Pain Management-High Risk Patients



Faxed records of the following:

1. Letter from a Licensed Physician who most recently treated you with CLASS II medication for long-term management of pain, specifically stating that he/she will NOT prescribe Class II medication to you as a patient for Chronic Pain Therapy hereafter.

2.  Pharmaceutical Records for the Patient over the Past Year

3. Imaging Studies or other Diagnostic Studies that would support the use of Class II medication for Long Term Therapy

4. Permanent Resident of Georgia within 100 miles of Atlanta Metropolis.

Patients may be misinformed with regards to safe chronic pain management.  We would like to provide helpful guidelines to those patients who may have been treated through  high risk management.  High Risk Pain Management includes those patients who are being treated or have been treated with more than 200 mg of morphine/opiate equivalent-dosage per day, and combination therapy including long-acting opiates, morphine, methadone, oxycontin, dilaudid, benzodiazepines (valium, Xanax, Klonopin), soma, sleep aid (ambien), etc.  High Risk Pain Management also includes patients younger than thirty (30) years of age, as well as those with a history of multiple doctors prescribing pain medications to them, around-the-clock opiate use, and narcotic-abuse.


1. HIGH-RISK Patients may need appropriate detoxification with appropriate withdrawal protocol under the care of an addictionologist or board certified MD-Psychiatrist prior to contacting our office for continuing ongoing chronic opiate therapy (COT).

2. ALL Patients, including those who are younger than thirty (30) years of age, should consider other alternatives for NON-opiate pain management including surgery, or anesthetic- injectables (under the care of a board-certified anesthesiologist); We recommend such NON-opiate therapy as: Topical Analgesics (Brand Names, OVER THE COUNTER: STOP PAIN, ICY HOT, etc); NON-steroidal ANTI-INFLAMMATORY Medications such as Advil/Motrin/Ibuprofen; Naprosyn (ALEVE), etc.; Or Trigger Point Injections which include a combination INTRAMUSCULAR injectable of steroid/lidocaine/marcaine

3. Patients should always demand an open  DIRECT-dialogue between each physician who previously or currently provides short term or long term pain management to them, as well as pharmaceutical records, and keep records of such oral and/or written communications.

4. Patients who relocate residence from one State to another should have their previous physician who provided pain management to them in their former State of residence to directly contact the physician (Dr. Gates) who will accept the transfer for continual care.


1. Acute, short-term pain SHOULD NOT be treated with Long-term, high-dose opiate therapy

2. Arm, leg, hand, foot, and shoulder pain, are often related to Inflamed Joint/Soft tissue or Arthritis, and SHOULD NOT be treated with Long-term, high dose-opiate therapy

3. Fibromyalgia, and/or chronic diseases causing nerve-related pain, ie. diabetes, HIV, etc, SHOULD NOT be treated with Long-term, high dose-opiate therapy

4. CERTAIN SLEEP/ANXIETY/MUSCLE RELAXANT medications, i.e. Ambien, Xanax, Klonopin, Valium, Soma, etc,  in combination with Chronic Opiate Use, SHOULD BE AVOIDED ALL-TOGETHER, OR AT LEAST MANAGED JOINTLY  under the medical-care of a board-certified psychiatrist, prior to use.

WE, at Medical Diagnostic Choices, remain committed to keeping our patients informed for better quality

and Safe Medical Care