The Doleys Clinic

We are happy to offer our multidisciplinary services to manage patients on an effective, conservative analgesic medication regimen. We can also assist primary care and specialist physicians or nurse practitioners with management of their own patients on controlled substances. ​1. We conduct a thorough psychological evaluation with testing to: ​Assist with opioid risk stratification ​Identify untreated mood or other psychological issues that may impact the pain experience ​Assess how pain, in turn, impacts multiple areas of the patient's life Generate a comprehensive mind-body treatment plan Review terms of the medical clinic agreement and create realistic patient expectations. ​2. We monitor patients with a routine and periodic urine drug testing monitoring program, with frequency based on level of risk. We also review Alabama pharmacy reports and conduct pill counts as needed in an effort to promote patient, family, and community safety. ​3. We follow the patient on a periodic basis for reassessment of risk, to monitor compliance, to document opioid therapy outcomes (e.g. analgesia/pain relief, activity/function/quality of life, affect and mood, aberrant drug behaviors, and adverse events) and adjust treatment plans accordingly. ​4. We teach self-management skills in our Pain Cornerstones Class to complement medical therapies and teach patients how to make their medication regimen work with their lifestyles. ​5. We are comfortable developing treatment plans for difficult-to-manage patients, with options such as closer monitoring schedules, non-oral opioid preparations, or even with use of a timed and locked medication dispenser filled here by our staff. ​ We have over 37 years of experience in the pain management field and a clinical staff that stays up to date on state/federal regulations, standards of care, and evidence-based approaches to pain management. We will gladly accept physician referrals to assume full care, or remain available to help local physicians with their challenging or medically-complex patients in a collaborative approach. ​

That sounds like a recipe for frustration and disappointment. You have real pain. You don’t want a temporary Band-Aid. Most likely, you want a solution that targets the underlying fibromyalgia disease process. ​That’s why we at The Doleys Clinic are so excited to offer our LDN (Low Dose Naltrexone) program for individuals suffering from fibromyalgia and associated fatigue. Naltrexone is not a typical pain medicine (i.e., it is not an opioid or other sedative). However, at lower doses, it has been shown in multiple published studies to provide relief from symptoms associated with Fibromyalgia and Chronic Fatigue Syndrome. ​LDN targets glial cells, which are immune and support cells that surround nerve cells. When triggered for action, glial cells start to release inflammatory chemicals that irritate the nerve cells around them. Pain pathways get hypersensitized. You already know this if you feel sensitive to the light touch of clothing or a shower, or when you feel that even your hair hurts! LDN essentially tells those glial cells to calm down and stop releasing inflammatory chemicals, which can allow the nerves to react normally to input again.

Physical therapy focuses on restoring an improving the mobility needed to move forward with life. Whether suffering from chronic or acute pain, balance or gait deficits, faulty posture, deconditioning, pelvic dysfunction or pain, orthopedic injury or trauma, PT aims to maximize functional independence in any environment. ​Our main goal is on Functional Restoration, through: ​Postural correction Therapeutic exercise Neuromuscular re-education Gait and balance training Manual therapy techniques, including joint and soft tissue mobilization Body mechanics and lifestyle education Modalities, including electrical stimulation, ultrasound, and iontophoresis Customized home exercise program ​The physical therapy examination includes a thorough musculoskeletal system assessment with development of a treatment plan tailored to the individual's needs. The patients who achieve the best long-term outcomes are committed to combating the disabling condition resulting from the injury or disease process. We are proactive with education to prevent and manage condition recurrence or flares.

Our psychologists specialize in: Individual therapy for: Depression Anxiety (general, panic disorder, PTSD) Anger management Stress management Grief Adjustment to chronic pain or other illnesses Marital issues (joint marital counseling also offered) Improving sleep Weight management Smoking cessation Relapse prevention (alcohol/substance use) Cognitive compensatory skills training (improving concentration, memory, etc.)

We are available for pre-surgical psychological screening evaluations for pain management interventional procedures, including: lumbar or cervical instrumented fusion, spinal cord stimulation (SCS) or intrathecal drug delivery systems (IDDS). ​ We use comprehensive interview and psychological testing procedures to assist in case conceptualization and treatment plan formation. We also provide informational sessions that involve both the patient and family in order to: ​ a) prepare/educate about a specific procedure, b) clarify and reorient the patient to appropriate outcomes expectations, c) set appropriate and manageable goals, and d) increase motivation. ​ Education itself can serve to reduce anxiety about surgical procedures, the recovery process, risks, and alternatives. Sessions may involve distribution of written material about the procedure, presentation of videos depicting surgical methods, and discussion about the patient's particular concerns. ​ Pre-intervention counseling can also be beneficial to alter negative perceptions and treat specific psychological risk factors for chronic pain and disability that may present barriers to recovery following surgery or device implantation.

In addition, we have an active Implantable Device Trialing Program and Pump Refill Clinic. ​Before permanent implantation of a spinal cord stimulator or intrathecal pump, we offer a program that includes: ​· A baseline functional assessment period · Extensive behavioral monitoring during temporary catheter or SCS lead placement · Review of device function, coverage, side effects, and mental status changes · Assistance with the decision for permanent implant We follow patients in our pump refill clinic for routine refills, medication changes, and monitoring. We work closely with technical representatives if device reprogramming is necessary. We monitor for side effects and have on-call contacts at local hospitals for pump myelograms and other medical monitoring procedures. Our pump refill nurse, Ms. Anne Adkins, has over 15 years of experience in this field.

Hippocrates had it right when he said, “Let food be thy medicine”. The definition of a drug is, “a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body”. When we eat sugar, our bodies produce insulin. When we eat protein, our bodies start a process called protein synthesis. Your intestines release chemicals to break down fats. These are all physiological responses to something ingested. So by definition food is a drug. All drugs aren’t the same; they create different effects in the body. Food is no different. Each source of food that we consume creates a different physiological effect. So if you want to reach a healthy weight, it's helpful to stop thinking in terms of eating the fewest calories and instead try to create the best chemical responses. There are molecules in the body produced by the immune system called cytokines. Research has shown that certain cytokines are over abundant in obese bodies. That’s why obesity is considered an inflammatory condition. The immune system views obesity as an injury and goes to work releasing inflammatory chemicals to solve the problem. Research has shown an abundance of the same cytokines in patients who are suffering from chronic pain. Losing weight may not cure chronic pain, but what studies tell us is that addressing widespread inflammation in the body may dramatically improve our ability to manage chronic pain. To create the best chemical responses and reduce total body inflammation, we at The Doleys Clinic recommend an anti-inflammatory diet that is high in protein, vegetables, fiber, and fats, and low in sugary carbohydrates.