Managing pain is a complex and nuanced issue for both patients and their treating physicians. While all doctors work toward lessening pain, a physician specializing in physiatry (pain management) brings a unique and multi-faceted set of tools to the challenge of helping people manage physical pain.

Under the leadership of Dr. Scott Epstein, Wayne Physiatry LLC uses both opioid and non-opioid medications as part of both acute and chronic pain management programs. With heightened awareness of the national opioid crisis, the Wayne Physiatry LLC team assures every patient for whom it provides care that each prescription is written to provide the highest level of patient care and physician accountability. Pain management medications are prescribed only after Dr. Epstein’s careful and ongoing review of patient status and progress.

Dr Scott Epstien with client


Non-steroidal anti-inflammatory (NSAID) medications are often first-line treatment for many musculoskeletal pain conditions. Though many pain medications work by altering electrical signals being sent from your nerves to your brain, NSAIDs, instead, work chemically at the location of the pain. When a body part is injured, the damaged tissue releases prostaglandins, which are chemicals that cause the injured tissue to swell, and cause the local nerves to amplify their signals to the brain… that causes pain. NSAIDs work by chemically blocking the effects of specialized enzymes that modulate the production of prostaglandins. By making less prostaglandin after an injury, NSAIDs minimize localized swelling and therefore decrease pain.

Routine physician management by Dr. Epstein is needed after medications are ordered to monitor both the effect of these medications after implementation and the risk of development of side effects from medications.

Other non-opioid options include adjuvant pain medicines, meaning medications that were not originally designed to treat pain, but have been found to be effective in chronic pain management, particularly for nociceptive (damage to a body tissue) and neuropathic (actual nerve damage) pain. Such medications include anticonvulsants, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants.

Chronic non-cancer pain is one of the most common reasons patients consult healthcare providers. However, it is often times inadequately treated. Narcotic (also called opioid) pain medications are widely used to treat chronic pain. They work by weakening pain signals to the brain. Guidelines and consensus statements recommend judicious use of opioids in patients who have not responded to other treatments and analgesic medications (e.g. non-steroidal anti-inflammatory medications and adjuvant pain medications). Guidelines and/or state requirements also recommend the use of screening tools to: identify patients who are risk for aberrant drug behaviors; improve clinical outcomes (pain reduction and functional improvement); utilize physician drug monitoring for prescribed opioids with each prescription; monitoring patients for potential adverse effects of medications; and perform random urine drug screening.


Wayne Physiatry LLC follows all standard guidelines when using opioids to treat chronic pain as part of a multi-disciplinary treatment program. Controlling pain and assisting in improvement of functional activities is the ultimate goal for the patient