Pain is not your diagnosis. It is an alarm. Your nerves, your metabolism or your body’s structure is telling you something has drifted out of balance. Treat the alarm without asking what set it off, and you get years of short-lived fixes. That is the cycle so many people are stuck in.
Our whole approach follows from this: fix the signal, then fix the terrain. Read the full overview in Interventional Pain Management in St. Louis, or watch Pain is a Signal, Not a Sentence.
The terrain is the inner world your nerves live in. That means your blood sugar and metabolic markers, your level of inflammation, your blood flow, your sleep and your nutrients. Two people with the same scan can have very different pain, because their terrain is different.
As Dr. Padda puts it: if we burn a nerve but your body is still on fire with meta-inflammation, the pain comes back faster and harder. Explore the full series in The Hidden Drivers of Chronic Pain.
Because a procedure silences the alarm. On its own, it does not change what set the alarm off. If insulin stays high, inflammation goes unchecked, or your sleep is broken, the relief tends to get shorter each time.
We use that window of relief on purpose. While you feel well enough, we go to work on the terrain. See Radiofrequency Ablation for Back and Neck Pain or watch The Truth About RF for Back and Neck Pain.
Because the nervous system adapts fast. Give it a narcotic and it starts adjusting right away. So the dose has to climb to get the same effect. That climb is not weakness or drug-seeking. It is how the brain is built, and you can predict it.
Chasing the dose rarely gives you your life back. Read Why Medications, Procedures, and Surgery May Not Fix Chronic Pain or watch Dr. Padda discuss it with Dr. Tony Hampton: Why meds, procedures & surgery may not be the biggest key.
Never start, stop or change any prescribed drug on your own. That is a choice to make with your doctor.
It is a bank account running dry from both ends. On one side, rising opioid doses build tolerance as the nervous system adapts. On the other side, your body has its own opioid system. It makes natural painkillers on its own. Poor sleep and a broken body clock weaken that system and lower your pain threshold.
So the outside supply loses power while the inside supply is being drained. Rebuilding the natural system is a big part of what we do. See Circadian Rhythm Disruption and Chronic Pain and Artificial Light at Night and Healing.
It began with over-prescribing. Doctors were told pain pills were not addictive. Those studies were later shown to be made up. Anything that hits the brain’s dopamine reward system makes you want more, and the brain learns that fast.
Then the pendulum swung hard the other way. That is why many people now come to us under-treated, not over-treated. Read Why Your Pain Doctor Asks About Your Life at Home or watch Social Determinants & Pain Management.
Yes. Dr. Padda is board certified in Addiction Medicine as well as Pain Medicine, Interventional Pain Management, Anesthesiology and Obesity Medicine. Pain, dependence and metabolic disease often travel together. Treat one and ignore the others, and the fix rarely holds.
The same reward wiring drives food cravings. See Pain and Addictive Eating or watch Pain & Addictive Eating: Uncovering Links.
It means aiming at repair, not masking. A steroid injection into a damaged knee can help. But it has not made the knee better. Regenerative work goes after the tissue itself. It supports repair of connective tissue, brings back stretch, and improves the blood flow that starved tissue needs to heal.
These are evolving, practice-based therapies rather than settled standard care, and results vary from person to person. See AGEs and Glycation: The Sugar Damage Behind Stiff, Painful Tissue and Tiny Blood Vessels, Big Pain.
Not at all. We do them every day, in our own suite, under live imaging. What we reject is the injection-only model. That means endless monthly shots, with nobody ever asking why the nerves are so twitchy in the first place. Used that way, a block is a band-aid on a leak in the foundation.
We use procedures to break the cycle of acute suffering. Then we use that window to change the terrain. Browse all pain treatments we offer.
A lot. Insulin resistance, visceral fat (deep belly fat) and body-wide inflammation make nerves twitchy and slow healing. We see a direct link between high HbA1c (a three-month blood sugar test) and chronic pain. Visceral fat is not just stored fuel. It pumps out inflammation signals.
See How Visceral Fat Pumps Out Pain Signals, Leptin Resistance and Chronic Pain, or watch Belly Fat Isn’t Passive.
Metabolic inflammation is a low, steady, whole-body inflammation. It is driven by diet, insulin resistance and body makeup, not by injury or infection. It is why pain can last long after the tissue has healed. It is also why two people with the same MRI can feel so different.
See How Inflammation and Diet Drive Chronic Pain and Hormone Problems.
Because each one changes pain in a way you can measure. Deep sleep is when your body recharges its own pain-relief systems. One bad night makes people more sensitive to pain the next day. Light at night blocks that repair. Diet drives the glycation (sugar damage) and inflammation that stiffen tissue and trap nerves.
These are not lifestyle extras. They are the terrain. Start with Circadian Rhythm Disruption and The Quiet Deficiencies That Drive Nerve Pain.
Lab normal ranges are based on a broad, mostly unwell population. They are not the level your body needs to repair nerves and control pain. You can sit at the bottom of normal and still be flat broke on what healing needs. The bar is just set too low.
