General Practitioners

• Arthritis
  In its early stages, arthritis of the knee is treated with nonsurgical methods. Your doctor may recommend a range of treatments, including...
• Fibromyalgia
  One enzyme at the forefront of pain perception, and the possible subsequent development into chronic pain, is catechol-O-methyltransferase (COMT). COMT is an enzyme involved in degrading catecholamines such as dopamine, epinephrine, and norepinephrine. These catecholamines, when elevated throughout the body, can cause a heightened response to pain. Individuals with lowered enzymatic activity have been shown in human and animal models to have increased pain sensitivity. A study of patients with fibromyalgia found that these patients tended to have lower levels of COMT activity. Individuals with low COMT activity, and hence higher catecholamine levels, and high pain catastrophizing preoperatively, are often more sensitive to pain and require more morphine after surgery.
• Medical Weight Loss
• Primary Care
  The rub of course is that insurance payors may not wish to pay for high opioid dosages and suppliers may not wish to see large stocks of opioids in a single pharmacy. For a multiplicity of reasons, some legitimate and others not so, some states and now the Centers for Disease Control and Prevention (CDC) want to restrict opioid dosages somewhere between 80 to 120 mg of morphine equivalents a day (MEQ).4 The CDC draft guidelines is aimed at primary care physicians (PCPs) who are treating chronic pain patients in an outpatient setting.The guidelines state that PCPs should start low and go slow and “should avoid increasing opioid doses over a certain level—90 milligrams MEQ.”4 Note, the draft is written for PCPs, and not pain specialists, but may be viewed as endorsing this practice for all patients, even those with chronic pain. The authors of the guidelines agreed that in general, “increasing dosages to 50 or more MEQ increases overdose risk without necessarily adding benefits for pain control or function.”

Internists

• Gastroenterology
  According to the American College of Gastroenterology  definition, constipation is defined as unsatisfactory defecation with infrequent bowel movements, difficult stool passage, or both. Functional constipation, as outlined by the Rome IV criteria, requires 2 or more of the following symptoms to occur no less than 25% of the time over the preceding 12 weeks: straining with bowel movements, passing lumpy or hard stools; feeling of incomplete evacuation; feeling of anorectal obstruction; using manual maneuvers for facilitation of defecation; and having less than 3 bowel movements per week.
• Lung Cancer
  Dr. McPherson, who works as a consultant pharmacist in both hospice and palliative care programs, described a scenario where a patient she was treating for chronic obstructive pulmonary disease (COPD)-related pain told her he had been diagnosed with lung cancer. When Dr. McPherson tried to discuss the pros and cons of pursuing the aggressive chemotherapy course recommended to him by his doctor, the patient became defensive and even stopped seeking her care from that moment on.

Psychiatrists

• Depression
• Mental Health
  Michael Driggs graduated from The University of Texas at Tyler in 1990 with a masters in professional counseling. He is licensed in the state of Texas as a Licensed Professional Counselor and a Licensed Psychological Associate. Michael has comprehensive experience in mental health. He has worked in private practice, community mental health, a private psychiatric hospital, a private prison, a university research hospital, employee assistance, a substance abuse ranch, and multiple medical practices. Michael has approximately nine years of professional experience in pain management.
• Behavioral Health
  Upon moving back to Tyler she established a private practice before joining the Care First team. Dr. Flores is the director of the physical medicine Department and continues to promote healthy lifestyles through collaboration with pain management and behavioral health.
• Anxiety

Endocrinologist

• Diabetes Care

Radiologist

• Ultrasound
  Ultrasound Imaging: This test uses sound waves to produce pictures of muscles, tendons, ligaments and joints throughout the body. It is used to help diagnose sprains, strains, tears and other soft tissue conditions. Ultrasound is safe, noninvasive and does not use ionizing radiation.
• MRI
  An MRI scan is particularly useful to assess certain conditions by providing detail of the intervertebral disc and nerve roots (which may be irritated or pinched). MRI scans are useful to rule out spinal infections or tumors.
• X-Rays
• Computed Tomography
  CT scan. This test is a very detailed x-ray that includes cross section images. CT scans provide details about the bones in the spine. They may also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans.
• Chemotherapy
  One example is the m-opioid receptor gene (OPRM1) that is responsible for encoding the m-opioid receptor. Liu and Wang examined the A118G polymorphism in OPRM1 in cancer patients who developed painful neuropathy following oxaliplatin chemotherapy and were treated with tramadol (Ultracet). They reported that different genotypes (AA, AG, and GG) were directly correlated with opioid requirements for pain relief 24 hours after surgery. Patients who had at least 1 G allele (genotypes AG or GG) required much higher doses of tramadol to achieve pain relief postoperatively—pretreatment and posttreatment visual analog scale (VAS) scores were 3.1 and 2.6, respectively—requiring rescue analgesia. However, patients with the AA genotype had a better analgesic effect—pretreatment and posttreatment VAS scores were 3.0 and 0.9, respectively.

Surgeons

• Sciatica
  An epidural injection is effective in significantly reducing back pain and/or sciatica from spinal stenosis and other conditions. Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain.

Physical Therapists

• Physical Therapy
  Injections comprise another nonsurgical treatment option for pain. They are typically considered as an option to treat joint pain after a course of medications and/or physical therapy is completed, but before surgery is considered. Injections can be useful both for providing pain relief and as a diagnostic tool to help identify the source of the patient's pain.
• Occupational Therapy
• Frozen Shoulder
• Neck Pain
• Back Pain