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Unfortunately all medications can have deleterious side effects on the human body. That is why at Cleaver Medical Group we make every effort possible to optimize treatment of the underlying cause of pain, while minimizing the risks to our patients. Our pain management services are currently offered at our Cumming location.

Chronic pain is pain that has persisted for greater than a three month time period. This type of pain can be related to:

• Previous injuries

• Underlying medical conditions

• Cancerous pain causing damage to the body.

The aim of medication management in the treatment of chronic pain is to provide symptomatic relief and to help progressively increase an individual’s daily level of functioning and activities. Due to advances in modern medicine over the years, there are now many types of safe and effective medications that can help with just this. Medications used depend on the type of chronic pain that each patient is experiencing and can be non-narcotic and narcotic in nature. Some examples of medication classes that are non-narcotic include:

• Non-steroidal anti-inflammatories
• Anti-depressants
• Acetaminophens
• Muscle relaxants
• Anti-convulsants

Do you prescribe Suboxone ?

Our practice does not offer Suboxone.

Do you require a referral or can I just call to make an appointment?

New patients typically need to be referred by a primary care physician or other specialist. If you feel you would benefit from our services, ask your physician for a referral or contact our center and we may be able to assist you in obtaining a referral from your provider.

What happens at the first appointment?

At this appointment you will meet with one of our practitioners for a comprehensive exam, where a personalized treatment plan will be developed for you.

*Please be aware that our providers do not prescribe controlled substances at your first visit, and any medication refills you need in the meantime would need to be coordinated with your prescriber.

My previous provider said she/he will not prescribe any more medication. What do I do now?

1) Talk with your previous provider about how to safely taper your medications.

2) If you are already out of medication, talk with them about managing withdrawal symptoms.

3) Unfortunately we cannot take over your prescription medications in an urgent situation like this.

• Do you prescribe opioid pain medications?

  Opioids can be part of a treatment regimen, but often certain types of pain are not well treated with them and because of their safety profile they are often not the best option in the long term.

Other than opioid medications, how could my pain be managed?"

The good news is that medication is only one part of effective pain management. A combination of approaches is often the best way to manage your pain. Our practice uses a multidisciplinary approach to treating pain. The whole focus of multidisciplinary programs is to get people functioning again. One of the drawbacks of long-term opiate use is many people who take these drugs over a long period of time lose physical function. The goal is to restore physical function and to help people learn that chronic pain does not have to prevent them from living a full, active life.

Will my pain get worse if I am very active?

When you have constant pain it seems natural to avoid doing things like walking, bending and moving around as they can make the feeling of pain worse. However our bodies are designed to move. When we decrease activity, we lose muscle strength – over time this means that even simple daily activities can become more difficult. Many people with pain fear exercise as they think it will cause more problems. However, regular stretching and exercise can actually decrease pain and increase your ability to function physically.

It is important to remember that chronic pain is not necessarily associated with ongoing damage to your body. This means that hurt doesn’t necessarily equal harm, and if no ongoing cause for the pain is found, you can slowly increase your physical activity despite a certain level of pain. This gradual approach to activity is called pacing.

Should I wait for my pain to go away before I go back to activities I used to do?

Starting to exercise and learning new coping skills are important strategies to help improve your ability to function and reduce the impact of the pain. It is also important not to wait for the pain to be completely gone before starting normal activities, including work.

I want to stop opioids, but I don’t know how, and I’m worried about withdrawal."

Withdrawal is a common effect of stopping opioids. It is uncomfortable but not life threatening and there are strategies to minimize this and help treat the symptoms.

I’ve been told that there is a difference between physical dependence and addiction to pain medications, but I don’t understand. Can you explain the difference to me?"

Physical dependence occurs with any person that takes narcotics at a certain dose for a time, if the medication is stopped abruptly then there may be withdrawal symptoms such as nausea, diarrhea, feeling shaky and sweaty.

Addiction occurs in susceptible individuals, and there are ways to figure out who may be more susceptible. This may manifest as a craving for the medication and may include escalating dosages and drug seeking behavior.

