Find the structure that hurts. Then fix the terrain that keeps it hurting.

Most patients arrive after the standard path has stalled. The MRI was read. The pills were tried. Physical therapy was done. The pain stayed, and the plan became "continue and review."

That stall changes the question. It is no longer how to manage the pain. It is what is producing it, and why it has not healed. Padda Institute answers both halves: the structure with image-guided diagnosis, the terrain with the metabolic workup most pain clinics never run.

Care is led by Dr. Gurpreet Singh Padda, MD, MBA, MHP, diplomate of five American specialty boards; his background is on his page. The practice describes itself as a nationally recognized center of excellence for complex chronic pain, with a team of registered nurses, physical and occupational therapists, biofeedback specialists, psychologists and case managers. Unsure this is your clinic? Tap the directory assistant (the light in the corner of the page).

What does an interventional pain physician do?

A primary care physician manages pain mostly with medication. A physical therapist treats it with movement. A spine surgeon treats what needs an operation.

An interventional pain physician works in the gap between them. The job is diagnostic first. Which structure is generating the pain: a facet joint, a nerve root, a sacroiliac joint, an entrapped nerve? Image-guided injections double as the test. A small dose of anesthetic placed precisely either abolishes the pain for a few hours or it does not. That is a test with an answer.

Treatment follows the answer. Back pain is a symptom, not a diagnosis.

Why diagnose before treating?

Because degenerative findings on MRI are common in people with no pain at all. A scan that does not match the complaint is a trap, not an answer.

The sequence is fixed:

1. Examination. Provocative maneuvers stress specific structures and narrow the field fast.
2. Imaging read against symptoms, never in isolation.
3. A diagnostic block where the source is still ambiguous, under ultrasound or fluoroscopy, so the practice knows where the medication went.
4. Treatment aimed at the confirmed generator. If the first target was wrong, the plan changes target.

There is no magic in a series of three. How many injections you need is decided by what the first one did. When a patient requests a repeat intervention, the practice requires documentation of at least 50 percent functional improvement. Without it, the therapy stops. That is the difference between treatment and an assembly line of endless injections.

What conditions are treated?

Organized by what hurts, because that is how you arrive.

• Spine: lumbar spinal stenosis, herniated disc, facet joint syndrome, sacroiliac joint dysfunction, vertebrogenic pain, annular tear, foraminal stenosis, spondylolisthesis, degenerative disc disease, spinal osteoarthritis, adult scoliosis, ankylosing spondylitis, and continued pain after back surgery.
• Leg and buttock: sciatica, piriformis syndrome, and cluneal neuropathy, frequently misdiagnosed as sacroiliac or disc pain.
• Nerve: diabetic peripheral neuropathy, complex regional pain syndrome (RSD), and foot pain that is really nerve pain.
• Head and neck: cluster headache, migraine, severe head and neck pain.
• Complex pain: chronic pain with anxiety or PTSD, cancer pain, pancreatitis and visceral abdominal pain, pain after a car accident.

Not listed? Call. Pain that has lasted more than six weeks without a clear path to resolution deserves a specialist opinion, whatever its label.

Which procedures are performed?

All on site, outpatient, under ultrasound or fluoroscopic guidance where the technique requires it. Ultrasound shows a joint, tendon or nerve while it moves. Fluoroscopy confirms needle position against bone for spinal work.

Spine

• Epidural steroid injection. Anti-inflammatory medication beside an irritated nerve root, under live fluoroscopy. The anesthetic can bring relief within hours; the steroid takes effect over two to seven days. Repeat blocks, when indicated, are usually one to three weeks apart.
• Selective nerve root block, facet joint injection and sacroiliac joint injection. Each relieves pain and confirms whether that structure is the true source.
• Epiduroplasty. A catheter breaks down scar tissue tethering nerve roots after spine surgery, most often in failed back surgery syndrome.
• Discogram, a diagnostic study for when MRI has not identified the source.
• Kyphoplasty and vertebroplasty for painful vertebral compression fractures.

