Office Policies

High Desert
Pain Management

18400 US Hwy 18
Suite A
Apple Valley,
CA 92307
Ph: (760) 242-3939
Fx: (760) 242-3232

Spinal Injection
Iinitial consultation
Message Service
Medications & Refill Requests
Medication restrictions
Procedure Details
Clear Liquid Diet
Post Procedure Instructions
Cancellations and No Shows
Hours of Operation
In Case of Emergency
To First Visit

  Spinal Injection Information:
Your doctor has requested that you have a spinal injection. There are many different kinds of injections, including epidurals, nerve blocks, facet or sacroiliac joint injections, etc. Each type of injection targets a different location in the spine. Your doctor has chosen your specific type of injection based on your history, physical exam, X-rays, and MRI's. A spinal injection is a steroid injection, similar to a knee or shoulder injection, but in order to get the medicine to the correct place in the spine, X-ray guidance is sometimes used. The steroids are meant to decrease inflammation and swelling, and therefore reduce pain. The steroid medication generally begins working after 2-7 days, gradually reducing the inflammation and pain over the first 2 weeks. It may take a full 2 weeks to take effect.
The steroids usually stay in the area for 3-6 months. Sometimes one injection is enough to feel much better, but it may require a series of up to 4 injections, spaced out over time, to be most effective. Instructions for before your procedure:
• Someone must accompany you home after your procedure. You may not drive.
• Wear comfortable clothing.
• You can not eat any solid foods 6 hours prior. A clear liquid diet is to be followed ( water, coffee without creamer, tea).
• You may take your normal medications as prescribed. If you take pain medications on a daily basis, continue to take them on the day of the procedure.

Iinitial Consultation Visit:
We request that your referring physician contact our office to set up your initial consultation visit. The referring physician’s office must also fax to our office any notes regarding your previous care 48 hours prior to your appointment; if they do not, we may have to reschedule your appointment.
Please be certain to bring your insurance cards and a photo identification to your visit.
You should also bring a complete list of your medications, including the strength and dosing instructions.

Referrals & Authorizations:
You must obtain a referral from your physician (primary care or other referring physician) prior to your appointment.

If your insurance requires authorization for a visit to a specialist you must also obtain this authorization number prior to your visit.

Message Service:
Due to the high volume of telephone calls, we request that if you get our answering service, please leave a complete message including your full name, a telephone number where you can be reached, and your reason for calling. All messages will be answered after 4pm.

Medications & Refill Requests:
You must discuss your medication needs, including refill requests, with the practitioner at the time of your appointment. Refills are not done over the phone; therefore, it is suggested that patients see their physcian before they run out of medication.

Medication Restrictions:
• Aspirin has to be stopped 24 hours prior to the procedure.
• If you are currently taking a blood-thinner such as Coumadin, Plavix, or Aggrenox, you must stop taking this medication 7 days prior. Please let us know the name of the medicine as well as the prescribing doctor.
•Our office will contact them and get approval before we have you stop the medicine.
Non Steroidal Anti-Inflammatory Drugs (NSAID's) will have to be stopped 3 days prior to the procedure. This includes ibuprofen, Naproxen, Advil, Aleve, Motrin, as well as certain prescription anti-inflammatories.
Certain diabetic medications, such as Metformin, will have to be stopped 3 days prior to the procedure. The prescribing doctors office will have to be contacted before you can discontinue this medicine.

Your procedure can not be done if you have any kind of active infection (bacterial,viral,or fungal), if you are currently taking an antibiotic, or if you are running a fever.

Procedure Details:
During the procedure, you will lie on your stomach and your skin will be cleansed with an antiseptic soap. Your skin will be numbed with a local anesthetic, and a small needle will be passed under fluoroscopy (X-ray guidance) to reach the target area (such as the epidural space, a specific nerve, or joint). Once the needle is in the correct position (this may be confirmed by using a small amount of radiopaque dye), the steroid medicine along with an anesthetic is injected. The entire procedure usually takes about 15 minutes. Once your procedure is completed, you will need to stay an additional 15-30 minutes for recovery time. You should be prepared to be there for up to 2 hours.

Clear Liquid Diet:
If you are having a spinal injection or other procedure, you may have a clear liquid diet up to 3 hours prior to your procedure.

• Coffee or tea (without creamer,sweetener, or milk)
• Clear Juices – (apple, white cranberry, white grape, lemonade)
• Liquid Gelatin
• Mineral or bubbly water
• Soft drinks that are clear-(sprite, 7Up, ginger ale, club soda)
• Sports drinks
• Water

• Clear broth or bouillon

• Popsicles
• Hard candy
• Honey (you may put these in your hot drinks as sweetener)
• Flavored Jell-O

Post Procedure Instructions:
You should limit your physical activity the day of your procedure. You can resume physical activity the following day, as tolerated. You may experience some bruising or tenderness at the injection site(s) and/or your pain may be worsened for a day or two after the procedure, this is normal, but rare. You may ice the injection site, but heat should not be used for two days. Please call our office if you experience any unusual pain symptoms, persistent weakness in your arms or legs, headache that doesn't go away with your usual headache medication, or if you develop a fever greater than 100.5 degrees.

Cancellations and No Shows:
If less than 24 hours in advance are charged $60.
After three no shows we have the right to refuse treatment of a patient.

Hours of Operation
Monday - Friday 9am-5pm -

In Case of Emergency:
Life or death, call 911, otherwise please leave a message with our answering service after hours and we will return your call the next day.

To First Visit:
Bring ID, insurance info and/or card, last doctors notes, and xrays or mri films.
Also please bring any and all copays and deductibles they are due at time of visit.

Cash credit or check – copays and deductables due at the time of the visit. If you need to make payment arrangements you will need to call the office and ask to speak to the practice manager.

Copyright © 2008, 2010, High Desert Pain Management Institute
Site Design by Swarm Interactive