Padda Institute Center for Interventional Pain Management

Pain medications are an important part of you care. We want to ensure that you are on an appropriate medication regimen for your specific pain. All patients who are prescribed narcotic pain medication must sign a narcotic agreement with The Center for Interventional Pain Management. This agreement is to ensure that we are the only physicians prescribing you pain medication, and that all narcotic pain medications are filled at a designated pharmacy. This will provide greater relief from the pain and also help prevent possible serious drug interactions. If you break this agreement, you will no longer be prescribed narcotic pain medication from the Center for Interventional Pain Management. The Center for Interventional Pain Management does not view running out of pain medication to be an emergency. You are responsible for taking your medication in the manner in which it is prescribed. No refills or medication changes will be given after hours, on weekend or holidays. Narcotic pain medications will not be refilled without physically seeing you in the office, on at least a monthly basis. Please remember, it is your responsibility to monitor your medication usage and to plan for your follow-up visit if you need a refill.

• Unless specifically stated otherwise, all prescriptions are written as a full thirty-day supply. If you have been prescribed a narcotic pain medication on an as needed basis, it must last you a full thirty days, the instructions on the bottle are the maximum permitted amounts, you should ration your medication to last a full thirty days.
• Don not take medications other than prescribed without consulting your health care providers. Even over the counter medications, such as Benadryl or Tylenol, can significantly interact with prescribed medications and cause serious complications.
• Do not combine sedatives or anti-anxiety medications with alcohol or with pain medications.
• Do not use pain medications as sleeping aids.
• Never give your pain medications to someone else.
• Do not suddenly stop taking your pain medications.
• Make a full list of all medications you are taking, including any over the counter medications or supplements, and bring this list with you to each appointment.
• Lock up all painkillers to keep them out of other people’s hands.

We may ask you to undergo psychological or psychiatric evaluation and/or counseling sessions because of your chronic pain. Chronic pain affects not only the body, but also the mind. It is beneficial to have someone to whom you can talk about the pain and its impact on your life. The therapist provides information to the pain management physician on the psychophysiological effects of the chronic pain. We provide psychophysiological therapy, family therapy, group and individual psychotherapy to assist in controlling and coping with the pain. Depending upon the cause and type of pain, as well as the type of therapy, we also sponsor community support groups in the St. Louis region. If you are considering a permanent implantable device, such as a Dorsal Column Stimulator (DCS) or Intrathecal Pump, we will require you to have psychological screening, to make certain you fulfill the criteria for implantation. Patient’s who have pre-existing psychiatric conditions such as bipolar disorder, borderline personality, schizophrenia, major depression, or any history of substance abuse should notify us immediately upon patient intake. Successful treatment of chronic pain in these particular patient groups depends upon a coordinated approach, especially in these specific conditions.

An individual with chronic disabling pain will naturally request pain killers, so why are some physicians reluctant to prescribe narcotics?

• For thousands of years, narcotic pain killers have been used for pain. When we break a bone, have a heart attack or after a surgery, it is comforting to know that these medications will relieve our pain and suffering. Similarly, for those dying from cancer narcotics can give excellent pain relief.
• Everyone seems to have an opinion on the use of narcotics for chronic pain. With the scale of prescription drug abuse in Missouri, most families are aware of someone who has been affected by this epidemic.
• There is no doubt that narcotics are effective in patients with acute pain or cancer related pain.
• There are no good quality studies to show that narcotic pain medications work in the long-term for musculoskeletal pain alone, but may be beneficial in combination with behavioral therapy, interventional techniques, and physical therapy.
• There are studies to indicate that narcotic pain medications can be effective in the short to mid-term for bone and joint pain. Such an indication might be for three months of pain control while awaiting a knee replacement.
• Research studies show that patients on chronic opiate therapy have increased depression, reduced function and decreased activity.

Opiates can cause multiple problems. We have highlighted some of the complications associated with opiate therapy in the sections that follow on addiction, tolerance, hyperesthesia and hyperalgesia, immune and hormonal changes, withdrawal and detoxification.

• Addiction
• Detoxification
• Hyperesthesia and Hyperalgesia
• Immune and Hormonal Changes
• Pseudoaddiction
• Withdrawal
• Tolerance

The Center for Interventional Pain Management staff are specially trained and certified in pain medicine. We utilize precise diagnostic techniques to determine the cause of pain, and then select the appropriate plan to treat the pain. Frequently we will do a series of diagnostic blocks to rule out or verify a particular cause of pain prior to doing an interventional technique to relieve the pain long-term. Many times patient’s come to us after suffering for months or years, often having more than a single cause for their pain. Because each type of procedure is highly specific, we may have to do several different techniques to relieve all of the causes of the patient’s pain. If there is any possibility that you may be pregnant, please notify us immediately, because many of our procedures are done with fluoroscopic image guidance, a special type of live x-ray.

Please know that phone calls are important to us, but we are constantly busy seeing patients, and may not be able to return your call immediately. Messages will be taken by the front office staff, and return calls are made after 4:00 PM. Please do not tie up the phone lines with repeat calls. All messages will be returned. Please do not fax questions about your care to the office. There is no guarantee that these notes will reach the proper person.

