Pain is not your diagnosis. It is an alarm from your nervous system, your metabolism, or your structural anatomy telling you something has drifted out of balance. Treating the alarm without asking what set it off is why so many people cycle through years of temporary fixes.
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 biological environment your nerves live in — your metabolic markers, your inflammatory load, your circulation, your sleep, your nutrient status. Two people with identical scans can have completely different pain, because their terrain differs.
As Dr. Padda puts it: if we burn a nerve but your body is still on fire with meta-inflammation, the pain returns faster and more intensely. Explore the full series in The Hidden Drivers of Chronic Pain.
Because an interventional procedure silences the alarm; it does not, on its own, change the environment that triggered it. If insulin is chronically high, inflammation is unaddressed, or sleep architecture is broken, relief tends to be shorter each time.
We use that window of relief deliberately — to work on the terrain while you are comfortable enough to do it. See Radiofrequency Ablation for Back and Neck Pain or watch The Truth About RF for Back and Neck Pain.
Because the nervous system is extraordinarily adaptive. Give it a narcotic and it begins adapting immediately — so the dose has to climb to achieve the same effect. That escalation is not a sign of weakness or drug-seeking; it is predictable neurobiology.
Chasing it rarely restores function. 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 medication on your own — that is a decision to make with your physician.
It is the account running dry from both ends. On one side, escalating opioid doses drive tolerance as the nervous system adapts. On the other, your body has its own internal opioid system — natural pain-relieving chemicals it makes on its own — and disrupted sleep and circadian misalignment impair that system and lower your overall pain threshold.
So the external supply loses power while the internal supply is being depleted. Rebuilding the natural system is a large part of what we do. See Circadian Rhythm Disruption and Chronic Pain and Artificial Light at Night and Healing.
It began with over-prescription. Physicians were told pain medications were not addictive — and those studies were later shown to be manufactured. Anything that hits the dopamine reward system is reinforcing, and the brain learns to want more of it.
The correction swung hard the other way, which is why many patients are now referred to us under-treated rather than 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 frequently travel together, and treating one while ignoring the others rarely holds.
The same reward wiring is involved in food. See Pain and Addictive Eating or watch Pain & Addictive Eating: Uncovering Links.
It means aiming at repair rather than masking. A steroid injection into a damaged knee can help — but it has not made the knee better. Regenerative work targets the tissue itself: supporting repair of connective tissue, restoring elasticity, and improving the circulation that starved tissue needs to heal.
These are evolving, practice-based therapies rather than settled standard care, and individual results vary. See AGEs and Glycation: The Sugar Damage Behind Stiff, Painful Tissue and Tiny Blood Vessels, Big Pain.
Not at all — we perform them daily, in our own suite, under live imaging. What we reject is the injection-only model: endless monthly procedures with nobody ever asking why the nerves are hyperexcitable in the first place. Used that way, a block is a band-aid on a structural leak.
We use interventions to break the cycle of acute suffering, then use that window to change the terrain. Browse all pain treatments we offer.
A great deal. Insulin resistance, visceral fat and systemic inflammation make nerves hyperexcitable and impair healing. We see a direct link between elevated HbA1c and chronic pain. Visceral fat is not inert storage — it actively pumps out inflammatory signals.
See How Visceral Fat Pumps Out Pain Signals, Leptin Resistance and Chronic Pain, or watch Belly Fat Isn’t Passive.
Metabolic inflammation — a low-grade, systemic inflammatory state driven by diet, insulin resistance and body composition rather than by injury or infection. It is the reason pain can persist long after tissue has structurally healed, and the reason two people with the same MRI can feel completely different.
See How Inflammation and Diet Drive Chronic Pain and Hormone Problems.
Because each one measurably changes pain. Deep sleep is when your body recharges its own pain-relieving systems; a single night of poor sleep makes people more sensitive to pain the next day. Light at night suppresses that repair. Diet drives the glycation and inflammation that stiffen tissue and trap nerves.
These are not lifestyle add-ons — they are the terrain. Start with Circadian Rhythm Disruption and The Quiet Deficiencies That Drive Nerve Pain.
Reference ranges describe a broad, largely unwell population. They are not the level your body needs to actually repair nerves and control pain. You can sit at the bottom of normal and still be functionally bankrupt of what healing requires — the bar is simply set too low.
Your signal was valid. See Magnesium, Vitamin D and B Vitamins: The Quiet Deficiencies That Drive Nerve Pain.
A physician-led evaluation that looks at the structural problem and the terrain around it: imaging where indicated, metabolic and inflammatory markers, sleep, nutrition and the social factors that shape recovery. From there we build a plan that usually combines interventional, regenerative and metabolic elements.
We are at 4477 Woodson Road, 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 would rather be transparent with you about every check we run than have you discover it 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.
We would rather you know this clearly in advance than learn it 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.
An individual with chronic disabling pain will naturally request pain killers, so why are some physicians reluctant to prescribe narcotics?
Opiates can cause multiple problems. We have highlighted some of the complications associated with opiate therapy in the sections that follow on addiction, tolerance, hyperesthesia and hyperalgesia, immune and hormonal changes, withdrawal and detoxification.
We may ask you to undergo psychological or psychiatric evaluation and/or counseling sessions because of your chronic pain. Chronic pain affects not only the body, but also the mind. It is beneficial to have someone to whom you can talk about the pain and its impact on your life. The therapist provides information to the pain management physician on the psychophysiological effects of the chronic pain. We provide psychophysiological therapy, family therapy, group and individual psychotherapy to assist in controlling and coping with the pain. Depending upon the cause and type of pain, as well as the type of therapy, we also sponsor community support groups in the St. Louis region. If you are considering a permanent implantable device, such as a Dorsal Column Stimulator (DCS) or Intrathecal Pump, we will require you to have psychological screening, to make certain you fulfill the criteria for implantation. Patient’s who have pre-existing psychiatric conditions such as bipolar disorder, borderline personality, schizophrenia, major depression, or any history of substance abuse should notify us immediately upon patient intake. Successful treatment of chronic pain in these particular patient groups depends upon a coordinated approach, especially in these specific conditions.