Sympathetic Nerve Block

The Clever medical group health care is providing to be an effective method for controlling chronic pain. A Sympathetic nerve block usually involves a sequence of injections to relieve pain caused by complex regional pain syndromes, usually after injury to a joint. This therapy targets the sympathetic nervous system and series of nerves that extend out from your spine to your body to help control several involuntary body functions, or body functions that you have no control over. These include blood flow, digestion, and sweating.

This nerve block can be used to treat pain relating the nerves of the sympathetic nervous system. If you have pain in the higher part of your body then you may get pain relief from blocking the ganglion in your neck area. If you have pain in the lower part of your body then a ganglion near the lower spine may be embattled with a sympathetic nerve block.

Splanchnic Nerve Block

The celiac plexus obstruct and the splanchnic nerve block can be used for abdominal soreness that may be caused by exasperation, firmness or setup of the nerve bundles inside various abdominal organs, as well as owing to tumor invasion, fibrosis, or chronic tenderness resultant from chronic pancreatitis disease, along with others. In scrupulous, soreness endorsed to pancreatic cancer responds especially sound to a celiac plexus obstruction.

The celiac plexus in addition to the splanchnic nerves are the names of the sympathetic nerves occupied in the utility of the abdominal organs. They are a solid cluster of nerve cells and underneath tissue, positioned at the back of the stomach, in the area of the celiac artery immediately lower the diaphragm. Nerve signals to the greater part of abdominal organs run all the way through the celiac plexus and the splanchnic nerves. This includes the pancreas, liver, gallbladder, stomach, small intestine, and the parts of the colon.

Neuromodulation

Neuromodulation including spinal cord stimulators & pump refills treatments that involve stimulation or administration of medications directly to the body’s nervous system for therapeutic purposes. Neuromodulation can be utilized to treat movement disorders, and epilepsy, as well as pain conditions.

Spinal cord stimulation involves electrical stimulation of the spinal cord to disrupt pain signals from the spinal cord to the brain, and to deal a painful sensation with a more pleasant tingling sensation. Spinal cord stimulation therapy and peripheral nerve field stimulation are related types of electrical stimulation that treat chronic pain. Electrical mild pulses are directed to interrupt pain messages to the brain, reducing the feeling of pain. Nerve stimulation also used to treat epilepsy, is now being applied to treat neuropathic neck pain and regions of neuropathic pain.

Supraorbital Nerve

The supraorbital nerve runs through the bones of the face at the eyebrow, provide sensation to the temple and the acme of the head. The nerve exits the head just higher than the eyes. Supraorbital Nerve Injections obstruct for Migraine and Headache. In sustain of patients who occurrence severe headache pain that is contained in the forehead, at or above the eyebrow, and for whom other therapies, together with drugs, have not worked, a supraorbital nerve (SON) block may give reprieve. The headache specialists at the Diamond Headache Clinic have years of knowledge in performing this process. To become skilled at if a supraorbital nerve block might be suggested as component of your individualized headache treatment plan, talk to your general practitioner. Although all doctors who execute this practice use a limited anesthetic, some mix the anesthetic with a corticosteroid. The anesthetic numbs the skin and it also reduces the nerve impulses passing along pain nerves. Corticosteroids are tough anti-inflammatories that may possibly facilitate to put a stop to headache pain for a longer interlude of time.

Sacroiliac Joint Injections

A sacroiliac joint inoculation moreover called a sacroiliac joint block—is largely used either to make a diagnosis or take care of low back pain and/or sciatica symptoms related with sacroiliac joint dysfunction. The sacroiliac joints stretch out subsequently to the spine and unite the sacrum with the hip on both sides. There are two sacroiliac joints, one lying on the right another one lying on the left. Joint inflammation and/or dysfunction in this part can origin soreness.

The use of a sacroiliac joint injection is double, it’s to identify the cause of a patient’s twinge, and to make available healing pain reprieve. At times, these are alienated and an enduring will go through a with the sole purpose to investigative or therapeutic inoculation, even though frequently the two are combined into one vaccination. The Sacroiliac Joint injection process is generally performed in an operating room or an uncommitted practice room. The complete course of action generally takes only minutes, and the patient goes address the same date.

