Pain Management Services offered in Oregon

Services Offered at Pain Management Partners

Complete Medical Pain Management Consultation
A complete history of the medical problem, physical examination, and a variety of diagnostic services form the backbone of a Pain Management Consultation. Appropriate recommendations to the referring provider and the patient result in new directions and opportunities for management of complex pain problems. Narcotic prescribing and assumption of care is NOT a usual component of the initial Pain Management Consultation, unless prior arrangements have been made.
Ongoing Medical Treatment and Pain Management
Although pain cure is desirable, pain management is an on-going process that maximizes function, improves comfort, and stabilizes medical care for the chronic pain sufferer. Regular office visits are necessary to provide continuity of care. Narcotic/opioid pain medication prescribing may or may not be part of the treatment plan. Special arrangements are made for those who need to take controlled substances in order to maximize function and manage their chronic pain.
Trigger Point Injection
Trigger points are usually small areas of tightly knotted muscle and connective tissue that cause localized and referred pain. By injecting anesthetic medicine into these points the muscle can relax so one can gently stretch the tissues back to normal length, bringing lasting pain relief.
Lidocaine Clinic
Pain Management Partners, LLC, offers lidocaine infusion for many types of neuropathic pain. Once one of our providers has approved the patient for this treatment, an appointment is made with one of our receptionists. At the time of the appointment, the patient checks in at the front desk and is directed to the Community Room in the lower level. The specialized room accommodates six patients for treatment, staggered every 15 minutes. The medical assistant checks the patient, the registered nurse administers the IV and a medical doctor concludes the visit. The entire appointment can take up to an hour. Please avoid scheduling other appointments so as not to feel rushed or anxious during this procedure.
Intravenous administration of Lidocaine, an anesthetic medication used to reduce nerve pain, can improve some types of pain. Periodic observation by our registered nurse, Linda, during the one-hour appointment helps ensure the best outcome. Vital signs and cardiac rhythm are monitored as indicated throughout the treatment.

Some conditions respond well to treatment and may have lasting results from several weeks to several months following treatment. IV lidocaine treatment is considered a success if more than 30% pain reduction occurs for 10 days or more.

Reasons for considering treatment are varied:

♦ Pain flare-ups that are not responding to usual treatment modalities.

♦ A desire for a reduction in baseline pain in order to improve function.

♦ Temporary improvement needed for a defined period of time such as travel for an upcoming vacation.

♦ As part of the treatment plan to achieve the next level in exercise tolerance, physical conditioning, functional capacity, or treatment tolerance.

♦ As a part of pre- or post-operative care.

Transcutaneous Electrical Nerve Stimulation (TENS) is a device that delivers an electrical pulse through the skin. The TENS unit works by blocking the pain messages and/or releasing endorphins, the body's natural pain relievers. This non-invasive pain treatment produces a mild electrical current by placing electrode patches on the skin. The electrodes are placed directly on or beside the affected area.


What is Suboxone?

Suboxone (a tablet with buprenorphine and naloxone) is an FDA approved medication for treatment of people with heroin or other opioid addiction. Buprenorphine can be used for detoxification or for maintenance therapy. Maintenance therapy can continue as long as medically necessary. There are other treatments for opiate addiction, including methadone, naltrexone, and some treatments without medications that include counseling, groups and meetings. Buprenorphine can be used for pain control, "off-label" when used as Suboxone in various forms, such as sublingually (under the tongue), as film on the tongue or as a patch. It's a powerful pain reliever that is very long acting.

When Scheduling Your Appointment for Suboxone.

Pain Management Partners, LLC uses Suboxone only for pain relief not for addiction. After discussing with your pain specialist, make an appointment at our office. Plan to be at the office for 2 hours. Please bring a driver.

What to do Prior to Your Appointment for Suboxone.

Your Provider will direct you regarding how to taper or discontinue opioids and benzodiazepomes (such as Valium, Librium, Ativan, Xanax, Klonopin, etc.) prior to your appointment. If you are dependent on opiates - any opiates - you must be in as much withdrawal as possible when you take the first dose of suboxone. If you are not in withdrawal, suboxone can cause severe opiate withdrawal. For that reason, you should take the first dose in the office and remain in the office for 2 hours. We recommend that you arrange not to drive after your first dose, because some patients get drowsy until the correct dose is determined for them. Prior to coming to your appointment, eat a light meal and bring something to read. Please bring your pain medications.

What to Expect During Your Appointment for Suboxone.

There is a brief form to fill out prior to your appointment. The nurse escorts you to an exam room, taking your vitals and discusses your general condition. The Provider assesses your readiness to receive suboxone. The nurse administers the dose per providers guidance. Vital signs are checked every 30 minutes and your current pain level is checked. Additional suboxone is administered as needed. You may have a family member with you. When stable, you are discharged home. Suboxone is called into your pharmacy along with directions of how to take this medication.