Ablation and nerve blocks

• Facet joint radiofrequency ablation, after diagnostic blocks identify the level. It targets the nerve rather than the joint, for longer relief than injection alone.
• Genicular nerve block and genicular radiofrequency ablation for the arthritic knee, only after a positive block. Relief is measured in months rather than weeks, the nerves regenerate over time, and it does not rule out a knee replacement later.
• Stellate ganglion, lumbar sympathetic, celiac plexus and sphenopalatine ganglion blocks.
• Trigger point injections and hydrodissection, which frees an entrapped nerve from scar tissue with ultrasound-guided fluid, no open surgery.

Joints

• Hip joint injection.
• Viscosupplementation for the knee, placed under ultrasound, as a single injection or a short weekly series.

Neuromodulation

• Spinal cord stimulation, always preceded by a temporary trial.
• Peripheral nerve stimulation, a fine lead beside one damaged nerve, placed with no sedation so your feedback guides the position. A sixty-day percutaneous system is worn and then withdrawn, leaving no implant.
• The NS-100, an FDA-cleared Class II programmable peripheral electrical nerve stimulator for painful diabetic neuropathy. It sits at the ear, on the auricular branches, and acts as a vagal stimulator. It is worn up to 30 days, most patients around 20, with no sedation and no activity restrictions.

Headache and nerve pain

• Botox for chronic migraine, thirty-one small injections in the PREEMPT pattern every twelve weeks. It is FDA-approved for chronic migraine, meaning 15 or more headache days a month, and the practice says so plainly when a patient does not qualify.
• Ketamine for RSD, CRPS and refractory nerve pain, by IV infusion, sublingual preparation or topical cream. For RSD and CRPS, sublingual or topical is typically where treatment starts. Every use for chronic pain is off-label, and the evidence does not transfer between routes.
• Electrodiagnostic testing (EMG and nerve conduction studies).

Is sedation used?

Not for epidural steroid injections, sphenopalatine ganglion blocks, peripheral nerve stimulation or the NS-100. The tissue is numbed with local anesthetic and you stay awake. Most patients drive themselves home and resume normal activity, including work, within two to four hours. The exception is temporary leg weakness or numbness after an epidural; wait until it clears before driving.

Does the practice perform surgery?

Dr. Padda is a licensed physician and surgeon with surgical privileges, and the practice does perform surgery. It leads with the least invasive option that can answer the question and reserves surgery for when it is the right answer, not the next step.

Why test metabolism and sleep in a pain clinic?

Two patients with the same MRI do not have the same pain. They do not respond the same way to the same injection. The difference is the terrain.

Chronic pain is frequently an extension of systemic metabolic inflammation. Fat tissue is endocrine tissue; it releases inflammatory cytokines. Insulin resistance changes how the nervous system processes pain signals. Uncontrolled blood sugar changes how nerves conduct and heal. One night of lost sleep amplifies pain reactivity in the brain while blunting the circuits that dampen it. Magnesium, vitamin D and B vitamin deficiencies are common and rarely checked.

Treat only the mechanical finding in a body whose chemistry is driving the pain, and you get the pattern patients describe on arrival: treatments that worked briefly, then stopped.

What do lifestyle medicine and counseling involve?

At least 40 to 50 percent of treating pain is patient lifestyle coaching.

Lifestyle medicine targets sleep and circadian timing, including night light exposure; whole food with adequate protein and healthy fat, less refined carbohydrate and fewer industrial seed oils; graded movement, which supports your own endogenous opioid signaling; and measured deficiencies. Patients who fix sleep and nutrition often need less medication and fewer repeat procedures.

Counseling is delivered in-house by a clinical psychologist, coordinated with the physician managing your procedures. Cognitive behavioral and acceptance-based therapy, including Acceptance and Commitment Therapy, works on the loop years of pain build: broken sleep, narrowed activity, low mood, fear of movement. It never assumes the pain is imagined.

