Hill Country Health and Wellness Center
THE TREATMENT OF CHRONIC PAIN: Philosophy and Process
F
inding helpful treatment for chronic pain is one of the biggest issues for many patients coming to Hill Country.
We know that many people feel stuck in a system that has only offered medication, or frustrated that
medications haven’t really helped. For many patients, depression and anxiety have become mixed in with the
physical pain.
We believe that chronic pain treatment should include a wide range of both non-medication and medication
options. We can provide you with an entire care team dedicated to improving your emotional, mental, AND
physical health while managing your chronic pain.
OUR PROCESS
At your first office visit, your primary care provider will get your history, do a physical exam, and will want to
hear what you have already tried, to manage your pain. However, she will not refill or prescribe any pain
medications until we have received all relevant records of your previous treatment and prescription history. We
want you to know that it may take from one to six months to receive the health information we need to
prescribe your pain medications.
Your second appointment will be for a chronic pain risk and safety assessment, with one of our behavioral health
consultants (BHC). The BHC will ask how your chronic pain has affected your emotional and mental health and
help your primary care provider evaluate your health risks. They will discuss options for ways to manage your
pain without medication, especially if you may need to be without medications while we receive your records.
They will help you identify goals you may have for dealing with daily activities. This appointment can usually
happen within a few days, and then the BHC will then work with you and your care team to create a safe,
individualized care plan. If you like, we encourage your family’s involvement.
For many patients, the chance to work with a BHC is just the opportunity they’ve been looking for, to get some
help to “take back my life!” A list of many non-medication options that may help is on the back of this page.
When we have all the information we need about your medication and treatment history, your primary care
provider will meet with you to plan the use of medications (if needed). We start with the options that provide
the lowest risk for side-effects and/or addiction. We follow all DEA guidelines, and we may also have to work
within limits of what is covered by your insurance plan. We will be strong advocates for getting the best care
options for you. Please keep in mind that the abuse of pain medication is a public health problem that we take
seriously. Our policies, and the controlled substances agreement that you may be asked to sign, are not intended
to cast suspicion on any of our patients, but have been developed to reduce the risk of prescription medication
abuse and addiction in our communities.
YOUR RESPONSIBILITIES AS A HILL COUNTRY PATIENT
Be honest with us at all times about what you are doing to address your chronic pain.
Follow the terms of the agreement signed by you and your provider
Stay open to trying new options!
Tell us what’s working, and what’s not.
Rev. 4/9/2014
OPTIONS FOR REDUCING AND MANAGING CHRONIC PAIN
NON-MEDICATION OPTIONS
1) Specific physical exercise, physical therapy
Examples: stretching, massage, hydrotherapy,
strength training, heat/ice, ultrasound, muscle
stimulation, etc.
2) Temporary restricted movement or physical support
Examples: rest, reduced activity, splints,
compression socks/gloves/sleeves/belts, braces,
etc.
3) Specific dietary changes to reduce inflammation or
promote healing/weight loss
4) Mind-body integration practices
Examples: yoga, meditation, tai chi, Healing
Touch, Reiki, prayer, religious/spiritual activity,
Feldenkrais Method, rolfing, Trager Approach
Movement Therapy
5) Neuro/biofeedback
6) TENS (Transcutaneous Electrical Nerve Stimulation)
7) Acupuncture/acupressure
8) Chiropractic
9) Osteopathic manipulation
10) Over the counter topical treatment
Examples: Creams and ointments such as Traumeel,
Capsaicin, Menthol.
11) Other “Complementary and Alternative Medicine”
(CAM):
Examples:
 Nutritional supplements
 Herbal supplements or teas/compresses
 Homeopathy
12) Support groups, classes, self-help resources
13) Counseling/Psychotherapy
Examples: Cognitive Behavioral Therapy, stress
management, relaxation therapy, Acceptance &
Commitment Therapy, behavior modification,
hypnotherapy
14) Online resources and self-management apps
Rev. 4/9/2014
MEDICATION OPTIONS
1) Non-opioid pain relievers (lower risk)
 May be over the counter or prescribed
Examples: acetaminophen, aspirin,
ibuprofen, other non-steroidal antiinflammatory drugs (NSAIDS)
2) Short-term opioid pain relievers (higher risk)
 Must be prescribed
Examples: Codeine, hydrocodone, vicodin,
norco, tramadol, etc.
3) Long-term opioid pain relievers (higher risk)
 Must be prescribed
Examples: morphine, hydromorphone, fentanyl,
methadone, etc.
4) Muscle relaxants
 Must be prescribed
Examples: flexaril, baclofen, dantrolene
5) Injectable steroids, local anesthetics
 Requires medical visit to administer
Examples: toradol, prednisone, kenalog, lidocaine
6) Antidepressants
 Must be prescribed
 Counseling/psychotherapy recommended
Examples: SSRIs (Zoloft, Lexapro, Prozac), SNRIs
(Cymbalta), Tricyclics
7) Anticonvulsants
 Must be prescribed
Examples: gabapentin, pregabalin, lamitrogene
8) OTHER: Surgical and neurosurgical procedures
 Require referral to specialty care
Examples: spinal cord stimulation, deep brain stimulation,
spinal delivery of opioids, ganglion ablation by phenol or
electrofrequency, sympathectomy