Frequently Asked Questions

About the prescribing of narcotics:

Why do doctors prescribe narcotics?

In general, narcotics are not curative. Narcotics are utilized to treat the symptoms (pain) of the underlying problem.  This is a fact that many people fail to comprehend.  While pain control is an important goal, it is not our only goal.  We often employ narcotics in our treatment plan, but we never use them as the sole method of treatment. It is essential to treat the problem itself, not just the symptom.  While pain is an important adaptive sensory input, when it’s excessive, it is often debilitating.   Narcotics often become “necessary” when the pain becomes so overwhelming that the patient’s physical, emotional and/or mental state is significantly affected.

What other modalities do we utilize?

Our patients must be ready to undergo treatment designed to minimize the underlying condition.  Sometimes, this involves an attempt at curing the patient’s main medical problem. More frequently, our action plan is steered towards minimizing the patient’s disease or at least halting the progression of their disease.  Our treatment plan is a multi-dimensional one.  In addition to treating with narcotics, we also employ a plethora of other therapies (i.e. Topical creams, chiropractic treatment, physical therapy, trigger injections, Electrical Muscle Stimulation treatments, Percutaneous Electrical Nerve Stimulation treatments, acupuncture and/or aquatic therapy.)

Will the doctor prescribe narcotics if I believe they are necessary?

The answer to this question is almost always yes.  However, the more pertinent question is the next question.

Which narcotic will the doctor prescribe and how much?

This is a very complicated question.  Dr. Berkowitz takes many factors into account.  It is very important to realize that Dr. Berkowitz will not prescribe a number of the most powerful narcotics.  These include Dilaudid, Morphine, Methadone, Oxycodone 30mg and Oxycontin.  That does not mean that some people should not be on these medications.  However, we have chosen to only treat patients with mild to moderate pain issues.  Patients that have severe pain issues which require very large doses of strong narcotics would do better to seek the care of pain specialists who are particularly knowledgeable and have a great deal of experience dealing with these powerful narcotic medications.  As a general rule of thumb, these specialists are fellowship trained and practice in tertiary medical centers (i.e. University of Pennsylvania, Jefferson University, Temple University, etc.)

How does Dr. Berkowitz determine the appropriate narcotic regimen for me?

This is a very complicated issue.  It depends on a variety of factors:

  1. Weight
  2. Age
  3. Medical condition(s) triggering the pain syndrome
  4. Other non-pain related diagnoses (e.g. diabetes, kidney failure, heart disease)
  5. Patient's history of narcotic use (e.g. what the patient tried in the past and how successful the results were)
  6. Tolerance level
  7. Susceptibility to addiction

Is narcotic use dangerous?

There are a variety of risks associated with narcotic use:

  1. Addiction
  2. Respiratory suppression
  3. Hepatitis
  4. Altered Mental State (intoxication, slumber, lethargy, coma)
  5. Dizziness
  6. Constipation
  7. Lethargy

Which people are more likely to have complications from the use of narcotics?

  1.  People with Chronic obstructive pulmonary disease (COPD), i.e. asthma, bronchitis or emphysema
  2. People with psychiatric problems and/or and dependency issues
  3.  Individuals with heart or kidney problems
  4. Individuals with sleep apnea

What is the difference between interventional and non-interventional pain specialists?

Interventional:

Most fellowship trained pain specialists are interventional. Their primary focus is on performing procedure(s). Some of them can be curative or near curative. However, these procedures do have their downsides. They can result in a number of complications. Additionally, they are generally very expensive. Here is a list of some interventional procedures:

  1. Nerve, root and medial branch blocks
  2. Facet joint injections
  3. Pulsed Radiofrequency Neurotomy
  4. Rhizotomy
  5. Intrathecal pumps
  6. Percutaneous Discectomy/Nucleoplasty

Non-interventional:

Dr. Berkowitz is a non-interventional pain specialist. He does not perform high risk procedures. His approach is less aggressive and more conservative. Dr. Berkowitz generally prescribes:

  1. Medicine regimens
  2. Topical Creams
  3. Physical therapy
  4. Laser treatment
  5. Trigger injections
  6. Acupuncture
  7. Electrical Muscle Stimulation
  8. Percutaneous Electrical Nerve Stimulation
  9. Psychological/Psychiatric counseling