The referral maze, and where patients get lost in it

A normal year of chronic pain looks like this. Your primary care doctor sends you to a spine surgeon. The surgeon orders an MRI and suggests an injection. The injection needs its own visit. Someone else orders the sleep study, someone else again orders the blood work, and the nerve test sits in a queue for weeks. Every office does its own part well. None of them owns the whole list.

The gaps are where things go wrong. A result comes back and nobody calls. A referral goes to a fax machine and dies there. A procedure gets booked before the test that should have decided whether you needed it. You end up as the coordinator of your own care, on the same days you are the one in pain. Medicine has treated that as normal for a long time, and the people paying for it are patients.

What your care manager chases so you do not have to

Once you enroll, a nurse or medical assistant on our team becomes your point person. Between visits, that person:

• follows a referral until the other office has actually booked you;
• tracks down lab and imaging results and puts them in front of Dr. Padda;
• handles the forms and paperwork that otherwise pile up on your kitchen table;
• keeps one up-to-date medicine list that covers all your prescribers and all your pharmacies.

Clinical questions reach Dr. Padda on the day they come up. He reads every month’s notes, and medicine changes are his alone. The care manager owns the follow-through. The decisions stay with your physician.

Three prescribers, two pharmacies, one list

When three doctors prescribe and two pharmacies fill, nobody sees the whole stack. A sleeping pill prescribed in one building and a muscle relaxer prescribed in another can add up to more sedation than either doctor meant to give. A pain medicine, a mood medicine and a blood pressure pill can each be reasonable alone and a problem together. Your care manager updates the full list every month, so Dr. Padda reviews the combination instead of the pieces. That is what comprehensive care means in practice: one person who sees the whole picture. It is also the everyday side of our opioid stewardship.

The months between procedures decide whether relief lasts

An injection or an ablation buys a window of less pain. What you do inside that window decides whether the result holds. So the monthly contact covers more than appointments. It asks how you are sleeping, whether you are walking, how your mood is holding up, and what your blood sugar is doing if that is part of your plan.

Each of those has a plain physical reason. One short night lowers the point at which a sore spot starts to hurt, so the same back feels worse the next day. Movement pushes nutrients into cartilage and discs, which get very little blood flow of their own. High blood sugar keeps tissue inflamed and slows repair, which is why we treat metabolic health as part of pain care. Mood gets the same monthly attention, led by the psychologist who works here and treats with Acceptance and Commitment Therapy, because fear of pain changes how much pain the nervous system produces. More on that work is on our sleep, movement and behavior page.

Before you sign up: who it fits, cost and stopping

The program is built for patients carrying two or more long-term diagnoses at once. Chronic pain is often one of them. The others tend to be sleep apnea, depression, high blood pressure, prediabetes or diabetes, poor circulation, nerve damage or excess weight. A single serious diagnosis gets a narrower version aimed at that problem alone. Pain with nothing else attached is handled differently: Dr. Padda follows it himself in his own chronic pain program.

Enrollment happens during a visit with Dr. Padda, the kind laid out in what to expect at your first visit. Your consent can be spoken or signed, and you walk out holding a written plan with goals you helped set. From then on, the team calls, video-chats or messages you through the patient portal. No extra trip, and your usual appointments do not move.

The service shows up on a monthly bill, the same as other medical care, and your plan may leave you a copay or coinsurance. Our staff looks up your coverage and explains it before anything starts. Just one practice can run this for you in any month, so mention it if a different office already phones you on a monthly schedule. Quitting is your call, whenever you want.

Nobody processes refills at night or on weekends, so send them on a weekday. Some problems skip the care manager entirely and go straight to 911: trouble breathing, chest pain, passing out, stroke signs, or being so sedated that someone struggles to wake you. The full list is on our when it is an emergency page.

Common questions