Frequently Asked Questions

General FAQ's

 


General FAQ's


What is “Pain Management”?

Pain Management is a treatment system designed to give you your life back.  The term describes a program of clinical evaluation, lifestyle improvement, medication therapy as indicated, and treatment procedures as indicated.  Underlying the treatment tools used is an environment of overall encouragement and support for people whose pain has been uncontrolled elsewhere, and whose function and enjoyment of life has been impaired.  In some cases, a previously undiscovered source of pain can be found and treated.  The goal of the management program for most patients, however, is to improve pain frequency and severity; improve tolerance for function and activity; and restore a sense of being “in control” of your pain.  As a result, most patients are able to rediscover the joy of living.


Who should be treated in Pain Management?

Two groups of people benefit from pain management.  The first group:   in an ideal world, anyone who is experiencing ongoing pain without adequate relief from current treatment, even if the pain has only been present a few weeks (“acute pain”), should have a pain management physician involved in their treatment.  Early in the course of pain, most types of pain respond quite well to adequate doses and scheduling of “pain medication”, usually opioids like hydrocodone, oxycodone, or morphine.

The reason the pain needs to be controlled as soon as possible is that the longer pain remains uncontrolled, the more sensitized the pain nerve information system becomes to painful signals.  At some unpredictable point, the part of the nervous system reporting pain becomes overwhelmed and recruits other parts of the nervous system, normally not giving pain information, to also start reporting pain.  More pain highways and intersections are built, and just like new government programs, once built they are very difficult to dismantle.  At that point your pain becomes much more complicated to treat and is less likely to permanently be completely eliminated.

The second group of people appropriate for pain management therapy is composed of those who have already reached the “chronic pain” stage discussed above.  Typically these individuals have experienced uncontrolled pain intermittently or constantly for months or years.  Frequently they have been treated with medications like Vicodin or Percocet, often at high doses, but no longer get adequate pain relief.  Usually they sleep poorly, have limited function because of pain, have lost much in life that gave them joy, may be financially suffering due to inability to work, and are often depressed.


What is acute pain?

Acute pain is a normal, protective response of the body to tissue injury or disease, and usually goes away after that condition has resolved.  It alerts the brain to take action, helping the body escape from further injury.  This kind of pain usually starts fairly suddenly and often includes a sharp quality to the pain.

Acute pain usually responds well to treatments such as Motrin, Vicodin, or Percocet; heat, ice, or physical therapy; limitation of movement or rest.   Some require specific therapy such as surgery or antibiotics to resolve.  Many causes, of course, exist but they can include:


What is chronic pain?

Chronic pain continues to be present but no longer serves a biological function, that is, it doesn’t serve any helpful purpose for the body.  It has recently been identified as a separate disease diagnosis, separate from the original cause of injury. 

Chronic pain has generally, but not always, been present for more than four months.  It is an abnormal, nonfunctional, persistent, irritating alarm call to action from the brain, and persists long after the initial cause of pain has healed or resolved.  The pain reporting system has been abnormally irritated and activated as discussed above, so this type of pain usually doesn’t respond well to the usual, nonspecific treatment programs.

Effects of this condition, in addition to the sensation of pain, can include poor sleep, poor energy, limited mobility, tense muscles, poor appetite, and financial loss.  Emotionally, people suffering from chronic pain often experience anger, anxiety, loss of self-worth or identity, depression, and fears of re-injury.

Examples of chronic pain can include:


Why does pain severity and quality vary so much from one person to another?

Chronic pain is a major health and economic problem worldwide, and as discussed above can result from a variety of original causes.  As a result, there are some quality differences.  For example, nerve damage typically causes a significant burning component to the pain.

A combination of factors can also contribute to perceived pain intensity. For one thing, the underlying disease process severity may differ widely among patients.  Each person also has a different threshold for and tolerance for pain, often affected by physical, emotional, cultural and experiential factors.
Pain seems to be less tolerated during an acute stage of an illness. Some possible explanations include the fact that the pain is new and there is concern as to whether or not it will improve; uncertainty of the cause will often increase anxiety which in turn increases pain.

In other words, emotional issues can clearly accentuate the perception of pain. Once patients have an explanation for their pain and treatment plan, many tolerate it better.

Finally, pain and anxiety about the symptoms may disrupt sleep. Non-restorative (non-restful) sleep can by itself aggravate pain. Thus, a vicious cycle occurs where a person’s pain and anxiety lead to disruptions in their sleep which further increases their pain.


