THE FIRST VISIT
You will be asked things nobody has asked you before, and some of them will not sound like back questions.
The appointment is built to answer one question: which structure is generating your pain? Everything in it serves that, including the parts about your shift pattern, your sleep and your last set of bloodwork.
What to bring
- The actual images, not only the reports — a disc, a portal login, anything that lets us look at them ourselves. Reading images against an examination is the step that has usually been skipped.
- Operative notes if you have had surgery, which say far more than the discharge summary.
- Everything already attempted, with what took the edge off and for how long. Partial responses carry real diagnostic weight.
- Your medications, all of them, including what you take occasionally.
- Recent bloodwork if you have any, particularly A1C, fasting glucose and a lipid panel.
- The list of what you have stopped doing. This is the one almost nobody brings and the one that changes the appointment most. Why it matters.
What happens, in order
- History, in more detail than you are used to. Where it started, where it goes, what makes it worse, what your week looks like, how you sleep, what you lift and for how many hours.
- Examination. Segmental palpation, range in flexion and extension, a proper neurological screen — dermatomes, myotomes, reflexes — straight leg raise and its crossed version, the sacroiliac provocation cluster, hip range, and gait watched rather than glanced at.
- Review of your imaging with you in the room. On a screen, with the findings named and their significance stated, including the ones that are normal for your age.
- A named hypothesis. One or two candidate structures, said out loud, with the reasoning attached so you can push back on it.
- A plan to prove it — usually a diagnostic block, sometimes further imaging, sometimes neither.
- Bloodwork, where it is relevant, which is most of the time and which is explained rather than simply ordered.
Why you will be asked about sleep and food
Because they are causal here rather than incidental. The tissue in your back is maintained by a metabolic system: collagen turnover, microvascular perfusion of the disc endplates and the nerve roots, and the inflammatory tone that determines whether ordinary microdamage clears or accumulates. Chronic hyperinsulinemia and metabolic inflammation degrade all three.
Sleep is where the repair actually happens, and it is also where descending pain inhibition is restored — which is why the same back is a five on Tuesday and an eight on Friday with nothing having changed structurally. And the shift pattern matters because it sets both, and because it is set by somebody else.
None of that is a preamble to selling you a program. It is there because a structural plan built on an inflamed terrain underperforms, and it is better to know that at the start.
What you will not be asked to do
- Taper before being assessed. If you are on long-term opioid therapy, that is a fact about your history, not a condition of being examined, and nobody here will treat the dose as a character question.
- Commit to a course of injections. There is no package of three. Quantity is a clinical decision measured against what the last procedure achieved.
- Accept a procedure at a level nothing has identified. If we cannot name what we think is generating your pain, we will say so rather than inject something.
- Prove you are in pain. You have probably been doing that for a while and it has not helped anyone.
How long it takes to get an answer
The first visit usually produces a working diagnosis and a plan for confirming it. Where a diagnostic block is indicated, that is a separate short appointment and the answer arrives within hours of it rather than weeks — you collect it yourself, on paper, hour by hour.
Where a confirmatory block is needed, add a second short appointment on a different day. It is inconvenient and we ask for it because a single positive block has a real false-positive rate and the treatment it authorizes is worth being right about.
On cost and coverage
Prior authorization is permission to proceed. It is not a promise of payment, and any office that implies otherwise is describing a system that does not exist. Where a service is not covered, you will be told before it happens and asked to sign for it, and the conversation will be about whether it is worth it to you. Non-coverage is a payer decision and not evidence about whether something works.
Common questions
Do I need a referral?
No. You can book by phone, by text, or online.
How long is the appointment?
Long enough to do the examination described above properly. This is deliberately not a fifteen-minute slot, because the whole premise of the practice is that the parts that get skipped are the parts that matter.
Will I get an injection on the first day?
Usually not. The first visit is for establishing what is wrong. Treating before that is how people accumulate procedures that did nothing.
What if you cannot help?
You will be told, on the day, along with what we think the right pathway is. Where the finding points to a surgeon or to another specialty, that is what you will hear rather than a course of something.
Can I bring someone with me?
Yes, and it is usually a good idea. A second set of ears catches things, and a partner often reports the functional losses more accurately than the patient does.
Related reading
- Back pain doctor in St. Louis
- The diagnostic block, explained
- What it quietly took
- What your MRI actually showed
- About Dr. Padda
Book the visit, bring the images and the list
We will tell you which structure we think is generating this, how we would prove it, and what we would do if we are wrong.
12174 Natural Bridge Rd, Suite 301
St. Louis, MO 63044
At DePaul Hospital on Natural Bridge Road, inside the I-270 and I-70 interchange, on the west side of the airport.