Diagnostic Nerve Block

Nerve blocks are used for pain treatment and administration. A Diagnostic Nerve Block involves deadening a specific nerve or group of nerves that may be concerned in taking a patient’s pain. If a particular pain-carrying nerve is insensitive and a patient notes significant improvement in pain symptoms, the location of the pain generator is likely confirmed. A Diagnostic Nerve Block is used to authenticate the location of the pain initiator and the nerve carrying pain impulses from these painful structures. Once identified, the pain generator can be treated with a variety of interventional treatments including repeated nerve blocks, Radiofrequency Cryotherapy.

We are committed to providing a full pain relief services to our patients with treatments. Diagnostic nerve blocks are used to conclude resource of pain. These blocks normally contain an anesthetic with a known duration of relief.

Trigger Point Injections

Trigger point injection (TPI) might be an alternative for treating soreness in various patients. TPI is a practice used to treat throbbing areas of muscle that have trigger points, or knots of muscle to facilitate when muscles do not unwind. Numerous times, such knots can be felt below the skin. Trigger points might exasperate the nerves in the region of them and reason referred pain, or pain that is felt in an additional fraction of the body. In the TPI course of action, a health care specialized inserts a minute needle into the patient’s trigger point. The injection contains a confined anesthetic or saline, and may include a corticosteroid. By means of the injection, the trigger point is completed inactive and the ache is alleviated. Frequently, to the point way of treatment will outcome in continuous relief. Injections are given in a doctor’s workplace and generally acquire in a minute a small amount of minutes. Numerous sites may be injected in one visit. If a patient has an allergy to assured drug, a dry-needle performance (involving no medications) can be used.

Radiofrequency Ablations

In Radiofrequency (rhizotomy) ablations procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain. The terms radiofrequency ablation and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy. Radiofrequency ablation is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

Radiofrequency ablation (RFA), also known as radiofrequency neurotomy or rhizotomy, is one of many pain reducing procedures. It is a non-surgical procedure in which radiofrequency waves are delivered to certain nerves in order to interrupt pain signals to the brain. Sensory nerves, not motor nerves, are targeted. RFA is usually used to treat pain from the facet joints, which can contribute to pain in the neck or lower back, as well as the sacroiliac joints, which can contribute to low back pain. Pain from neck facet joints can radiate to the head, neck, shoulders, shoulder blades and arms.

Medial Branch Blocks

Medial branch blocks can be used independently to provide long-term pain relief. They can also be used to precisely identify the facet joints as the cause of pain, and are the preliminary procedure prior to radiofrequency neurotomy of the medial branch nerves. The facet joints are the small joints located between each vertebra that provide the spine with both stability and flexibility. Facet syndrome occurs when one or more of these joints become inflamed or irritated.

Medial branch blocks have been performed safely for many years with excellent outcomes. The benefit from this procedure will typically occur several minutes following the procedure. The patient is asked to record pain levels during the first days of the procedure to ensure accurate diagnosis of the facet joints as the pain source. Medial branch blocks in one area are generally limited to three within a six month time frame. In many instances, only one or two injections are required to obtain benefit.

Cryoablation

According to the Clavien-Dindo classification, five grade II complications and four grade complications occurred. The technical success rate was 94%. Two tumors required a second session of cryoablation because of recurrence or residual tumor. Twelve months after treatment the overall survival was 96.7%, and the disease-free survival rate was 96.4%, including patients with recurrent genetic tumors. Renal function remained unchanged even in the subgroup of patients with a single kidney.

Midterm follow-up shows that percutaneous renal cryoablation is an effective and safe alternative technique for patients whose condition does not allow surgery and that renal function is preserved. Cryoablation combined with percutaneous thermal protection techniques allows treatment of more complex tumors. The treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) is catheter ablation of the atrioventricular nodal slow pathway. The purpose of this study was to ascertain whether cryoablation (Cryo) with 6-mm-tip catheters is as effective as radiofrequency ablation (RF).