What is the best way for me to approach my pain?

Better ways to manage pain are continually being sought. With pain relief as the goal, pain physicians and patients often try a variety of pain management techniques, determining which works best. The success or failure of each type of treatment is individual. What works for one person may not work for another person.  Some of the tools we can draw from are listed below.


What types of pain are treated at the Allayant Pain Management clinic?

Most types of pain can be helped through pain management.  Ideally, if we can see a patient before the pain becomes chronic we can prevent the “domino” effect of deterioration.  For the most part, however, we end up by default in seeing people with established chronic pain.  As a specific disease, chronic pain can usually be treated with symptomatic and functional improvement for a wide variety of initial causes. 

Pain problems managed include but are not limited to the following:


What methods do you use to manage chronic pain?

All pain management programs are multi-dimensional and individualized for each patient.  Specific types of treatment can be drawn from, but not limited to, the following menu:

MEDICATION
Medication of some kind is used to help almost all types of chronic pain.  Some kinds of chronic pain respond at least partially to opioid medication.  Some types of chronic pain require other medications to reduce nerve irritability, promote sleep, or reduce muscle irritation.  Medicines designed for depression help some kinds of nerve pain greatly, and are also sometimes used to improve sleep.  The use of depression medicine in the treatment of chronic pain does NOT mean that your doctor considers you to be “crazy” or have your pain “all in your head”.

EDUCATION
Education in many forms helps people understand the causes for their pain, how to avoid or deal with flares in pain.   Learning proper pacing for desired activity, alone, significantly reduces many patients’ pain flares. It is very important to pay attention to your body’s signals and allow the body the required time to recharge. Inflammation decreases during a restful phase, however too much stillness can lead to more muscle stiffness and weakness. It is essential to strike a balance between rest and exercise.

Education also includes realizing that the treatment team at Allayant takes their pain seriously and is available for support to help their functional progress. 

EXERCISE
A variety of exercises of the specific type needed for your pain condition can also reduce pain effects and improve quality of life.  Flexibility exercise relieves the stiffness, muscle shortening and poor flexibility that usually accompanies pain-related inactivity.  Strength and / or stability exercise improves muscle strength and stability, improving pain tolerance for life’s activities, and reducing excess stress on painful structures.  Aerobic and endurance exercise allows the person in chronic pain to improve the duration of physical activity while controlling the amount of pain that causes.  This produces greater independence and a more satisfying quality of life.

LIFESTYLE IMPROVEMENT
Anything that affects your body will also affect its ability to heal, strengthen, rest, and deal with pain.  Correction of poor eating habits, often also with nutritional supplementation, improves nutrition which increases the building blocks your body can take in to repair tissue or add muscle tissue.  Reducing or preferable stopping smoking improves tissue oxygen supply, improving healing and tissue health.  Regular, adequate sleep permits the body to rebuild during the night, and the mind to process the day’s events.  This in turn reduces fatigue and improves mood.

WATER THERAPY
Heat of any kind can decrease pain and stiffness. Gently exercising in a pool or hot tub may be easier because water takes some weight off painful joints. Some also find relief from the heat combined with movement, feeling less stiff and sore afterward.

TRIGGER POINT INJECTIONS
Injection of some tiny areas of muscle tissue can relax “locked up” areas of muscle fibers, improving the associated pain and stiffness with activity or at rest.  There is usually an immediate sense of  “release” and significant pain reduction.  This mechanical effect also allows better subsequent stretching with decreased pain.

OTHER KINDS OF INJECTIONS
If needed, epidural steroid injection or nerve root sleeve injection may be scheduled.  These are intended to reduce pain and swelling enough to allow ongoing nonsurgical therapy to improve the patient’s overall condition.  A similar problem with spinal joint pain and inflammation can be relieved by doing a “facet block” to the affected joints.  Although designed to deal in the short term with flares in inflammation, many patients note very long acting pain relief from such injections, including Dr. Bothe himself.

PHYSICAL THERAPY
By the time they reach Pain Management clinics, many chronic pain patients have already been tried exhaustively in Physical Therapy.  In acute pain cases, it can be extremely valuable.  Even for chronic pain patients, when an acute pain flare or impaired function occurs, another series of PT visits may be appropriate and helpful.  Certain types of bracing may be suggested, or changing cane use from one hand to the other to reduce pain and stress on a joint.