Your signal was real. See Magnesium, Vitamin D and B Vitamins: The Quiet Deficiencies That Drive Nerve Pain.
A doctor-led exam that looks at the structural problem and the terrain around it. That means imaging when needed, metabolic and inflammation markers, sleep, food and the life factors that shape recovery. From there we build a plan. It usually mixes procedures, regenerative care and metabolic work.
We are at 4477 Woodson Rd, Suite 100, St. Louis, MO 63134, minutes from Lambert International Airport. Book at painmd.tv/appointment, call (314) 481-5000 or text (314) 886-5902. Individual results vary.
It is the opposite. Close monitoring is what allows us to keep prescribing safely for the patients who genuinely need it, and to keep treating people other clinics discharge.
We are transparent with you about every check we run, so nothing arrives as a surprise. Everything below is written into the medication agreement you sign, and we review those expectations with you at each visit — roughly every two weeks. Nothing here is hidden, and you are entitled to ask why any of it applies to you.
Urine drug testing is routine, roughly every six to twelve weeks, and it runs through an independent high-complexity laboratory using gas chromatography rather than a simple in-office cup. The more sensitive test protects you: it distinguishes real adherence from a false positive far better than a basic screen.
Two results concern us. Finding a substance you were not prescribed is one. The other surprises people: not finding the medication we prescribed. That can mean the medication is going somewhere other than into you, and it is treated seriously. If a result is unexpected we talk to you about it — but understand that illicit substances or non-prescribed sedatives end the treatment agreement.
Yes. Clinical areas are camera-monitored, and we are telling you rather than leaving you to notice. It protects patients and staff alike, and it gives us an objective record if there is ever a question about what happened during a visit.
We may review publicly posted content — and you consent to this in writing as part of your medication agreement. We are not accessing private accounts or messages.
We are candid about why: when someone is prescribed controlled substances, public posts sometimes show things that contradict what is reported in clinic. That is uncomfortable to say plainly, but burying it in a contract nobody reads would be worse. If you would like to discuss this provision before signing, ask us.
Designating a single pharmacy is our main protection against duplicate prescribing — and it means one pharmacist knows your full history and can catch an interaction. Tell us before you change and there is no problem; changing without telling us looks like something it may not be.
Bringing your bottles to each visit lets us confirm the count matches the prescription. It takes a minute and it protects you from being wrongly suspected.
You should know this clearly in advance, not at the point of discharge:
Discharge means no refills and no continuation of care, and in cases of suspected diversion we are obliged to report. If you are struggling with your medication, tell us before it becomes one of the above — that is a clinical problem we can treat, and Dr. Padda is board certified in addiction medicine precisely so that conversation can happen here.
Because medication alone does not change why your nervous system is hyperexcitable, and prescribing into an unchanged terrain is how people end up on escalating doses for years.
We require at least 12 physical therapy sessions a year, ongoing behavioral health support, and metabolic screening. These are the parts of treatment that make dose reduction possible. See why medication is a bridge, not a destination and how we establish medical necessity.
The complete protocol we share with pharmacists and referring physicians is published openly at Opioid Stewardship: what pharmacists and physicians should know. It is the same document either way — we do not describe our practice one way to clinicians and another way to patients.
If anything in it concerns you, raise it at your next visit or call (314) 481-5000.
A person with chronic, disabling pain will of course ask for painkillers. So why are some doctors slow to prescribe narcotics?
Opiates can cause many problems. We cover some of them in the sections below: addiction, tolerance, hyperesthesia and hyperalgesia (extra sensitivity to touch and pain), immune and hormone changes, withdrawal and detox.
We may ask you to have a psychological or psychiatric exam, counseling, or both, because of your chronic pain. Chronic pain hurts the mind as well as the body. It helps to have someone you can talk to about the pain and what it does to your life. The therapist tells your pain doctor how the pain is affecting your mind and body. We offer psychophysiological (mind-body) therapy, family therapy, and group and one-on-one counseling to help you control and cope with pain. Depending on the cause and type of pain, and the type of therapy, we also sponsor support groups in the St. Louis region. If you are thinking about a permanent implanted device, such as a Dorsal Column Stimulator (DCS) or Intrathecal Pump, you must have a psychological screening first. It makes sure you meet the criteria for the implant. If you have a mental health condition such as bipolar disorder, borderline personality, schizophrenia or major depression, or any history of substance abuse, tell us right away at intake. Treating chronic pain in these groups works best with a coordinated plan.
Pain medications are an important part of your 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 weekends or on 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.
Chronic pain has many causes. They include arthritis, fibromyalgia, migraines, nerve damage (neuropathy) and injuries that don’t heal right. Sometimes the source is hard to pin down. Pain is the body’s signal that something is wrong. With chronic pain, that signal keeps going for a long time. It can trap you in a loop of pain, stress and lost fitness that makes the pain worse and drags down your health. It can wreck sleep, cut your activity, make daily tasks harder, feed depression and anxiety, and strain your relationships. Chronic inflammation linked to some types of pain can also hurt your metabolic health. That can lead to problems like heart disease and diabetes. Good pain care goes after both the source of pain and these knock-on effects.
