FOR PHYSICIANS
Six weeks of radicular pain is a referral, not a failure.
You do not have to exhaust every conservative option before sending a patient our way. Interventional pain management works best layered in early, and a referral at six weeks of unresolved radicular pain is appropriately timed care, not an admission that primary management failed.
What to refer, and when
Radicular pain that has not meaningfully improved after roughly six weeks of appropriate conservative management is the clearest, best-supported referral we receive — the North American Spine Society’s evidence-based guideline on lumbar disc herniation with radiculopathy supports interventional options, including epidural steroid injection, within this window rather than after months of waiting. Facet-pattern axial pain that localizes with extension and rotation, sacroiliac joint pain in a patient with a positive provocative exam cluster, and post-surgical pain following a spine or joint procedure all belong here as well. CRPS is the one diagnosis where timing matters more than any other on this list — refer at first suspicion, not after months of watching a limb stay swollen and discolored, because early sympathetic blockade materially changes the trajectory. Painful peripheral neuropathy, particularly diabetic, is worth a referral once first-line pharmacologic management has plateaued rather than after every oral agent has been tried in sequence.
Patients on long-term opioids who want to taper
We are a genuinely useful referral for the patient who wants to come down from a long-standing opioid regimen but cannot tolerate the pain that reappears when the dose drops. Interventional procedures targeting the actual pain generator — not just more medication — give many of these patients room to taper without the withdrawal-driven relapse that sinks most unsupported attempts. This is harm reduction applied clinically, not a zero-opioid mandate; some patients taper to none, some taper to a lower, safer, function-preserving dose, and the goal is set with the patient, not imposed on them. We track this cohort closely: arriving patients average more than 90 morphine milligram equivalents per day after 2.5 or more years in pain, and under interventional treatment 21% are fully weaned within 90 days and 34% within one year. Practice-reported figures from our own population, not trial outcomes, and individual results vary.
What comes back to you
A diagnosis established by objective response to a diagnostic block, not a differential list. A plan with a stated endpoint — what the next step is if the current one works, and what it is if it does not — rather than an open-ended series that quietly continues for years. And, where relevant, the bloodwork: fasting insulin and HbA1c are part of our standard workup for most chronic pain referrals, because a patient’s metabolic terrain frequently explains why a technically well-executed procedure is not holding, and that finding is often as useful to your ongoing management of the patient as the pain diagnosis itself. We send that data back regardless of whether it changes our own plan, on the assumption that it may change yours.
How to refer
Call our office directly to discuss a patient before sending the referral, particularly for CRPS or anything time-sensitive — a same-day conversation can shape what we prioritize on the first visit. Fax records and referral information to (314) 481-3037. We will send a consultation note back promptly, and we are available to discuss ongoing co-management for any patient we share, including questions between visits about how a taper or a procedure sequence is progressing.
Hospital affiliations
Dr. Padda holds staff privileges at Anderson Hospital in Maryville, Illinois, and at SSM Health St. Clare Hospital in Fenton, Missouri, in addition to outpatient care at our Woodson Road location.
Common questions
Do you require imaging before a referral?
Helpful, not required — a clear exam and history is often enough for us to start the right workup, and diagnostic blocks frequently answer questions imaging cannot. What to expect covers how we sequence testing at the first visit.
Will you continue prescribing what I’ve already started?
We coordinate with the referring physician rather than unilaterally changing an existing medication plan; most patients continue with their PCP or specialist for ongoing prescriptions while we manage the interventional side. See opioid stewardship for our general approach.
What if the diagnosis turns out to be something outside interventional pain?
We refer back or onward promptly rather than holding a patient in a workup that is not going to help them — a knee that is genuinely end-stage arthritis goes to a surgeon, not through another round of injections. Knee pain describes where that line sits for one of the joints we see most.
Can I refer a patient directly for a spinal cord stimulator evaluation?
Direct referral works well, particularly for failed back surgery syndrome or painful diabetic neuropathy that has not responded to standard management; see spinal cord stimulation for the trial-then-implant process we use to confirm candidacy before any permanent device.
Related reading
- Opioid stewardship
- Spinal cord stimulation
- Complex regional pain syndrome
- Metabolic health and pain
- What to expect
We will send your patient back with a diagnosis and a plan, not just an appointment history
Call to discuss a referral, or fax records directly. We are glad to co-manage ongoing care for any patient we share.
4479 Woodson Rd, Suite 401
St. Louis, MO 63134
Next to St. Louis Lambert International Airport, off I-70 at Woodson Road.
Sources
- Kreiner DS et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. The Spine Journal, 2014. PubMed 24239490
- Centers for Disease Control and Prevention. CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022. cdc.gov/mmwr