MASSAGE THERAPY
Massage  can hasten pain relief, soothe stiff sore muscles, and reduce inflammation and swelling. As muscle tension is relaxed and circulation is increased, pain is decreased.

MENTAL HEALTH THERAPY
For patients whose lives are profoundly disrupted by pain and / or other stress factors, or people with severe anxiety or depression, talking with a mental health professional may be recommended.  A psychologist can provide extensive coping skills for your life, and sometimes will also instruct you in how to reduce pain through biofeedback.  A psychiatrist may be needed to assist with medication adjustments for complex or poorly responsive depression or anxiety problems.  Again, this does NOT mean you are considered “crazy” or that your pain is thought to be “in your head”.

ELECTRICAL STIMULATION
Many patients in chronic pain have already used a TENS unit with or without success prior to starting Pain Management.  Sometimes additional types of nerve stimulators can be valuable, however.  For patients with severe, unrelenting nerve-related pain, in implanted programmable electrical stimulator trial may be scheduled and is often effective.

IMPLANTED MEDICATION PUMP
Some patients who can’t be adequately relieved of pain with various combinations of opioid and other pain medications may be scheduled for a trial of medication delivery directly into the spinal fluid.  If that trial is tolerated and helpful, implantation of a small, programmable and refillable pump can be performed.  Medications used in the pump may include any of or a combination of opioids, spasm medication, blood pressure medication, and blockers of pain nerve transmission.


I’m in uncontrolled pain but am afraid of becoming addicted to pain medication. Is it true that I can become addicted to pain medication?

Everyone is aware of the addiction potential of drugs such as morphine and heroin. But there are a number of studies that suggest there is no higher incidence of addiction among patients using opioids for pain control than among the rest of the population.  In other words, if you already have a tendency toward addiction, use of opioids may trigger addictive activity.  Typically, people who use opioids for pain, however, use the least amount of medicine that adequately relieves their pain, and are eager to reduce or eliminate their doses if their pain improves or resolves. 

The worst addictive problems with these opioid drugs are seen among healthy people who are not in pain. They become addicted when they use these drugs illegally for the feeling of euphoria that they can generate. If a person who is in severe pain properly uses these narcotics for the relief of pain, they do not feel euphoria; they do not become addicted; they simply have relief from intense pain. A wide range of people are in need of such medication, from individuals who are suffering from advanced cancer to untreatable back pain and diabetic nerve pain.


Why won’t my family doctor treat me with enough pain medicine to let me sleep and function without misery?

One barrier to using such medicine effectively is a lack of training and experience.  Just as a pain physician will leave diabetes management up to a primary care doctor or internist, family physicians often prefer for a Pain Management physician with more knowledge and experience to deal with such treatment.

Many older physicians were trained in medical school not to use opioids long term on any patients but those with terminal cancer.  If they have not subsequently updated their knowledge to modern pain management research, they will continue to maintain that outdated concept.

Additionally, the attitude toward obesity and alcoholism as diseases but opioid addiction as a legal and character issue colors the opinions of physicians, enforcement agencies, and the general public.  Many doctors are, as a result, unwilling to risk intense official scrutiny and possible censure, or to deal with the record keeping and supervisory complexities of managing opioid therapy. 


I have an elderly parent who is complaining of pain. Is it safe for her to be treated by pain management?

Yes, it is safe to treat pain in senior citizens, but older individuals may respond differently to pain medication and other types of medication.  Often they are more sensitive to it, and need to be treated conservatively with careful monitoring.  Those who are aging also typically have additional health issues such as high blood pressure, diabetes, or cancer. These diseases and their medications need to be taken into account when treating their pain, so that medication conflicts and diseased-related side effects are minimized.

We are developing an increasingly aging and diverse society.  Some studies suggest that we are generally underestimating the amount of pain suffered by the elderly in society.  We know that older people may use different words for pain, such as "it hurts" or "it aches" or "it's just my arthritis." This means we often need to open up new ways of communicating about pain.  We listen to the patient, and try to use their words to lead them to being able to discuss their pain using whatever words are meaningful and familiar to them.


My friends say that taking a nutritional supplement is helpful for my general health. Could this be important for me, in pain, to pay attention to?

