Trigger Points, Botox Muscle Groups, Generalized Joint Injections
At North Shore Medical Center
(knees, shoulders), Synvisc Injections and
Name: _________________________________________________________________________________________ You have been scheduled for a _______________________on Date ________________at Time__________________ Arrive 15 minutes before procedure.
Please call our secretary at 781-477-3676 if you have any questions or need to change your appointment.

The instructions below may be changed according to each patient’s clinical history and pain management needs.
• For your safety, it is strongly recommended that you be off of any blood thinning medications for a certain
number of days before the pain procedure. However, do not stop this medication without getting permission
to do so from the physician who prescribed it.
You must do this before each pain procedure, as your medical
situation can change over time.
• If the prescribing physician will not authorize you to stop this medication, please contact the Pain Clinic to discuss alternative treatment options. General guidelines are as follows: For Coumadin, you will need to stop taking this for 5 days before having your procedure.
 If you are on Coumadin, a PT/INR should be ordered by your primary care physician. You can have your blood work drawn on the day before your scheduled procedure and have the results faxed to us at 781-477-3652. For Plavix, Persantine, Aggrenox, Trental or Arixtra you will need to stop taking them for 7 days before
having your procedure.
For Lovenox, you will need to stop 48 hours before having your procedure.
For Heparin, you will need to stop 6 hours before having your procedure.
For Ticlid, you will need to stop 14 days before having your procedure.
For Pradaxa (Dabigatran), you will need to stop 4 days before having your procedure.
• If you are a Diabetic:
Do not take your insulin or diabetic pills the morning of your procedure. Please bring them with you. If you test your blood sugar at home, please bring your equipment with you, or you may test your blood sugar before leaving home. If you are on Glucophage: Please tell the nurse as it can interact with contrast dye. • Bring your asthma inhalers with you to the hospital. • You must be off antibiotics for 2 days and free of infection before the procedure. • If you are pregnant, please inform the pain clinic staff.
Morning of Appointment: If you will be receiving Sedation:
• No solid food, gum or mints for 6 hours before your procedure. • You may have clear liquids up to 3 hours before your procedure. Clear liquids would be water, apple and cranberry juice, ginger ale, black coffee or black tea (no milk).
If you received sedation:
You should not drive, operate machinery or make legal decisions for 24 hours after
the procedure. Please arrange for someone to drive you home. You may not go home alone in a taxi. Otherwise,
your procedure may be rescheduled for another day.

If you have any questions related to your condition or your procedure, you may call the pain clinic between 8:00 am and
4:00 pm Monday-Friday. For emergencies after hours and weekends, call the Physician on Call at 1-888-421-5890.
Thank you and we look forward to your visit.

Source: http://newenglandpain.com/pdf/NewFormsPDF/northshore-preprocedure-forms/northshore-preprocedureC.pdf


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