Treatment & Procedures

Patient Instructions

Patient Forms

Patient Resources

Referring Physicians

Contact & Location

 

Lars R Newsome, MD

Lise Wiltse, MD

  Patient Instructions

   Initial Consultation
   Pre-Procedure Instructions
   Post-Procedure Instructions
   Medication Management
  


Initial Consultation


1. In general, your physician will refer you to the pain clinic. Once we have insurance authorization (depending on your health plan), then a consultation will be scheduled with Dr. Newsome.

2. Please bring your insurance information with you.

3. Please complete the new patient questionnaire and bring it with you to the consultation. The questionnaire can be faxed to you, mailed to you, or downloaded from this website. Completing the questionnaire is extremely important. Please answer to the best of your ability and recollection. We do not expect that every question be answered. However, not completing the questionnaire will only delay your office visit and may cause your visit to be rescheduled. Even though you may have completed this information with another specialist or your primary care physician, we do not always have access to that information.

4. We will ask your referring physician for pertinent copies of your medical records. However, often times your records are incomplete since patients are often seen by multiple physicians. Therefore, if you have copies of your records please bring them with you.

5. The initial consult typically takes thirty minutes. A treatment plan will be discussed. If a procedure is recommended, then we will obtain authorization (depending on your health plan) and schedule the procedure at the surgery center. Procedures cannot be done the same day as the consult.


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Pre-Procedure Instructions


1. Unless otherwise approved with the office, you must have an adult drive you home after the procedure.

2. Fasting guidelines for sedation are as follows: Nothing to eat (solid food) for eight hours before your procedure. Non clear liquids (orange juice, coffee with cream, smoothies), may be consumed up to six hours before your procedure. Clear liquids (apple juice, grape juice, water) may be consumed up to 4 hours before your procedure. If these guidelines are not followed you will not receive intravenous sedation for the procedure.

3. Wear loose comfortable clothes for the procedure.

4. Arrive one hour earlier than your scheduled procedure time at the surgery center to allow adequate time to be checked in, change, and have an IV started (if you are having sedation).

5. It may take 2-3 hours from the time you arrive at the surgery center to time of discharge.

6. If you are on an anticoagulant (coumadin, plavix, etc.) contact the office for further instructions. These must be stopped 7 days prior to the procedure.

7. Take your other medications as usual with a sip of water.

8. If you have an infection at the time of the procedure, your procedure will be rescheduled. Please contact the office for further instructions.

9. No driving or operating heavy machinery until the next day.

10. You will see the physician in the procedure room. The physician will review your history and answer any questions prior to the procedure. This is not an office visit. Therefore, if you need medications refilled, if family members need additional information, or if you need additional time to review treatment options, then you need to make an office visit appointment.

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Post-Procedure Instructions


1. If you were not instructed to contact your referring physician to schedule a follow up office visit, our office will contact you to schedule another procedure or an office visit. If you have not be contacted by our office after a week then call our office for further instructions.

2. You may eat or drink anything you want. If you have an upset stomach, you may want to drink liquids until it passes.

3. Limit your activity today; have someone stay with you for 12-24 hours.

4. You may place ice packs on the injection site for 20 minutes, 2-3 times a day for the next 2-3 days, if the injection site is sore.

5. You may remove the bandage and take a shower tomorrow. Keep the injection site clean and dry.

6. Only take the pain medications that your doctor prescribed.

7. Because of the medications you have received, do not: drive or operate machinery, drink alcohol, or sign or make important decisions for 24 hours.

8. Do not smoke for 48 hours.

9. Do not lift heavy objects and do not do strenuous activity.

10. The injection may make your arms or legs weak which will improve over the course of the day. Therefore, you must take care in handling objects, ambulating, or applying heat/cold to prevent further injury.

11. The will experience tenderness at the injection site which should improve over a few days.

12. The pain for which you are being treated may worsen for a few days after the procedure.

Contact the Office Immediately:
1. If you develop a fever greater than 100F.
2. If your pain significantly worsens, new symptoms develop, or if you experience worsening numbness or weakness.
3. If you develop redness, swelling, bleeding, or pus at the injection/incision site.
4. If you have not been able to eat or drink for eight hours after the procedure.

Proceed to the Emergency Room:
1. If you are not doing well after the procedure and if you feel that it is an emergency, then proceed to the emergency room or contact 911. Then contact the office.
2. If you are unable to urinate for eight hours after the procedure, go to the emergency room, then contact the office.

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Medication Management

 

Medication management involves the use of a variety of medications with different properties to provide partial pain relief. It is impossible to provide complete relief of your pain with medications alone. Some medications are to be taken on a routine basis to provide a steady state level of the medication in your blood. Others are to be taken on an intermittent (break through) schedule for when the pain becomes severe. Medications can be administered by a variety of methods including: oral, transdermal, transmucosal, intrathecal, and by injection.

There are many different classes of medications including:

  • Non-steroidal anti-inflammatory drugs
  • Steroids
  • Narcotics
  • Muscle relaxants
  • Sleep aids
  • Antidepressants
  • Anticonvulsants
Many of these medications have abuse potential, can have adverse effects on the body, and are controlled substances. We therefore require that the patient be seen on a regular basis. It is unreasonable to expect multiple refills and to not be seen in the clinic. You must be evaluated in order to monitor the effects and continued appropriateness of the medication. Please see our medication policy overview. All patients prescribed narcotics must sign a medication management agreement. These are used by most reputable pain programs and clearly define patient responsibilities and terms for discharge from the practice. Patients are randomly asked to provide urine samples in the office to ensure that the medications prescribed are being taken and that no other controlled substances are present. We occasionally obtain prescribing information which tells us when a patient filled a prescription and who was the physician. Controlled substances should only be prescribed by one physician. On occasion we will request a behavioral screening and behavioral therapies if we are to continue with the medication management. Many of the expenses are not reimbursable by the insurance carrier and therefore would have to be handled by the patient.

The following are some definitions related to pain and the use of medications:
  • Acute Pain: Acute pain is the normal, predicted physiological response to an adverse chemical, thermal or mechanical stimulus and is associated with surgery, trauma and acute illness. It is generally time-limited and is responsive to opioid therapy, among other therapies.

  • Addiction: Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence" and "psychological dependence." Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction.

  • Analgesic Tolerance: Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. Analgesic tolerance may or may not be evident during opioid treatment and does not equate with addiction.

  • Chronic Pain: A pain state which is persistent and in which the cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease.

  • Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

  • Physical Dependence: Physical dependence on a controlled substance is a physiologic state of neuro-adaptation which is characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence is an expected result of opioid use. Physical dependence, by itself, does not equate with addiction.

  • Pseudoaddiction: Pattern of drug-seeking behavior of pain patients who are receiving inadequate pain management that can be mistaken for addiction.

  • Substance Abuse: Substance abuse is the use of any substance(s) for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed.

  • Tolerance: Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect, or a reduced effect is observed with a constant dose.

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2014   |   Interventional Spine & Pain Management