Make Pain a Thing of the Past – Pain Medication – Physician Partners of America

Tag Archive for: Pain Medication


Cyndi: Many of have been there. We go to a doctor for whatever may be ailing us and we walk out with a prescription. Some of you may be taking a long list of medications right now, but how much is too much? Dr. Rudy Gari from Florida Pain Relief Group joins us now to help answer that question. Dr. Gari, great to have you back.

Dr. Gari: My pleasure.

Cyndi: So there are a lot of people right now who are on medications their doctor has prescribed, and they are taking some over-the-counter medications as well. How do they know what’s working?

Dr. Gari: Well, there are many times where they don’t know. And so, for example, there is something in medicine called hyperalgesia, and we see that a lot in pain management. And what that means is that sometimes pain medications in and of itself causes pain, because you’re taking way too much of a medication, your body gets used to it. There are different receptors, and once you have saturated those receptors so much, it becomes counterproductive. So that’s one of the things. We often have to do what’s called an opioid rotation, where we switch the medication from a certain type to a different medication, and a lot of times we can lower it in half and get better pain relief.

Cyndi: Well, is there a test that can be taken to see how effective medicines are for certain people, for certain ailments?

Dr. Gari: Absolutely, and it’s a test that we provide to all of our patients because we believe in that. And it’s called pharmacogenomics. Pharmacogenomics is a very exciting test. I believe that it’s the way of the future and I believe every physician’s office will be offering this. And what it does is that it looks at your unique genetic makeup and how your own body metabolizes those medications. And we’re all different. So that’s the first thing that we do is, you know, you might be taking medications that you had to take 10 times more than you will. And sometimes it’s the reverse. Your body can be very susceptible to medications. For example, codine. We know that the FDA issued a box label warning against hypermetabolizers of codine, because codine gets converted to morphine, and there were actually, like, five kids that died from tonsillectomies.

Cyndi: Taking codine?

Dr. Gari: Just regular codine, normal doses, but they overdosed because their genetic makeup was such that they ended up producing a lot more morphine from the codine than normally would happen.

Cyndi: Do some pills cancel each other out?

Dr. Gari: Yes, yes, absolutely. They do. So we have to look not only at your genetic makeup and how it metabolizes, we have to look at how the medications work on your body and how they interact with each other.

Cyndi: Is there a type of miracle pill out there that can help all pain?

Dr. Gari: I think in the future we’ll have one. Not today, though. No.

Cyndi: So for people who are taking a lot of different medications right now, first of all it’s not healthy, is it, to be mixing all different pills?

Dr. Gari: Well, it’s not good at all, Cyndi. I mean, there are side effects with each medication, and those side effects become exponential, so that if you’re taking three of those pills, the side effects may be like fivefold instead of threefold because they interact with each other, and they counteract each other and they make things worse. So one of the things a doctor has to do, especially if they’re coming in for whatever it may be, we have to look at all of the medications that you’re on and determine which ones you may no longer need, or substitute a different medication for one that you’re taking that works better for you.

Cyndi: So the goal of the Florida Pain Relief Group is to get you off as many of those medications as possible, right?

Dr. Gari: We want to get you to what you were before you started taking the pills, as much as possible.

Cyndi: That is music to a lot of people’s ears. Dr. Gari, thank you very much. You can visit their website,  to schedule your same-day appointment.  Give them a call today. We’ll be right back.


Cindy: Complex regional pain syndrome, it doesn’t that like something that anyone would want to deal with. It is also called CRPS.This chronic pain condition can wreak havoc on your body. Doctor Rudy Gari from Florida Pain Relief Group joins us now to fill us in on what this is. Great to have you back.

Dr. Gari: Thank you.

Cindy: Complex regional pain syndrome sounds awful. What is it?

Dr. Gari: Yes, it does. And the reason why it is called complex regional pain syndrome is because it’s just that, it’s complex. This is something that has been going on Cindy, for a very long time. In fact, this goes all the way back in the Civil War. We have documented case studies of soldiers who actually had so much pain in their arm that they wanted to cut their arms off.

Cindy: Oh, okay.

Dr. Gari: It used to be called something called causalgia, it was called the reflex sympathetic dystrophy. The term that is used right now is called complex regional pain syndrome and what that really is, if you think about it, think about if you get pain in your hand or your arms, anywhere. Normally, that pain shoots up your brain and it stops. What happens with complex regional pain syndrome is that it becomes a vicious cycle. So the pain keeps going in circles, keeps going in circles and it never stops.

Cindy: Any particular area of the body that you see it most often?

Dr. Gari: It usually affects the extremities. It affects the arms, it affects the legs, it can actually spread, but the good thing Cindy is there’s a lot of things that we can do to help complex regional pain syndrome. One of the first things is that the earlier that we see it the better. And so it often travels through these nerves called sympathetic nerves. So what we do is what we call sympathetic blockade. We want to stop that seizure and that pain constantly going in circles but it’s a certain specialized field in medicine they use, physicians like myself, I’m an anesthesiologist, I’ve been treating this for many, many years and I’ve actually had great success. So there’s blocks, there’s something called sponcra [SP] stimulators and the earlier that we treat this the better it is for our patients.

Cindy: How often do you see somebody coming in with complex regional pain syndrome?

Dr. Gari: I just saw a patient this morning.

Cindy: Really?

Dr. Gari: This patient has horrendous, horrendous leg pain and has all kinds of issues going on. Not just nerve pain it affects his vascular system and the pain is never ending. She’s has unfortunately, has this for many, many years.

Cindy: Oh gosh. Well, she doesn’t have to live with it for any more years, right?

Dr. Gari: No, no. We have her on a plan.

Cindy: What are you able to do for her? What are you going to do?

Dr. Gari: So what we do is we can give her some medications probably to help with that pain. We’re gonna go after and try to stop that seizure if you will of the pain syndrome, blocks and we’re considering a sponcro stimulator as well.

Cindy: So get to the source, right?

Dr. Gari: Absolutely, absolutely.

Cindy: Instead of just you know, treating the…

Dr. Gari: It can be cured.

Cindy: It can?

Dr. Gari: It can be cured, yes.

Cindy: Okay. So when is it time to come see you? When they feel like this is something that has been going on with them?

Dr. Gari: The sooner the better, the sooner the better. Have seen someone like myself because we can treat you in those things that we can do.

Cindy: So, usually fingers, legs, any…

Dr. Gari: Fingers, arms. It’s usually the arms or hands or legs. It usually begins as something as mild as just bumping into the wall somewhere that can cause, like, a seizure which will just continue, where we have to stop that vicious cycle.

Cindy: It goes on and on and on. Okay, good stuff Dr. Gari, that’s really good news for so many people. Florida Pain Relief Group has scheduled same day appointments so be sure to visit their website. It is or you can give them a call at 844-KICK-PAIN. Doctor, always good to see you. Thank you very much.

Dr. Gari: My pleasure.

Cindy: We’ll be right back.

Dr. Gari: Thank you.