Pain medications are an important part of you 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 weekend or 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 can be caused by several conditions, such as arthritis, fibromyalgia, migraines, nerve damage (neuropathy), and injuries that don’t heal properly. Sometimes, the source of chronic pain can be difficult to determine. Pain is the body’s signal that something is wrong, and in the case of chronic pain, this signal continues long term. Chronic pain can lead to a cycle of pain, stress, and physical deconditioning that further exacerbates the pain and can negatively impact overall health. It can disrupt sleep, decrease physical activity, reduce the ability to perform tasks, contribute to depression and anxiety, and affect relationships. Furthermore, chronic inflammation associated with some types of pain can affect metabolic health, potentially leading to conditions like heart disease and diabetes. Addressing both the source of pain and these downstream effects is an important part of comprehensive pain management.
Interventional pain treatments aim to directly address the source of pain, often by blocking the pain signals from the affected area to the brain. Common interventional pain treatments include epidural steroid injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, and intrathecal pump implants. Physical therapy can also be considered an interventional treatment as it helps improve function and reduce pain. The type of treatment recommended will depend on the cause and location of your pain, your overall health, and how you’ve responded to previous treatments. I encourage a multidisciplinary approach, including psychological support, nutritional advice, and lifestyle modifications along with the interventional procedures to manage the pain effectively.
Opioids can be an effective tool for managing certain types of pain, particularly acute pain such as that experienced after surgery. However, for chronic pain, the picture is more complicated. While opioids can provide short-term relief, they do not treat the underlying cause of the pain. Additionally, long-term use of opioids can lead to tolerance (needing more of the drug to achieve the same effect), dependence, and even addiction. There are also other potential side effects, such as constipation, drowsiness, and suppressed breathing. Therefore, I generally consider opioids as a last resort and focus primarily on other pain management strategies such as interventional procedures, physical therapy, and lifestyle modifications. However, in cases where these strategies are not effective, and the pain is severe, opioids may be considered under careful monitoring.
Lifestyle changes can play a crucial role in managing pain and inflammation. Regular physical activity can strengthen muscles, reduce joint pain, improve flexibility and boost mood, all of which can help manage pain. Diet also plays a key role in inflammation; certain foods can promote inflammation while others can reduce it. For instance, foods rich in omega-3 fatty acids, like fish, and those high in antioxidants, like fruits and vegetables, can help reduce inflammation. In contrast, processed foods and those high in sugar and unhealthy fats can promote inflammation. Maintaining a healthy weight can also reduce pressure on joints and decrease pain. Lastly, smoking and excessive alcohol can exacerbate pain and should be avoided. Sleep and stress management are also vital; both poor sleep and high stress can worsen pain and inflammation.
Physical therapy is a crucial component of the multidisciplinary approach to pain management. It aims to improve mobility, restore function, decrease pain, and prevent further injury, which in turn helps enhance overall health. Physical therapy might include exercises to strengthen muscles and improve flexibility, posture corrections, manual therapy techniques, and modalities like heat, cold, and electrical stimulation. It can help patients manage conditions like back pain, arthritis, fibromyalgia, and neuropathy effectively. Physical therapists can also educate patients about the biomechanics of their bodies, helping them to minimize or avoid activities that might exacerbate pain.
Pain is not just a physical sensation, but is significantly influenced by emotional and psychological factors. Stress, anxiety, and depression can exacerbate pain, and living with chronic pain can, in turn, increase psychological distress, creating a vicious cycle. Cognitive behavioral therapy (CBT), a type of psychological therapy, has been shown to be effective in managing chronic pain. CBT helps individuals identify and change negative thought patterns and behaviors that can amplify pain and lead to mental health struggles. Techniques such as mindfulness, relaxation, and biofeedback are also used to help manage the perception of pain and reduce associated distress.
The specifics of what you can expect during an interventional pain procedure depend on the type of procedure you’re having. However, in general, these procedures are done under local anesthesia or mild sedation to ensure you are comfortable. They involve the use of imaging technologies, such as X-ray or ultrasound, to guide the procedure and ensure precise treatment. You might experience some discomfort during and after the procedure, but severe pain is uncommon. Most procedures are done on an outpatient basis, meaning you can go home the same day.
The timeline for improvement varies depending on the specific treatment and individual patient characteristics. Some patients may experience immediate relief, while others might take several days or weeks to notice significant improvements. In some cases, a series of treatments might be needed to achieve optimal pain relief. It’s important to note that interventional pain treatments are often only one part of a comprehensive pain management plan. Ongoing physical therapy, lifestyle modifications, and possibly medications will continue to be important for long-term pain management.
As with any medical procedure, there are potential risks and side effects associated with interventional pain treatments. These can include infection, bleeding, allergic reactions to the medications used, nerve damage, and worsening of pain. However, these risks are generally low, and the procedures are considered safe when performed by experienced physicians. Side effects from the procedures, such as soreness or bruising at the injection site, are typically temporary. We will discuss the potential risks and benefits of any proposed treatment in detail before proceeding to ensure you make an informed decision about your care. It’s also essential to remember that while risks exist, these procedures can offer significant pain relief when other treatments have failed. They can play a crucial role in restoring function, improving quality of life, and reducing reliance on medications like opioids.