What to Expect
By the time some patients are referred to PMA, they are often confused and even skeptical about pain management. Unfortunately, chronic pain and unanswered questions have left them feeling doubtful about their treatment results. PMA understands these concerns and our physicians work with each patient to ensure they are informed and knowledgeable about the treatments and their outcomes.
Before your visit
When scheduling your appointment, we will ask a few questions regarding recent vaccinations and any medication you are currently taking. Because we generally provide treatment the day of your visit, it’s important to identify any potential drug interactions. Unless otherwise noted, on the day of your injections you should take your prescribed medications, with the exception of blood thinners (see list below). If you have any questions regarding the holding periods for blood thinner medication, please check with your prescribing physician. On the day of your procedure, be sure to eat a light meal before your visit and arrange for a driver accompany you to your appointment.
Your first visit
During you appointment, we will take a complete medical history. This will cover your general health history, your current problem, a physical examination, a review of the information provided by the referring physician and a full review of your diagnostic testing results (MRI/CT Scan, EMG and X-rays). Together, this information will be used to recommend a treatment intervention to address your specific problem. We will explain the recommended procedure and answer any questions you may have.
To make the best use of your time, we generally perform the recommended procedure during that first visit. You will be taken into a separate room for treatment. The procedure is conducted using local anesthesia and fluoroscopic (real-time X-ray) guidance. IV sedation is seldom needed.
Receiving an Injection
Injections are typically administered while you are laying face down or on your side. Monitors will be placed on you to watch your pulse and oxygen level (Oxygen is available should you need it). An X-ray is used to locate the correct injection site. The site is then cleaned with an antiseptic and a local anesthetic is injected to numb the area of the injection.
Once the area is numb, you will be given the pain injection. The entire procedure generally takes only a few minutes. Once complete, we do a thorough check of your vital signs. Unless you required sedation, you will be able to leave the office at that time. Within 2-3 hours after the injection, the local anesthetic will have subsided.
NOTE: If you believe you will require sedation for your injection, you MUST request this consideration when scheduling your appointment. Sedation involves starting and IV in your hand or arm up to an hour prior to the procedure. Keep in mind, the cost of sedation may not be covered by your insurance company and will be an out-of-pocket expense. Additionally, sedation involves a longer recovery time following your procedure and requires that someone can be with you at your home when you return.
Post-Procedure Expectations
In general, patients will begin feeling pain relief soon after their procedure. However, in many cases there will be some minor discomfort immediately following the treatment. Most patients will experience one or more of the following sensations:
- Temporary numbness or weakness from the numbing medicine that lasts 2 to 3 hours
- Temporary increase in pain with possible flare-ups for 1 to 2 days
- Temporary pain at injection site that can be treated with ice or a heating pad
Drug Interaction
Because pain injections are inserted deep into the body, patients on blood thinning medication will need to temporarily suspend their usage. Patients using certain anticoagulants will be required to have blood work conducted prior to treatment and may be asked to hold off usage for a short while following the procedure. The chart below lists the pre- and post-treatment hold periods for various blood thinners.
| Brand Name | Drug | Hold Period | Additional Notes |
|---|---|---|---|
| Aggrenox / Persantein | Dipyridamole | 3 Days | |
| Arixtra | Fondaparinux | 4 Days | |
| Coumadin / Jantoven | Warfarin | 7 Days | Needs PT/INR drawn before each injection |
| Effient | Prasugrel | 7 Days | |
| Eliquis | Apixaban | 2 Days (48 Hours) | |
| Elmiron | Pentosan Polysulfate | 1 Day | |
| Fragmin | Dalteparin Sodium | 24 Hours | |
| Heparin | Porcine | SQ = 7 Hours Infusion = 4 Hours |
|
| Lovenox | Enoxaparin Sodium | 24 Hours | |
| Plavix | Clopidogrel | 7 Days | |
| Pletal | Cilostazol | 4 Days | |
| Pradaxa | Dabigatran | 5 Days | |
| Ticlid | Ticlopidine | 7 Days | |
| Xarelto | Rivaroxaban | 3 Days (36 Hours) |
Possible Side Effects
Following an injection, there is a slight chance you may experience some minor side effects. These symptoms are not typical, but they do occasionally happen. If you encounter such issues, there is no need for alarm. They generally resolve themselves within a couple days.
Risks
Pain management is safe and effective and offers welcomed relief from chronic pain. However, as with all medical procedures, these treatments do come with some risk. These risks are very low, but can be serious and should be carefully monitored.
- Spinal headache (lay down and increase fluid and caffeine intake. Call us as soon as possible)
- Nerve or Spinal Cord Injury (unusual and rare)
- Spinal Injection, Infection or Bleeding (unusual and rare)
If you experience any severe pain, numbness, weakness or fever, during regular office hours (7:30 am to 2:30 pm) call us immediately at (513) 585-0658. After office hours, call (513) 585-2000 and ask for the anesthesiologist who is on call.