When severe pain strikes, waiting days or weeks for relief is unacceptable. Pain is an active biological signal that requires immediate, precise evaluation — not a queue. That is why the Padda Institute holds same-day and urgent appointments open at our Woodson Road office, adjacent to the St. Louis airport and reachable from anywhere in St. Louis, St. Louis County, St. Charles and southwestern Illinois.
We are an interventional pain practice, not an emergency room. Call 911 or go to the nearest emergency department immediately if you have any of the following:
These require emergency imaging and stabilization that only a hospital can provide. Everything below is about the far more common situation: severe, escalating pain that is not immediately life-threatening, where an emergency department is the wrong tool for the job.
Many patients default to the hospital emergency department when pain becomes overwhelming. The federal data shows why that so often ends in frustration. Under the Centers for Medicare & Medicaid Services quality reporting behind Hospital Compare, the median Missouri patient spends 154 minutes in an emergency department before leaving. At high-volume emergency departments that rises to 210 minutes, and across the St. Louis region’s busiest emergency departments the average is roughly three hours and fifty minutes. The longest in the state is 336 minutes — over five and a half hours for a single visit.
Those hours are not distributed evenly. Emergency departments triage by threat to life, exactly as they should, which means non-emergent pain waits behind cardiac arrest, stroke and trauma — and waits again every time a new ambulance arrives. The result is measurable: at the region’s busiest emergency departments, as many as 7 percent of patients leave before ever being seen by a clinician, against a national average of 2 percent. Nobody walks out of an emergency room after four hours because their pain resolved.
Even when you are seen, the emergency department is not equipped to diagnose or treat complex neuromuscular conditions. It is structured for crisis stabilization — rule out the catastrophe, treat the acute threat, discharge. Root-cause interventional care is a different discipline, requiring image guidance, diagnostic blocks, and the time to map which structure is actually generating the signal.
The published research on how pain itself is assessed in that setting is blunt. In a study of 539 emergency patients presenting with acute musculoskeletal injury, nurses underestimated patient-reported pain by an average of 2.4 points on a 0–10 scale, and the score they documented matched the patient’s own self-report only 27 percent of the time; 63 percent of pain was underassessed.1 A study at the University of California, San Francisco found the same gap in a US emergency department: patients rated their pain 7.5 while triage nurses rated the same patients 5.1.2
That gap is not indifference — it is a system asked to do something it was never designed for. But the consequences fall on the patient. In the U.S. Pain Foundation’s 2022 survey of 2,378 people living with chronic pain, 63 percent said they felt stigmatized by their providers, and 79 percent said they feel stigmatized because of their pain.3 A 2022 review in Pain and Therapy describes how structural stigma in clinical environments — including inadequate clinician education in pain assessment — contributes to routine skepticism toward patients who are suffering.4
A same-day visit at the Padda Institute is a physician evaluation, not a triage slot. You are seen by an interventional pain physician who examines you, reviews your history and any prior imaging, and uses our on-site diagnostic capability to identify what is actually generating the pain.
And when a procedure is indicated, we can often perform it the same day. That is the part an emergency department cannot offer at all. Our procedure suite, fluoroscopy and ultrasound are on site, so the gap between “we know what this is” and “we have treated it” can close in a single visit instead of becoming another wait for a scheduled slot. Whether that is appropriate depends on your examination, your imaging and your current medications — but it is genuinely on the table from the first appointment.
Because we are a dedicated pain practice, the questions asked are pain questions: what structure, what nerve, what mechanism, and what has already failed. That is the difference between being stabilized and being diagnosed.
If there is one condition the emergency department serves worst, it is cluster headache. Attacks arrive suddenly, peak within minutes, last anywhere from fifteen minutes to three hours, and most often strike at night. Wait three or four hours to be seen and the attack has frequently ended on its own — untreated, undocumented, and with the next one still coming.
Cluster headache also responds to a specific intervention rather than to general painkillers. The sphenopalatine ganglion block targets the parasympathetic ganglion sitting just behind the nasal cavity — the hub of the trigeminal autonomic reflex that produces the watering eye, the blocked nostril and the drooping eyelid on the affected side. Those signs are not incidental; they are the reflex itself, which is why interrupting that one structure can quiet the attack.
The transnasal approach takes only a few minutes, uses no needle through the skin and no sedation, and most patients drive themselves home afterwards. During a cluster bout it is frequently used to break the cycle. That combination — fast, low-risk, no sedation, no driver required — is precisely what makes it practical as a same-day treatment in a way that almost nothing in an emergency department is. If you are in an active cluster bout, you can be evaluated and treated in the same visit, rather than waiting weeks for a scheduled block or hours for an emergency room that has no specific treatment to offer you. You do not need a referral from another physician, and you do not need to be an existing patient.
More detail: cluster headache treatment, SPG and stellate ganglion blocks for cluster headache and migraine, and the nerve reflex behind the watering eye and the blocked nostril.
One caution. A headache that is new, or different from your usual pattern, needs evaluation to exclude other causes before it is treated as cluster headache. And if it is the worst headache of your life or arrived like a thunderclap, that is an emergency — see the red flags above.
Padda Institute — Center for Interventional Pain Management
4477 Woodson Road, Suite 100, St. Louis, MO 63134
Phone: (314) 481-5000 · Text: (314) 886-5902
Monday–Friday, 8:00 AM–5:00 PM
The Woodson Road office sits immediately adjacent to St. Louis Lambert International Airport, which makes it one of the most directly reachable points in the region from I-70, I-170 and I-270. We also see patients at our Bridgeton office, 12174 Natural Bridge Road, Bridgeton, MO 63044.
We hold same-day and next-day appointments open Monday through Friday specifically for patients in severe or rapidly escalating pain. Text or call as early in the day as you can — the earlier we hear from you, the more likely we can see you that same day.
Often, yes. Our procedure suite and imaging are on site, so when the examination and your history point clearly to a target, we can frequently treat it the same day rather than booking you back. It depends on what we find, what imaging you have, and what medications you are taking — particularly blood thinners — so bring your current medication list.
Cluster headache is one of the best reasons to come to us rather than an emergency room. A sphenopalatine ganglion block is a short transnasal procedure — a few minutes, no needle through the skin, no sedation, and most patients drive themselves home. It is often used during a cluster bout to break the cycle. If your headache is new or has changed character, we will evaluate it properly first rather than assume it is cluster headache.
No. You do not need a referral from another physician to be seen here, and you do not need to be an existing patient — call or text and we will book you. Some insurance plans do require a referral for coverage, so we check your benefits when you contact us and tell you before anything is scheduled.
If you have any of the red-flag symptoms listed above, go to the emergency room or call 911 — those need emergency imaging and stabilization. For severe pain without those features, an interventional pain practice can usually evaluate and treat you faster, and with far more diagnostic precision, than an emergency department can.
Our office is open Monday through Friday, 8:00 AM to 5:00 PM. Text messages sent outside those hours are answered the next business morning, and we will work to fit you in. If your pain cannot safely wait until then, or you develop any red-flag symptom, go to the emergency room.
We accept all commercial insurances. Copays, deductibles and each plan’s policies on specific treatments vary, so we verify your benefits before any procedure and tell you what to expect.
Bring a photo ID and your insurance card, a current list of your medications, and any imaging you already have — MRI, CT or X-ray discs and reports are especially useful, because they often let us reach a working diagnosis in the first visit.
No. We are an outpatient interventional pain management practice. We can evaluate and treat severe pain quickly, but we do not provide emergency or trauma care, and we are not open overnight.