1Just what is Pain anyway?

Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain.

Most forms of pain can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last a lifetime.

2Q. What happens at the first appointment?

The doctor and nurses will sit with you and review your physical history and pain history. The doctor will then perform a detailed medical exam designed to identify the specific cause of your pain. Then, our staff will discuss treatment options with you.

3Q. The Doctors and Nurses at your practice seem to take prescription medications VERY seriously. I ran out of a pain med prescription and called in for a refill and instead was given an appointment to visit the Physician Assistant the next day. Why is this?

We DO take medication prescriptions VERY seriously indeed! We want to manage pain in the safest, most effective way possible.

There are so many different kinds of medications available that can be effective in treating pain as long as they are taken exactly as prescribed. All the different meds we prescribe have different actions, uses, doses and side-effects. It is critical that the patient take these meds strictly according to instructions. We make every effort to make sure that the patient understands what each medication does and why it is prescribed as a particular dose taken at a particular time. We also encourage each patient to ask questions of us and their pharmacist about their medications so that they feel comfortable taking the medicine.

Now, to answer your question directly, we write pain medications on a 30-day basis. This is especially true of any opioid narcotic pain medicines. These medications are strong and effective but each carry a different risk if not used properly, which is why we require that the patient return every 30 days in order for us to assess how the patient is responding to the medication.

So, if you were instructed, for example, to take 1 tablet of Oxycodone/acetominophen two times per day, only if needed, we would give you 60 tablets (2 x 30 = 60) for the next 30 days. If you ran out of this medication after say, 20 days, it would mean that you are not taking the medicine as prescribed. You are actually taking more medicine than prescribed. If this is happening because your pain is not controlled, it would not be safe for us to simply give you another prescription without examining you directly to see why the pain is not controlled. In addition, most opioid narcotic medications can not, by law, be called into a pharmacy, and the only way you could get another prescription is by having another office visit.

One more point, because you signed a Medication Agreement with our practice, you can only get a pain medication from one physician source. This means, if you get that oxycodone/acetominophen prescription from us and then obtain a pain prescription from another physician, you can be dismissed from our practice. This may seem harsh but it is the safest, most efficient way of managing your pain.

4Q. I'm having trouble getting through to the office by phone, what can I do?

We take hundreds of phone calls on a daily basis, so there may be times when it is difficult to to speak to someone immediately by phone. If you are having trouble trying to get through to the office on the phone, please use the Contact section (if it can go to the drbuyanov@gmail.com)

5Q. I am on blood pressure medications. When you ask if I am taking blood thinners before a procedure, I wonder if the two meds are the same.

A. No, blood pressure medicine and blood thinning medicine are two different things. It is important that we know if you are taking blood thinners. You may be advised to stop your blood thinner meds for a couple of days before a procedure, but you will never be advised to stop your blood pressure meds.

6Q. I had a spine fusion surgery, and my back still hurts every bit as bad as before the surgery.

A surgeon will perform surgery to correct an anatomical problem with your spine that was threatening to permanently damage the nerves that go to your arms or legs. The surgery is considered a success when your spinal nerves have been taken out of danger of being destroyed. However, there are times when your back still hurts, even though the surgery was a success. This is called Post Laminectomy Syndrome and it occurs after a percentage of all spinal fusion surgeries.

Ask about how disc repair can help with any discomfort you are having.

7Q. I have chronic low back pain but I want to keep running to stay fit. Any Tips?

As surprising as it sounds, you can still enjoy running with low back pain. Disc repair is a great option for all our lower back patients. Call 210-255-8084 for more info

8Q. What is PRP?
Why Should I Choose PRP Therapy Over Another Treatment Option?

PRP Therapy vs. Steroid Injections – Steroid injections are not considered a long-term solution and frequent steroid injections to control pain can actually weaken tissue in the treated area. PRP Therapy offers the opportunity to heal the affected area, which can be a permanent solution.

PRP Therapy vs. Surgery – If an injury or pain is severe enough to consider surgery, consider PRP Therapy first. Assuming you are a candidate for PRP Therapy, it is a less invasive option which could provide permanent relief. Compared to surgery, PRP Therapy also offers a lower out-of-pocket cost, reduced risk of infection, and shorter recovery period.

How long does it take?
The procedure takes approximately one to two hours, including preparation and recovery time. Performed safely in a medical office, PRP therapy relieves pain without the risks of surgery, general anesthesia, or hospital stays and without a prolonged recovery. In fact, most people return to their jobs or usual activities right after the procedure.

Is there any pain?
Some patients report swelling and stiffness or mild to moderate discomfort lasting a few hours after the injection. This is a normal response and is a sign that the treatment is working. Over time, the affected area will begin to heal and strengthen and you will experience considerably less pain.

How many treatments will I need?
Regenerative medicine is not a “quick fix” and is designed to promote long-term healing of the injured tissue. While most patients require only one injection, the regeneration of collagen takes 4-6 months and may require multiple injections. Pain and functional recovery will be assessed 2-3 weeks after the injection to determine further therapy needs. The total number of treatments you will need depends on your age, the area being treated and the amount of pain you were experiencing before starting therapy.

Will My Insurance Cover It?
While PRP has helped thousands of patients over the years, it is still relatively new and as a result is not yet covered by many insurance plans. However, some parts of the treatment may be covered. Since the cost for and types of treatment required varies significantly from patient to patient, we will provide you with pricing info during your initial consultation, based on your specific needs and situation.

9Q. What is the recovery time?

This is an outpatient procedure, and patients go to the recovery room immediately following the procedure for one hour. You will likely need a few days to rest, however, we want you up and walking around the day following your procedure. After the first few days, when you are feeling up to it, we want you beginning a daily regimen of walking, gradually building up your walking distance every few weeks. Most people need prescription pain medication for the first few weeks. Everyone is different and it typically depends on the patient's pain threshold. Most people see a change within 3 - 12 months after disc repair Lumbar procedure, and some are sooner than that. Disc repair Cervical procedure tends to have a quicker recovery time than the disc repair Lumbar procedure. Most people are back at work within a couple of days after the cervical procedure, noticing change within the first six weeks.

10Q. How long will it take for my disc to be fully healed?

It can take 3 - 12 months for the disc to be restored to a fully healthy state. Beginning the day of your procedure, your discs will begin the healing process.

11Q. What about my pain medications after surgery?

We will work with your prescriptions and provide pain medications immediately following your procedure. If you are an out of state patient, because of pharmacy regulations, we ask that you follow up with a pain management doctor in your hometown before your prescription runs out if you need to continue meds to manage your pain.