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Pain Management Testing Overview:

In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed.  Our clinic does request some testing that is and not commonly performed in more mainstream medical clinics.  24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff.   Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient's names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The doctor in charge reports any findings in his medical notes.

Specific Pain Management Testing:

1. Neurotransmitters Test

What is the Neurotransmitters Test?

A neurotransmitters test checks for the level of neurotransmitters (Serotonin, Dopamine, Epinephrine, Norepinephrine) in the body. These neurotransmitters are required for proper brain function and suboptimal or deficient levels can cause serious health problems.

Indications and Contraindications

Neurotransmitters are made in the body from amino acids. If the body does not have a sufficient supply of the right amino acids, neurotransmitter levels can become depleted and this chemical imbalance can result in many symptoms such as:

• Depression
• Anxiety
• Insomnia
• ADD/ADHD
• Poor appetite control
• Compulsive behaviors
• Fibromyalgia
• Chronic pain
• Lowered ability to focus
• Sleep problems

How do you prepare for a Neurotransmitters Test?

The patient is required to avoid certain foods that increase levels of neurotransmitters 2-3 days before the test. These include tea, coffee, cocoa, vanilla, chocolate, cider vinegar, soda, licorice, citrus fruits and bananas. Follow the diet restrictions that your doctor will be prescribing to you.

Avoid vigorous activities, stress, and starvation before the test.

Notify your physician if you are taking OTC or prescription medications. You may be advised to discontinue taking these drugs prior to the test.

Drugs that may affect the test include:

• Aminophylline
• Caffeine
• Chloral hydrate
• Clonidine
• Disulfiram
• Erythromycin
• Insulin
• Levodopa
• Lithium
• Methenamine
• Methyldopa
• Nicotinic acid (large doses)
• Nitroglycerin
• Quinidine
• Tetracycline
• Clonidine
• Disulfiram
• Guanethidine
• Imipramine
• MAOIs
• Phenothiazines
• Reserpine
• Salicylates

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. Drawing a blood sample only lasts for a few minutes

Expected effects after the test:

Normally, there are no major effects after the test. In most cases, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur.

Special instructions after the test:

After drawing blood, cover the needle site with a clean and dry bandage. If advised by the health care professional, apply pressure or warm compress on the area several times a day to minimize swelling and bruising.

Results:

Normal Findings:

Epinephrine: 20 ng/100 mL

Norepinephrine: 60 ng/100 mL

Serotonin: 101-283 ng/ml

Abnormal Findings:

Low neurotransmitters levels: If neurotransmitters are low, the nerves fire ineffectively or not at all. 

Low neurotransmitter levels can result from prolonged stress, anxiety, sleep disorders, genetic predisposition, depression and diets low in the amino acids from which neurotransmitters are made. Toxic substances like heavy metals, pesticides, illicit and some prescription drugs can cause permanent damage to the nerves that make neurotransmitters.

Norepinephrine: depression

Serotonin: sleep disorders, depression, obsessive-compulsive behavior, violence, aggression, suicide, panic disorder, urinary frequency, hyperactive bladder, and urge incontinence.

GABA: anxiety

Dopamine: schizophrenia and incoherent thoughts, Parkinson's disease, and depression.

High neurotransmitters levels: If the levels of neurotransmitters are too high, nerves may fire inappropriately.

Neurotransmitters exist in a delicate balance with one another. If the levels of one neurotransmitter become too low, the balance can shift and other neurotransmitter levels can become too high.

Norepinephrine: irritability, panic attacks, fear, anxiety

Serotonin: low appetite

Dopamine: anger and aggression

2. Tender Points Test

What is the Tender Point Test?

The Tender Points Test sets the criteria to meet the diagnosis for Fibromyalgia. It checks on the 18 tender points in the body and presence of pain in the four quadrants (left and right side; above and below the waist) of the body.

Indications and Contraindications:

This test is used to help in the diagnosis of Fibromyalgia. It is performed by a specialist to patients who have widespread pain in the four quadrants of the body.

How do you prepare for the Tender Points Test?

There are no special preparations for the Tender Points Test.

How does it feel? How long will it take?

Pain and discomfort may be experienced while pressure is applied to the 18 tender sites.

Expected effects after the test:

Normally, there are no major effects after the test. In most cases, the patient may feel sore at the tender sites that are the most affected after the test.

Results:

Fibromyalgia may be diagnosed if the patient has widespread pain in the four quadrants of the body. Pain is felt at the 18 tender points when light pressure is applied.

The 18 tender points of the body are:

1. Occiput: Bilateral, at the suboccipital muscle insertions.
2. Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
3. Trapezius: bilateral, at the midpoint of the upper border.
4. Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
5. Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces.
6. Lateral epicondyle: bilateral, 2 cm distal to the epicondyles.
7. Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
8. Greater trochanter: bilateral, posterior to the trochanteric prominence.
9. Knee: bilateral, at the medial fat pad proximal to the joint line

The Right Diagnosis and Treatment for Pain Management

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical's Personal Approach to Pain Management

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer's, Diabetes, Parkinson's, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.