What to Expect During Your Visit to OSC as a Pain Management Patient – Raj N. Sureja, MD

Orthopaedic & Spine Center

You have scheduled an appointment with one of the Fellowship-trained Inverventional Pain Management specialists at Orthopaedic and Spine Center. What should you expect during the course of your visit and how should you prepare? What are the documents you should bring with you to your consultation? How should you dress? Will you have to have any tests? In this article, we will help you understand what you can do to help your Interventional Pain Management Physician provide you with the best possible care, by being well-prepared for your office visit.

1. Bring previous treatment records with you to your appointment. Your treatment records offer a wealth of information to our physicians. Not only do they provide a history and timeline of your medical care, they provide insight into your condition and your level of pain, helping the OSC specialist understand what treatments or medications may have helped or which did not.

Prior to your visit, we ask that we receive the following:
a. last 5 office notes from your primary physician or the physician currently treating your pain
b. if you have seen a Pain Management specialist in the past, we require those records
c. any imaging films or CDS from x-rays, CT or MRI scans
d. a CURENT list of all of the medications you are currently taking, with dose and frequency
e. any other information which you believe could be helpful, such as PT records or prior injections/ treatments

2. Dress comfortably, in clothing that can be removed easily, if required for your examination. A thorough physical examination will be conducted by your OSC physician. You may be asked to put on an examination gown for your consultation. It is important to wear comfortable clothing which can be easily be taken off and put on. Please wear comfortable shoes as your physician may ask you to walk or move around so that your gait and motion can be observed.

3. Your physician will want to know very specific details about your pain to determine the source and then prescribe the best treatment. Keeping a pain journal may help you organize the details that will assist in your care.

It is important to note the following:
a. How did your pain originally begin? Was it a sudden or gradual onset
b. The severity of your pain using a numeric scale (0= no pain, 10= worst pain ever)
c. The time(s) of day your pain is worse or better
d. Activities/ movements that make your pain better or worse i.e. driving, bending, laying flat on your back
e. Effect of pain on your activities of daily living i.e. bathing, grooming, dressing, toileting, etc.
f. Any associated weakness or numbness, or lack of control of bowel and bladder function related to your pain
g. Do you take any medications? Do they help your pain? Relieve it wholly or partially?
h. Do you try any alternative methods of relieving your pain? Heating pad? Warm bath? Massage? Acupuncture? Do these alternatives help? If so, for how long?
Make sure you bring this with you to your consultation for review with your doctor.

When you come to OSC for your first appointment, you will need to check in at the registration desk, directly in front of the lobby doors. As this is your first visit, you will be asked to fill out some paperwork before you can be seen by on OSC physician. You may feel exasperated at having to complete more forms and provide the same information you have given out to multiple physicians. Please know that we collect information for not only our records, but we collect information required by the government and by your insurance company in order for your visit to be covered. Please allow some extra time prior to your scheduled appointment time to complete your paperwork thoroughly and accurately.

Upon completion of your paperwork, our front desk personnel will note in our system that you are ready to be seen by a physician and you will be directed to our Main Waiting Room to wait to be called for your appointment. Should you need any x-rays, you will be taken to the OSC Imaging Department to have those images taken. Otherwise, you can make yourself at home, help yourself to our free coffee or hot chocolate service and watch TV, read a magazine or use the internet.

When your name is called, a Medical Assistant will escort you to the scale where you will be weighed and your height will be measured. You will then be taken to an exam room and asked to change into a gown for your examination.

When your OSC physician enters the room, he or she will do everything possible to make you feel comfortable, while working with you to do the best examination possible. They will ask you many questions about your condition and your pain. This is a great time to refer to your pain journal for reference. They will do a thorough physical examination, including asking you to move, bend, twist, and will perform specific tests to try to determine your pain generator. They will review your past treatment and discuss your past & current pain medications. Your OSC specialist may decide to order more tests to better determine your current state of health and to more accurately diagnose your condition.

Once you and your OSC Interventional Pain Management Specialist have decided to work together to find the best treatment options for your pain, you may be given medications to take for your pain. These medications may or may not be narcotic. The newest and most effective ways of treating your pain with medication is by using a combination of drugs that work on different aspects of pain. For example, you may be given a drug that soothes the irritated and inflamed nerves. You may be given an anti-inflammatory to reduce pain and swelling to treat arthritic conditions. You may be given an anti-depressant proven to help with pain. Narcotic medications may be needed if your pain is acute or severe. If narcotic medications are necessary, you will be asked to enter into a “Pain Contract” which lists the risks and benefits of this type of medication, and also acts as a guide for appropriate and safe use of this opioid medications. Your OSC Pain Management Specialist will develop a medication regimen specifically for your condition and pain symptoms.

If you are given medication and it does not work, makes you unable to function or causes some unpleasant side-effects, your OSC specialist can adjust, change or take you off of that medication completely.

Depending on the severity of your symptoms and if you have had previous treatment for pain, your physician may recommend an interventional procedure designed to directly address the cause of the pain symptoms. These procedures are done at OSC, are outpatient and usually do not cause you to miss more than one day of work or activity. Our physicians perform epidural steroid injections, radiofrequency ablation, facet joint injections and many other interventional procedures. Our website also has information on some of the more advanced non-surgical techniques that can be utilized to treat your pain

Your treatments and your progress will be carefully monitored. You will be scheduled for follow-up visits to measure your results and to discuss next steps. Your physician may suggest other ways to control your pain, such as chiropractic care, physical therapy, exercise, massage, acupuncture, or psychological counseling.

It is important that you work closely with your physician so that you can achieve the absolute best outcome from your treatment.

Raj N. Sureja, MD is a Fellowship-trained, board-certified Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Dr. Sureja has been recognized as a Coastal Virginia Magazine “Top Doc” for 2012, 2013 and 2014. For more information on Dr. Sureja or OSC, go to www.osc-ortho.com.