treatments, so our office can manage almost any kind of pain. You will receive a thorough examination, and your doctor will then recommend the treatment option(s) that he or she believes will best treat your condition.

With respect to procedures offered, please view list of both traditional and cutting-edge procedures that we offer to our patients.  Most of these procedures will be performed in our office using either fluoroscopic or ultrasound guidance.

If you are being seen by one of our providers for the first time, please arrive 30 minutes prior to your appointment time so you have adequate time to complete our new patient paperwork. If you prefer, you can download, print, and complete this paperwork prior to your visit, using this link. If you bring your completed paperwork with you, please arrive 15 minutes prior to your scheduled appointment time.

For return clinic appointments, patients are requested to arrive 15 minutes before their scheduled appointment time.

For procedures, please arrive 30 minutes before your scheduled procedure time. It takes time to prepare for your procedure including check-in, changing and checking vital signs. We want to make sure we have enough time to give you truly great care and not rush anything.

Since each insurance company has its own guidelines and process for authorization and approval, it is hard to predict how long your authorization will take. Some authorizations may only take a few days, while others may take weeks. In certain cases, patients can significantly expedite their authorization by contacting their insurance carrier directly. You can always check on the status of your authorization request by calling our office.

Epidural steroid injections can be an important part of your treatment plan. The epidural space surrounds your nerves and discs. Injecting steroids, which are potent anti-inflammatory medications, directly into this space can precisely target the source of inflammation.

Much like a topical steroid removes irritation and redness from a skin rash, the injected steroid decreases the inflammation and swelling around the nerves and discs, thus relieving pain and pressure. The injection is typically enough to ease the pain to the point that you can engage in the exercise that will help you on your road to full recovery.

The ultimate answer is “No”. Steroid injections can decrease the inflammation around the discs and nerves, which in turn can alleviate pain enough to allow return of more regular exercise and activity.

Yes, all medical management tools from medicines to invasive procedures such as surgery carry risks. Generally, interventional pain management techniques carry unlikely and minimal risk. We’ll explain these risks during your office visit.

The goal of interventional pain management is to improve function and reduce suffering. We strive to provide as much pain relief as possible with the least amount of risk. Every patient is different and may have different outcomes.

We do recommend that you bring a driver for all procedures.  If you have a procedure performed with sedation, you will need someone to drive you. The sedation may impair your reaction time and make you groggy.

The vast majority of our patients indicate that the procedures are relatively painless. Most procedures are performed with a local anesthetic that usually reduces the discomfort of the procedure.

Most minimally-invasive procedures performed in our clinic are quick, relatively painless, and require only local anesthesia. In certain circumstances, we offer oral sedation to decrease anxiety and apprehension. Your pain management physician will discuss each step in the procedure, including the anesthetics you'll receive and any necessary fasting or preparation needed, prior to your treatment.

“Minimally invasive” simply means that the majority of the procedures we perform (with few exceptions) are done percutaneously or through the skin. Percutaneous procedures involve the introduction of very small needles or needle-like instruments, and do not require stitches afterwards. This approach means that the risk of infection and complications, while still present, is minimized.

It can be normal to have pain after an injection. Every person responds differently; some patients feel worse before they feel better, others feel better right away. If pain persists, apply icepacks for 10-15 minutes every 4-6 hours. DO NOT use a heating pad for 3-4 days after your injection.

Call the office if you experience any of the following symptoms: fever, persistent headache, bowel/bladder issues, or new onset weakness.

At Spine & Pain Associates, pain medications are sometimes utilized as one component of a balanced, comprehensive plan for pain management. On an initial visit, your doctor will review your history, perform a physical exam, review imaging if available, and come up with a plan tailored uniquely for you.

In addition, we will evaluate your list of medications during the initial visit and provide our recommendation to you and your primary doctor about continuing opioid therapy. We may recommend another course of treatment that does not include opioids. We do not always write a prescription for opioids, so please do not arrive with the expectation that we will automatically refill your prescription. If we opt to prescribe opioids as part of your care plan, we may adjust the medication to a more appropriate dose, a better dosing schedule, or a better medication.

No. Don't wait until pain becomes severe to take pain medications.  Pain is easier to control when it is mild. You should take your pain medication as prescribed. Sometimes this means taking medicine on a regular schedule, even when the pain is minimal.

Not necessarily.  A person's likelihood of becoming addicted depends, in part, on his or her addiction history. Addiction is less likely if you have never abused drugs or had an addictive disorder. Ask your doctor about any concerns you may have.