When severe pain strikes, waiting days or weeks for relief is unacceptable. Pain is an active biological signal that needs immediate, precise evaluation — not a queue. That is why the Padda Institute holds same-day and urgent appointments open at our Woodson office. It sits next to the St. Louis airport and is easy to reach from anywhere in St. Louis, St. Louis County, St. Charles and the Metro East.
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 need emergency imaging and stabilization that only a hospital can provide. Everything below is about the far more common case: severe, escalating pain that is not an immediate threat to life. There, an ER is the wrong tool for the job.
Many patients default to the hospital ER when pain becomes overwhelming. The federal data shows why that so often ends in frustration. The Centers for Medicare & Medicaid Services reports quality data through Hospital Compare. By that data, 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 spread evenly. Emergency departments triage by threat to life, exactly as they should. So 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 ER is not equipped to diagnose or treat complex neuromuscular conditions. It is built for crisis stabilization — rule out the catastrophe, treat the acute threat, discharge. Root-cause interventional care is a different discipline. It requires 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. One study looked at 539 ER patients with acute musculoskeletal injury (injury to muscle, bone or joint). Nurses underestimated patient-reported pain by an average of 2.4 points on a 0–10 scale. The score they recorded 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 ER. 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 patient pays the price. 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 settings — including poor clinician training in pain assessment — feeds routine skepticism toward patients who are suffering.4
A same-day visit at the Padda Institute is a physician evaluation, not a triage slot. An interventional pain physician examines you and reviews your history and any prior imaging. Then we use our on-site diagnostic tools to find 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 ER 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. It does not become another wait for a scheduled slot. Whether that is right for you depends on your exam, your imaging and your current medications — but it is truly on the table from the first appointment.
Because we are a dedicated pain practice, we ask 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 ER serves worst, it is cluster headache. Attacks arrive suddenly and peak within minutes. They 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, a nerve hub sitting just behind the nasal cavity. It is the hub of the trigeminal autonomic reflex. That reflex 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. That is why interrupting that one structure can quiet the attack.
The transnasal approach (through the nose) takes only a few minutes. It uses no needle through the skin and no sedation, and most patients drive themselves home afterward. 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. Almost nothing in an ER is practical in that way. If you are in an active cluster bout, you can be evaluated and treated in the same visit. You do not wait 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 first. Other causes must be ruled out 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 Rd, Suite 100, St. Louis, MO 63134
Phone: (314) 481-5000 · Text: (314) 886-5902
Monday–Friday, 8:00 AM–5:00 PM
The Woodson office sits right next to St. Louis Lambert International Airport. That 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 second office, 12174 Natural Bridge Rd, St. Louis, MO 63044.
We hold same-day and next-day appointments open Monday through Friday 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. When the exam and your history point clearly to a target, we can frequently treat it the same day instead of booking you back. It depends on what we find, what imaging you have, and what medications you take — especially blood thinners. So bring your current medication list.
Cluster headache is one of the best reasons to come to us instead of an emergency room. A sphenopalatine ganglion block is a short transnasal procedure — a few minutes, no needle through the skin, no sedation. 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. We will not assume it is cluster headache.
No. You do not need a referral from another physician to be seen here. 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 than an ER can. It can also do it with far more diagnostic precision.
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, your insurance card, a current list of your medications, and any imaging you already have — MRI, CT or X-ray discs and reports. Imaging is especially useful, because it often lets 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.
Longer than most people expect. Federal Hospital Compare data show the median Missouri patient spends 154 minutes in an emergency department before leaving. At high-volume departments that rises to 210 minutes. At 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. Pain that is not life-threatening waits behind cardiac arrest, stroke and trauma. It waits again every time a new ambulance arrives.
First, check the red flags listed above: chest pain, signs of stroke, new loss of bladder or bowel control, fever with severe back or neck pain, or pain after major trauma. Any of those means 911 or the emergency room. Without them, text (314) 886-5902 or call (314) 481-5000 as early in the day as you can. We hold same-day appointments open Monday through Friday for severe, escalating pain.
Often, yes. In a study of 539 emergency patients with acute musculoskeletal injuries, nurses underestimated pain by an average of 2.4 points on a 0–10 scale. Their score matched the patient’s own rating only 27 percent of the time. At a University of California, San Francisco ER, patients rated their pain 7.5 while triage nurses rated the same patients 5.1. The ER is built to rule out catastrophes, not to measure pain.
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Same-day and emergency appointments are available.