What to Expect After the Appointment.

Generally, within the first 30 minutes, the feeling of withdrawal subside. One can expect partial pain relief on the day of induction and gradually improved pain control over the coming weeks. It may take several weeks to determine just the right dose for you. Another appointment is scheduled within 1 to 2 weeks. Some patients find that it takes several days to get used to the transition from the opiate they had been using to suboxone. During that time, any use of other opiates may cause an increase in symptoms. After becoming stabilized on suboxone, it is expected that other opiates will have less effect. Attempts to override the suboxone by taking more opiates could result in an opiate overdose. No other medication should be taken without discussing it with the physician first.

Ketamine Infusion

Ketamine is an anesthetic that has been in use for decades. It has also earned a reputation as a drug of abuse. In full doses it can be used in the operating room or veterinary clinic alongside other medications for anesthesia. In low intravenous doses, it can produce light sedation and a profound amount of pain reduction. It is currently used in some Emergency Departments as an alternative to opioids in various situations. Infused intravenously in the outpatient clinic, Ketamine may reduce certain types of pain for hours or days, sometimes even weeks. It is also being investigated for the alleviation of treatment resistant major depressive disorder. At present, Ketamine infusion in the outpatient setting remains "experimental" and is not FDA approved for relieving chronic pain or depression. Ketamine can have side effects, including a dream-like state, hallucinations, unpleasant experiences and other temporary effects. We use Ketamine as a last step in addressing intractable pain conditions like complex region pain disorder (reflex sympathetic dystrophy).

Alpha Stim
Alpha waves are one type of brain waves. Other types of brain waves include beta, theta, delta waves, each pointing to a different state of brain functioning. Alpha waves correspond with a state of relaxation. Meditation can produce alpha waves. Alpha-Stim is a non-invasisve device that uses microcurrent electrical therapy (MET). This electrical waveform allows the body's cells to operate naturally, bringing pain relief.
This non-invasive treatment delivers a variety of drugs directly through the skin, hence bypassing the gastrointestinal tract. An iontophoresis device delivers medication to the specific painful area using a low voltage electrical current. This technique helps manage pain and reduce inflammation without injection.
Joint Injections
The term "arthritis" means joint inflammation. Inflammation can cause pain, swelling and stiffness. The two common types of arthritis are osteoarthritis (OA), the breakdown of joint cartilage, and rheumatoid arthritis (RA), the inflammation of the joint lining, called synovium. Joint injections are useful therapeutic techniques for arthritis, impingement syndromes and tendinopathies.
Bursa Injections
The bursa is what cushions the tendon and helps prevent friction between the tendon and the bone. A Bursa Injection can help determine the pain source and may provide long-term relief by reducing inflammation. A thin needle is inserted into the center of the bursa thought to be causing the pain and a combination of anti-inflammatory (steroid) and anesthetic (numbing) medication is then injected to decrease inflammation and relieve pain.
Nerve Blocks
Plexus or ganglion is a group of nerves that can mediate pain from a specific organ or body region. An injection of medication into a specific area can block the pain. This nerve-numbing substance is called a nerve block. There are different nerve blocks for various areas of pain such as:
♦ Trigeminal nerve blocks (face).
♦ Ophthalmic nerve block (eyelids and scalp).
♦ Supraorbital nerve block (forehead).
♦ Maxillary nerve block (upper jaw).
♦ Sphenopalatine nerve block (nose and palate).
♦ Occipital nerve block (head and scalp).
♦ Peripheral nerve blocks, including shoulder, arm, leg, foot, hand, abdomen and back.
The following blocks are performed by other providers in the community. We will refer you to the appropriate provider:
♦ Cervical epidural, thoracic epidural, and
lumbar epidural block (neck and back).
♦ Cervical plexus block and cervical paravertebral
block (shoulder and upper neck).
♦ Brachial plexus block, elbow block and
wrist (shoulder/arm/hand, elbow and wrist).
♦ Subarachnoid block and celiac plexus block
(abdomen and pelvis).
Osteopathic Manipulative Techniques
Manipulation of body structures in specific ways can induce muscle relaxation, mobilize joints, change proprioceptive function, and re-establish function. Examples of these techniques include myofascial release, counterstrain, percussive mobilization, etc.
Urine Drug Screen
Pain Management Partners, LLC, operates a CLIA-certified lab onsite to perform urine drug screens. Testing helps us monitor a patient's progress and the medications they are prescribed. PMP requires patients to provide a urine sample at their initial visit and at various follow-up visits. Our multi-panel urine drug screen determines the presence of specified drugs or their metabolites. Urine is collected in a secure cup and tested in our lab. Results are generally provided within 48-hours and included in the patient's chart.