Discogram

The indications for getting a discogram prior to a lumbar fusion surgery are extremely variable amongst spine surgeons. Ordering the procedure depends on access to a skilled discographer. A discogram is basically a very subjective test, and if there are no experienced discographers available, then the spine surgeon may forego the test since a poorly done discogram does not yield any useful information. It should be understood that the discogram is less about the anatomy of the disc (what the disc looks like) and more about its physiology (determining if the disc is painful). It is well known to discographers that a really abnormal looking disc may not be painful and a minimally disrupted disc may be associated with severe pain. It is impossible to definitively diagnose a painful disc without performing a discogram.

The lumbar discogram, if performed properly, is designed to induce pain in a sensitive disc. A spinal fusion procedure that is designed to obliterate an internally disrupted, painful disc (pain generator) would not be the procedure of choice if pressurization of the disc didn’t reproduce the patient’s clinical discomfort. The spine surgeon needs to be absolutely sure that the level or levels being fused are responsible for the patient’s pain.

Coccydynia 

 Coccydynia is an inflammation of the tip of the tailbone, called the coccyx. If you’re struggling with this condition, you may be experiencing pain and tenderness between the buttocks that can make it difficult to sit or even walk comfortably.

Cervical Neck Pain 

Cervicalgia is a term for neck pain and stiffness, which can occur for a wide variety of reasons including poor sleep posture, underlying nerve conditions, and more. If you’re struggling with chronic neck pain and seeking relief, The Physicians can help provide you with an accurate diagnosis that pinpoints the source of your symptoms.

Cervical Radiculopathy 

Cervical radiculopathy is an irritation or compression of one or more nerve roots in the cervical spine. Because these nerves travel to the shoulders, arms and hands, an injury in the cervical spine can cause symptoms in these areas. Cervical radiculopathy may result from a variety of problems with the bones and tissues of the cervical spinal column, and can cause serious back pain that interferes with your daily life. 

Lumbar Radiculopathy 

Lumbar radiculopathy, also known as sciatica, is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column. 

Degenerative Disc Disease 

Degenerative Disc disease is a term used to describe the pain and symptoms from a degenerated disc in the spine. Degeneration of discs occurs naturally with age -- however, this degeneration does not always result in spinal pain. Degenerative disc disease is most commonly found in the cervical spine (neck) or the lumbar spine (lower back). Because degenerative discs become worse over time, it’s important to receive a diagnosis and treatment as soon as possible.

Herniated Disc 

A herniated disc is a common injury in which one of the discs in your spine protrudes from its casing, pressing into one of the nerves in the surrounding area. Herniated discs can affect any part of the spine, and they can cause severe pain and other problems in the arms or legs. 

Spinal Stenosis

The spinal column contains open spaces that create passageways for the spinal cord and the spinal nerves. Spinal stenosis is a narrowing of (or an intrusion into) these openings. This can cause a compression of the nerves. Spinal stenosis most commonly affects the cervical and lumbar regions of the spine. 

Spinal Spondylosis/ Facet Joint Pain 

Spinal spondylosis is a term used for the natural wear and tear that occurs in the human spine, which can often result in degeneration that causes pain. Spondylosis is common and can become worse as we get older, especially if it occurs in conjunction with other conditions such as osteoarthritis of the spine. 

Facet joint pain describes a deterioration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and are surrounded by a lubricating capsule that enables the vertebrae to bend and twist. If you’re living with facet joint pain, you may experience serious pain and a reduction in your range of motion.

Intercostal Neuralgia 

The intercostal nerves are located in the muscles beneath your ribcage. When these nerves are compromised, you may feel sudden pain in the chest, beneath the ribs, or when performing an action like sneezing or coughing. A common cause of this stems from the herpes zoster infection called Shingles.

Sacroiliac Joint Pain

Sacroiliac joint pain, or sacroiliitis, is the term used to describe inflammation of one or both of the sacroiliac joints. The sacroiliac joints are located where the pelvis connects to the lower spine, and are primarily used to absorb shock from the spine. Sacroiliitis most often results in pain in the hips, legs, buttocks and lower back.

Post Laminectomy Syndrome 

The term “failed back syndrome” or “post-laminectomy syndrome” is an umbrella term used to describe an unsuccessful operation and does not describe a single syndrome. If you have undergone back surgery and are still experiencing pain, you may be suffering from failed back syndrome (FBS), also known as post-laminectomy syndrome. 