The staff of The Center for Interventional Pain Management would like to welcome you as a new patient to our facility. You have come to a place where someone understands what life is like for those who suffer from acute and chronic pain. Pain doesn’t effect people in an isolated way, it affects every aspect of their life, and it affects them physically, emotionally and psychologically. Beyond causing feelings of anger and hopelessness, chronic pain can disrupt sleep, affect work performance interfere with relationships and strain family life. Pain can disrupt your life, keep you from work and prevent you from enjoying your after work activities. The staff will examine the impact your pain is having on your life, attempt to pinpoint the exact cause of your symptoms, and institute a personalized plan to alleviate the pain and return you to an acceptable level of activity. We will do our best to help you reduce or eliminate your pain. We feel that the whole person must be treated, not just the pain. Therefore, we use a multidisciplinary team approach to manage pain. The Center for Interventional Pain Management is a nationally recognized center of excellence for the treatment and management of complex chronic pain. The Center provides comprehensive multidisciplinary inpatient and outpatient treatment options tailored to individual patient needs. The medical staff is supported by a team of experienced care providers specializing in pain management; including registered nurses, physical and occupational therapist, biofeedback specialists, psychologists, and case managers. The Center’s integrative approach to pain management adopts the best techniques offered by allopathic, osteopathic, naturopathic, and homeopathic remedies; all the while striving to return the patient to whole once again. The Center combines state of the art microinvasive interventional techniques with aggressive physical rehabilitation and psychological support to help alleviate the suffering of our patients and recognize that one size does not fit all. In order to improve patient care and enhance compliance, all areas of the Pain Management Center are continuously monitored by audio and video surveillance. This includes all common areas, all procedure rooms, and all telephone conversations.

The office is open Monday to Friday 8:00 AM to 5:00 PM. We are closed New Years Day, Memorial Day, Labor Day, July 4th, Thanksgiving and the day after Thanksgiving, and Christmas Day. The physician on call will only be paged after hours if there is a true medical emergency. Running out of medication is not a medical emergency. If you have a true medical emergency, please go to the nearest emergency room.

As a courtesy to you, we will submit insurance claims on your behalf. We expect that you will pay all of your bill, including all co-pays, co-insurance, and deductibles. If you have a financial hardship please notify us immediately and special individual accommodations may be made. Some insurances may deny a specific procedure or treatment option or pay a reduced rate for your care, even though we believe that a particular course of care may benefit you. You will still be responsible for your full bill, the insurance company is your insurance company and works for you, not us. Remember, you are ultimately responsible for your bill, including any unpaid portions from your insurance. Any bill not paid within ninety days by your insurance company will be billed directly to you. We charge a rebilling fee of $50, every thirty days. We accept check, credit card or cash. If you have been involved in an accident or injury and have an attorney, we may accept deferred payment plan on a lien basis; however, you are still responsible for your full bill.

If for any reason you are unable to keep your scheduled appointments and do not cancel or reschedule your appointment at least twenty-four hours prior to your appointment, you will be charged a cancellation fee of $50.00. This fee must be paid before another appointment will be scheduled. This fee is not covered by any insurance or worker’s compensation. Please contact us at the office where you were scheduled to cancel or reschedule your appointment. The Padda Institute Center for Interventional Pain Management 5203 Chippewa Suite 301 St. Louis, MO 63109 (314) 481-5000 (314) 481-3037 fax or The Padda Institute Center for Interventional Pain Management 505 Buckeye Troy, IL 62294 (618) 667-1735

In order to disrupt the clinic and perform depositions, records reviews, independent medical evaluations, or other medicolegal work we charge $1,600 per hour, paid in advance. This charge covers the operational overhead of the clinic and loss of patient care revenue. See ruling Missouri Circuit Court Twenty-Second Judicial Circuit (City of St. Louis): Cause No. 0922-CC01685 Division 31 which reaffirmed reasonableness of $1,600/hour fee for Dr. Gurpreet Padda pursuant to Rule 56.01 (b) (4) (b) as of May 18, 2011.

We respect your individual privacy, and will not release personal medical information without your express written communication. We will provide copies of your medical record to you at no cost. If a copy is necessary for legal purposes, we charge a fee to copy the record and certify the record. In order to improve patient care and enhance compliance, all areas of the Pain Management Center are continuously monitored by audio and video surveillance. This includes all common areas, all procedure rooms, and all telephone conversations.

The Center for Interventional Pain Management is not an acute care facility. If you need to see the physician for any reason, you must have a scheduled appointment. You will be given a same day appointment if you have a medical emergency. Medication refills due to loss of medication is not considered an emergency.

We receive dozens of requests daily for the completion of disability forms and ratings. These forms typically require extensive knowledge of the patient’s medical condition, as well as the patient’s mental and physical limitations in concert with the patient’s work load and type. We charge $1,600 for the completion of these forms.

Every patient we see is suffering from pain. We ask that you consider the feelings of others by not bringing children to your appointments. We do not provide childcare.