Medical weight loss adds structured coaching, nutritional counseling and, where appropriate, prescription medication.

How are opioids handled?

Medication is a bridge, not a destination. Roughly 95 percent of patients are interventional pain patients, and about 5 percent are co-managed for addiction alongside severe pain. The practice does not accept patients for medication management alone.

For patients already on long-term opioids, procedures take over the work the medication was doing so the dose can be tapered without withdrawal. Patients on long-term opioid therapy agree to ongoing counseling, a minimum of twelve physical therapy sessions a year, and metabolic participation. Inherited high-dose patients generally reach a routine dose within one to three months.

The numbers, by tier. Arriving: the average new patient comes in after more than two and a half years in pain, on more than 90 MME a day; some are inherited from primary care at 400 to 500 MME. Under active interventional treatment: 21 percent are completely off opioid pain medication within 90 days, and 34 percent within one year; most who cannot be fully weaned are brought below 30 MME. Established: fewer than 1 percent remain above 90 MME. These are practice-reported figures from our own population, not trial outcomes, and individual results vary.

More on the opioid stewardship page, including tapering off high-dose opioids and non-opioid pain treatment.

Can I be seen the same day?

Yes. Same-day and urgent appointments are held open at the Woodson office, and the team can usually see you within 24 hours. A same-day visit is a physician evaluation, not a triage slot. The procedure suite, fluoroscopy and ultrasound are on site, so when your exam and imaging support it, a procedure can often happen the same visit. An active cluster headache bout is the clearest case: the transnasal sphenopalatine ganglion block takes minutes.

The practice is not an emergency room. Chest pain, stroke symptoms, a sudden worst-ever headache, new loss of bladder or bowel control, fever with severe back pain, or pain after significant trauma: call 911.

What about insurance and office policies?

The practice accepts most major insurance plans, including Medicare, and verifies your benefits before anything is scheduled, so you know your portion beforehand. Procedures happen in an outpatient office rather than a hospital outpatient department, so the facility component of the cost is generally lower. A prior authorization is not a promise of payment.

Standing policies from the office:

• Cancel or reschedule at least 24 hours ahead, or a $50 cancellation fee applies and must be paid before the next appointment.
• Copies of your own medical record are free.
• Disability form completion is $1,600. Medicolegal work, including depositions and records reviews, is $1,600 per hour, paid in advance.
• The practice does not provide telehealth. Care is in person.
• Running out of medication is not a medical emergency.

Where is Padda Institute?

The main office is at 4477 Woodson Rd, Suite 100, St. Louis, MO 63134, beside Lambert International Airport. A second office is at 12174 Natural Bridge Rd, St. Louis, MO 63044. Both are open Monday through Friday, 8 AM to 5 PM. Call (314) 481-5000 or text (314) 886-5902. Patients have left 1,551 five-star reviews across both offices. Practice NPI: 1508067208.

Padda Institute is one of several clinics on pain and metabolic medicine in St. Louis.

Frequently asked questions

Will I get an injection at the first visit?

Only if it is clearly indicated and you agree. The first visit is primarily diagnostic, and nothing is performed without a discussion of what it is for and what it should achieve.

What if injections have not worked for me before?

Ask whether they were image-guided and whether any of them was diagnostic. A landmark injection placed by feel tells nobody where the medication went. A practice with a full range changes the target instead of repeating the miss.

What if my scan is normal but I still hurt?

Nerve pain, centrally mediated pain and several joint problems do not show on standard imaging. The diagnosis then comes from examination and diagnostic blocks.

Do I need a referral?

Not in most cases. Many patients refer themselves. Some plans require a referral for coverage, and staff can help you confirm that.

Do you see patients from Illinois?

Yes. The practice is licensed in Missouri and Illinois, sees patients from across the Metro East, and Dr. Padda is on staff at Anderson Hospital in Maryville.