Compression Fracture

Compression fractures are tiny cracks in the vertebrae that make up your spine. These usually happen as a result of trauma to your spine; however, they may also present themselves in conjunction with osteoporosis and pathologic fractures. Compression fractures can be extremely painful, and can become worse if left untreated.

Cervical, Thoracic, Lumbar, Caudal Epidural Steroid Injections

•  Caudal - This outpatient procedure is an injection of a steroid-anesthetic medication through an opening in the sacrum. The medication can reduce swelling and inflammation of irritated spinal nerves. The injection takes only a few minutes to complete, and can make a massive difference for patients who are struggling with chronic back pain. 
• Cervical - This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves. 
• Thoracic - thoracic epidural steroid injection is an outpatient procedure which the physicians at Cleaver medical group often perform to relieve pain in the upper back. Those who struggle with back pain in the thoracic area -- that is, the area between the shoulders -- often find that steroid injections provide them with much-needed relief from their chronic condition.

Lumbar Injections

Lumbar epidural steroid injection procedures to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions, and lumbar (lower back) conditions are no exception.

Transforaminal Epidural Steroid injection

This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. 

Epidural Lysis of Adhesions

An epidural lysis of adhesions procedure (LOA) is a minimally-invasive method of removing scar tissue in the abdomen or pelvis, which is often a source of chronic pain. Scar tissue can develop for a number of reasons, from surgery to infection.

Cervical, Thoracic, Lumbar Medial Branch Block

The facet joints, found on both sides of the back of the spine, can become painfully irritated or inflamed. A medial branch block injection may help diagnose the source of a patient’s pain but numbing up the nerve that lies adjacent to these joints. 

Radiofrequency Neurotomy/ Ablation

This is a minimally invasive procedure that uses heat from radio waves to treat painful facet joints in your lower back. This procedure is also called radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy.

Sacroiliac Joint injection

A sacroiliac injection is aimed at relieving pain caused by arthritis in the sacroiliac joint where the spine and pelvis meet. The steroid medication can reduce swelling and inflammation in the joint. 

Trigger Point Injections

This outpatient procedure is designed to reduce or relieve the pain of trigger points and myofascial or muscle pain. These small, tender knots can form in muscles or in the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). 

Genicular Nerve Block

This is an injection of anesthetic to the genicular nerves. These are the sensory nerves that transmit pain signals from the knee to the brain. Anesthetizing these nerves can disrupt the pain signals caused by degeneration of the knee. A genicular nerve block can provide temporary pain relief. It may help determine if a patient is a candidate for genicular nerve ablation, which can provide long-term relief using a permanent nerve block for knee pain.

Lumbar Sympathetic Block

This procedure is an injection that numbs branches of nerves in your lower back. It helps doctors find and treat a number of problems linked to these nerves. 

Intercostal Nerve Block

A steroid medication and local anesthetic are injected into the Intercostal nerves, located under each rib, and can help reduce inflammation and alleviate pain.

Stellate Ganglion Block

The stellate ganglion is part of the sympathetic nervous system that is located in your neck, on either side of your voice box. A stellate ganglion block is an injection of medication into these nerves that can help relieve pain in the head, neck, upper arm and upper chest. It also can help increase circulation and blood supply to the arm.

Ganglion Impar Block

A ganglion of impar block is safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain. This injection is a type of sympathetic block that can be used in the treatment of sympathetically-mediated pain, pain secondary to malignancy, neuropathic pain, and post-surgical pain. Candidates for this procedure frequently complain of a vague and poorly localized pain in the “seat” region, which is burning in character and frequently accompanied by sensations of urgency with urination and/or defecation. 

Spinal Cord Stimulator

Spinal cord stimulation (also called SCS pain treatment) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain, making SCS an invaluable technology for spine pain treatment. Spinal cord stimulation procedure candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed. 

Peripheral Nerve Stimulator

Peripheral nerve stimulation (Sprint System) uses electrical impulses to relieve chronic pain of the effected area. It is believed the electrical pulses can help relieve irritated nerve tissue even after completion of the 60 day treatment period. Evidence demonstrates that even after completion of the treatment period a majority of the patients report continued pain relief.