Interventional pain treatments go straight at the source of pain. Often they block pain signals from the hurt area to the brain. Common ones include epidural steroid injections, nerve blocks, radiofrequency ablation, spinal cord stimulation and intrathecal pump implants. Physical therapy can also count, since it improves function and cuts pain. The right treatment depends on the cause and location of your pain, your overall health, and how you did with past treatments. I push a team approach. That means mental health support, food advice and lifestyle changes alongside the procedures, so the pain is truly managed.
Opioids can be a useful tool for some types of pain, mainly sudden pain like the pain after surgery. For chronic pain, the picture is messier. Opioids can give short-term relief, but they do not treat the cause of the pain. Long-term use can also lead to tolerance (needing more of the drug for the same effect), dependence and even addiction. Other side effects include constipation, drowsiness and slowed breathing. So I treat opioids as a last resort. I focus first on other tools, such as procedures, physical therapy and lifestyle changes. But when those fail and the pain is severe, opioids may be used under close watch.
Lifestyle changes play a big role in managing pain and inflammation. Regular exercise builds muscle, eases joint pain, improves flexibility and lifts mood. All of that helps with pain. Diet matters too. Some foods drive inflammation, and others calm it. For example, foods rich in omega-3 fats, like fish, and foods high in antioxidants, like fruits and vegetables, can help cut inflammation. Processed foods and foods high in sugar and bad fats can drive it up. Keeping a healthy weight takes pressure off joints and lowers pain. Smoking and heavy drinking make pain worse, so avoid them. Sleep and stress control matter as well. Poor sleep and high stress both worsen pain and inflammation.
Physical therapy is a key part of the team approach to pain care. It aims to improve movement, restore function, cut pain and prevent new injury. That helps your overall health too. It might include exercises to build strength and flexibility, posture fixes, hands-on techniques, and tools like heat, cold and electrical stimulation. It can help people manage back pain, arthritis, fibromyalgia and neuropathy. Physical therapists can also teach you how your body moves. That helps you cut back on or avoid activities that make pain worse.
Pain is not just a physical feeling. Emotions and the mind shape it significantly. Stress, anxiety and depression can make pain worse. Living with chronic pain can, in turn, raise mental distress. That creates a vicious cycle. Cognitive behavioral therapy (CBT), a type of talk therapy, has been shown to work for chronic pain. CBT helps people spot and change negative thoughts and habits that can turn up pain and lead to mental health struggles. Mindfulness, relaxation and biofeedback are also used to change how pain is felt and to ease the distress that comes with it.
What happens during a procedure depends on which one you are having. In general, though, our injection procedures are done under local numbing with no sedation. You stay awake, and most patients drive themselves home. We use imaging, such as X-ray or ultrasound, to guide the needle and hit the exact spot. You might feel some discomfort during and after, but severe pain is rare. Most procedures are outpatient, which means you go home the same day.
How fast you improve depends on the treatment and on you. Some people may feel relief right away. Others may take several days or weeks to notice a real change. Sometimes a series of treatments is needed for the best relief. Procedures are often just one part of a full pain plan. Ongoing physical therapy, lifestyle changes and maybe medicine will still matter for long-term pain control.
Like any medical procedure, these treatments carry some risks and side effects. They include infection, bleeding, allergic reactions to the drugs used, nerve damage and worse pain. But these risks are generally low, and the procedures are considered safe in experienced hands. Side effects such as soreness or bruising at the shot site usually pass. We will go over the risks and benefits of any treatment in detail before we start, so you can make an informed choice. Keep in mind that while risks exist, these procedures can bring real pain relief when other treatments have failed. They can play a key role in restoring function, improving your life and cutting your need for drugs like opioids.
At the Padda Institute, the first visit looks at the structural problem and the terrain around it. That means imaging when needed, plus metabolic and inflammation markers. Metabolic screening stays part of ongoing care. If you are prescribed a controlled drug, urine drug testing runs about every six to twelve weeks. It goes through an independent high-complexity lab that uses gas chromatography. It checks for drugs you were not prescribed, and for the one you were.
Sometimes, and under close watch. Opioids work well for sudden pain, such as after surgery. But they do not treat the cause of chronic pain, and the dose tends to climb as the nervous system adapts. Here they are a last resort. We consider them when other treatments have not controlled severe pain. When they are prescribed, you sign a medication agreement and fill at one set pharmacy. You are also seen in the office at least monthly before any refill.
Make a full list of every drug you take, including over-the-counter drugs and supplements, and bring it. If you have a mental health condition such as bipolar disorder or major depression, or any history of substance abuse, tell us at intake. Expect questions beyond your scan: sleep, food and the life factors that shape recovery. Book at painmd.tv/appointment or call (314) 481-5000.
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