The history covers more than the pain

Expect questions that do not sound like back questions. How you are sleeping, and whether it is the pain waking you or something else entirely. What a typical day of food looks like. Whether your work is on your feet, at a desk, on a rotating shift, or lifting — because a nerve root that is angry at 6 a.m. after a night shift is telling you something different than one that is angry after eight hours in a chair. Bloodwork gets ordered here, at a pain visit, not filed as a separate program for later. Insulin resistance and metabolic inflammation change how quickly tissue heals and how loudly a nerve fires independent of what is structurally wrong, so a picture of your metabolic terrain is part of the diagnostic picture, not an add-on to it.

The exam happens before the scan is believed

If you bring imaging, we will look at it. We will also examine you first, because a disc bulge or a facet that shows wear on a picture may or may not be the structure actually producing your symptoms, and a large share of spine imaging in people with no pain at all shows the same findings. Range of motion, provocative maneuvers that reproduce or fail to reproduce your pain, and a neurological check for strength, reflexes and sensation tell us more about which structure is live than the film does on its own. Where the exam and the imaging agree, that agreement is meaningful. Where they disagree, the exam usually wins.

What we will not do on day one

You will not leave the first visit having had a procedure, with one specific exception: if the entire purpose of that visit is a diagnostic block — a targeted injection whose only job is to answer a question about a specific nerve or joint — that is scheduled and explained in advance, not sprung on you. Outside of that case, the first visit produces a plan, not a needle mark.

What to bring

• Any imaging you have — the actual images on disc or portal access, not just the written report, if you can get them.
• A list of what you have already tried, including physical therapy, chiropractic care, injections elsewhere, and medications, with rough dates.
• Recent bloodwork if you have it. If not, plan on a draw at this visit or shortly after.
• If an accident or work injury is involved, any claim number, adjuster contact, or attorney information you already have. After a car accident.

How long it takes

Plan on the better part of an hour, and expect most of that time to be spent talking and being examined rather than waiting. A visit that is mostly waiting followed by a five-minute look is how a structural problem gets missed in the first place.

Who you will meet

Your physician, for the history and the exam. Depending on what the workup shows, you may also meet the practice’s in-house behavioral clinician — a licensed, pain-trained provider who delivers Acceptance and Commitment Therapy directly, inside this practice, not as a referral to someone else’s waiting list. Sleep, movement and behavioral change are roughly 40 to 50 percent of the treatment plan here, and that conversation starts on day one when it is relevant, not months in. Sleep, movement and behavior.

How the plan is stated

Before you leave, you will hear what we think is generating your pain, what the next step is meant to prove or accomplish, and what counts as it working. A plan that never states an endpoint is not a plan, it is a subscription. If a diagnostic block is next, you will know what a positive result means and what happens if it is negative. If bloodwork or a sleep change comes first, you will know what we are watching for and when we will check back in.

Common questions

Related reading

• About Dr. Padda
• The metabolic terrain and pain
• Sleep, movement and behavior
• When it is an emergency
• Contact