Doctor Bothe believes in personally using certain nutritional supplements daily, and has noted improvements in general well-being, incidence of virus infections, and mental focus. Nutritional supplements contain essential nutrients but many also contain other compounds purported to be good for your health.  If you have an excellent diet, you may be able to get many of these essential nutrients without a supplement, but this is often difficult.

It may be helpful for pain patients, as well as those without pain, to take a nutritional supplement.  You should always check with your physician before taking any product to be sure you are taking a product safe for you, as well as a product that best fits your needs.  I would also be happy to share the name of the product that I take.  Remember also that too much of even a good thing can be damaging, so use any such product as directed. 


How do I make an appointment?

For new patients, a referring physician MUST request a consultation with the pain management physician. This can be your primary care doctor, surgeon, or prior Pain Management physician.  Your doctor should mail or fax all pertinent medical history, including X-ray reports, surgical reports, prior consultations, etc. Records must include a printed history from all pharmacies you use, for the past 12 months.  You can hand carry your records to our office, if preferred, but any such records must be sealed in a large envelope with your doctor’s signature across the seal.   The Allayant Pain Management clinic will send you a number of intake forms to complete, [or you can download them from our web site].

Once the Allayant receives your Intake Forms and past records as described above, an appointment can be set up for you.  We cannot make an appointment before these items have been received, as it is critical for Dr. Bothe to have all information at the time of your visit, in order to conduct a thorough and meaningful consultation.

Once a consultation has been performed, recommendations will be made to your referring physician.  If you and that physician feel you would be best managed in our clinic for awhile, Dr. Bothe will decide based on his consultation whether you will be accepted for care.


Why do I need a referral?

A referral is required for several reasons. The most important, however, is to provide the evaluating pain management physician with all relevant history and data so that the consultation is productive and focused on the patient and his/her pain problem.  Some insurance carriers may require a referral from you primary physician, also, in order to cover the cost of the consultation.


What information do you need in order to set up my appointment?


What am I to send prior to my first appointmentat Allayant Pain Management?

All patients should send the following prior to your first appointment:

Previous patients should send the following:

Do not send or bring X-rays or films


What are the Clinic hours?

M-Th 8:30 AM - 5:00 PM
Fri     8:30 AM - 1:00 PM 


Can I reach the Pain Doctor after clinic hours?

No.  As a specialty referral clinic, questions may be left after clinic hours and will be answered at the end of the following work day.  You may also ask relevant questions at the time of your appointments.  Other medical questions can be answered from our web site; from handouts you’ve received or instructions received from Dr. Bothe; or by your primary care physician.  Dr. Bothe will not be available evenings, weekend days Allayant is not open, or on vacation days.  You will be informed ahead of time of the dates of vacation.

If you have a life-threatening type of medical emergency (such as a severe allergic reaction), you should present to the Emergency Department for emergency intervention.


Where are you located?

We are conviently located in Arden, NC, near Ashville. Click here for address and directions. 


Do I need to bring anything with me to my appointment?

You must bring a CURRENT copy of your health insurance card.  You must bring a credit or debit card; cash; or check to cover your portion of the cost of the initial consultation, or any subsequent visits.  Without both of these, you cannot be seen.  An estimated range of cost for your portion of the visit cost will be given you before your first visit.  It is not necessary to bring films or CD's to your appointment. We only require the typed results of these tests.  


What happens at the first appointment?

At your initial consultation, you will meet with a pain management nurse or medical assistant who will review your Intake information with you.  Dr. Bothe will then discuss your history and symptoms with you, and perform a physical examination.  The doctor will then recommend a treatment plan based on this assessment and the diagnoses made. 


Will my pain doctor take over as, or act as, my primary care physician?

No. Dr. Bothe respects the integrity of your relationship with your physician and recognizes its value as a vital source of information and support in your treatment plan. We work with your physician keeping them updated on your care and follow-up plans.


Do you accept my insurance?

Allayant Pain Management clinic accepts Medicare.  We are applying for Provider status with most of the major commercial insurance companies.  If we are not Preferred Providers with your insurer you will need to pay at the time of your appointment and apply to your insurer for remibursement.


What can I do for my pain before Dr. Bothe sees me for his consultation?

Dr. Bothe and his staff will make every effort to see you quickly.  We understand that you may have a great deal of pain.  However, we cannot provide you any medication or other treatment until we have seen you.  We suggest you obtain ongoing care from the doctor that has currently been treating you.  Indeed, often your referring physician will continue to manage your pain after our consultation, based on Dr. Bothe’s recommendations.