Medication Management

This includes non- steroidal anti-inflammatory drugs or acetaminophen

  • muscle relaxants, such as cyclobenzaprine, methocarbamol and metaxolone
  • true antispastic medications, such as baclofen or tizanidine
  • antidepressants including tricyclic antidepressants, serotonin re-uptake inhibitors, and combined serotonin and norepinephrine reuptake inhibitors
  • Gabapentinoids
  • Tramadol and
  • Opioids

All of these classes of medications have potential side effects and contraindications.  Some of them can cause or aggravate ulcers.   Some can cause kidney and liver function to decline.  When combinations of medication classes are employed the potential for side effects multiplies.  Non-opioid medications are considered adjunctive pain medications but may be insufficient for Failed Back Surgery Syndrome or post-traumatic arthritis in multiple joints after major trauma.  There is often a ceiling effect with respect to actual pain relief.  More is not necessarily better and opioid induce hyperalgesia- or more pain with high dose opioids- is a well recognized clinical phenomenon that can occur. 

However, opioids are generally considered safe and effective for moderate to severe pain but the use of long-term opioids for chronic non-cancer pain has become controversial.  The risk of addiction is very real.  Before we prescribe opioid medications, we will perform a history and physical exam that typically lasts one hour with a physician.  You should bring all of your old records, operative reports, and diagnostic studies to that first visit so that they can be reviewed.  We also require that you will sign a pain management agreement and we will closely monitor your progress.  We reserve the right to discontinue medications if you cannot be compliant with our clinic protocols.

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Office Hours
Monday: 9:00 AM - 5:00 PM
Tuesday: 9:00 AM - 5:00 PM
Wednesday: 9:00 AM - 5:00 PM
Thursday: 9:00 AM - 5:00 PM
Friday: 9:00 AM - 5:00 PM