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Our Practice

Who We Are

Welcome to Virginia Pain Specialists (VPS). My name is Nino Dobrovic, and my single-specialty medical practice is focused exclusively on caring for people in pain. My personal mission is to help my patients lead a life with the least pain and most function that their condition and effective treatment will allow. My patients, as with anyone suffering from extreme pain, are all truly suffering and as a result have a reduced quality of life that affects their entire life — their whole person. I bring to the practice of pain medicine my extensive experience, board certification in physical medicine and specific training in rehabilitation. I completed two fellowships, in anesthesiology-based pain management and in traumatic brain injury medicine. I wish to alleviate or ameliorate your pain to provide you the best quality of life possible in your particular circumstance.

Your Care & Treatment at VPS

Determining Your Treatment Plan: Your First Appointment

The key to caring for a patient suffering from pain is to first identify the origin of your pain by taking a detailed intake history to gain a deep understanding of your situation so we can create a treatment plan specific to you. This begins with the standard "PQRST" inquiry to determine:

• Pain intensity
• Quality
• Radiation of pain
• Severity
• Timing

Your intake history will include an inventory of prior interventions, including surgery, physical or occupational therapy, interventional pain management procedures, medication management, and behavioral health. Please see the link to the appropriate forms on this web site. After completing your thorough intake history, I perform a complete physical exam —  I do not delegate this responsibility, since it is critical that your physician is personally knowledgeable about you and that we have the time to get to know each other in preparation for your treatment. The results of your physical exam will then be correlated with my review of your relevant and pertinent imaging studies as well as your available medical records. The process is collaborative — it is critically important for us to work together to get to the essence of your pain and catalog how it affects your everyday life. This initial evaluation will require a minimum of an hour together.

You will leave your initial appointment with a prescription for a urine screening test and an appointment to meet again in one week once I receive the results of that test. The urine test is for me to understand current levels of any prescriptions you may be taking and, unfortunately, to help screen out those few individuals who may be simply seeking drugs of abuse.

Your Second Appointment

Our second visit together is focused on my providing you with my diagnosis and opinion as to how I may be able to help you, what the likely range of outcomes are likely to be, and the initial steps of our collaboration on your treatment plan.

About Pain & Treatment

Pain is designed to get our attention. Just recall the experience of stubbing your toe if you need a reminder of just how much immediate attention pain demands. At a point in time and for reasons that are still being unraveled by scientists pain loses it’s primary purpose of protection and becomes "chronic." As a result, mood and sleep as well as function are effected. We will work together to identify how your pain is affecting your ability to concentrate and whether it impacts your ability to get a good night's sleep. Pain is most treatable when it is acute or subacute, meaning that it has been less than about 3 months since it started. This is especially true of neck and back pain.

Tools that I use to treat your pain can include

• contemporary interventional pain management modalities (treatments)
• therapy, e.g., occupational therapy, physical therapy.
• behavioral interventions, e.g., psychiatric psychological, biofeedback, etc.
• surgery
• medications

Since pain medicine is my specialty and my expertise, I refer patients to other specialists for psychological, surgical, and physical therapy services. Interventional pain modalities are performed in our state-of-the-art fluoroscopy suite.

Medication management is an involved, time consuming (both in terms of longer appointments and more appointments over time), but useful tool for treatment of pain. We use a broad range of FDA-approved medications, including adjuvants such as muscle relaxants, tricyclic antidepressants, psychotropic agents, antiepileptic drugs, topicals, and opioids. We screen all patients for substance abuse (the initial urine screening test) and diversion, if appropriate, at the outset of treatment and periodically during the course of treatment and always prior to prescribing any DEA-controlled medications. This screening is not only best practice, but is necessary to insure that we are careful when and if drugs that have a risk of abuse are included in your treatment plan. We also employ the Commonwealth of Virginia’s Department of Health-sponsored Prescription Management Program to identify your prior pattern of controlled substance use. I avoid conflict of interest in urine screening by having you go to a commercial laboratory for all urine assays. Controlled substances are highly effective tools for the treatment of pain, but carry risks; however, we are also attentive to and concerned with the risk of abuse that can occur with these tools.

Pain is a complex biological phenomenon. It has a long history of formal academic study, however and surprisingly to many, only recently has it become a recognized medical specialty onto itself. I trained in this discipline because it fascinates me and requires a unique combination of skills on the physician's part to help the person in pain. I believe that an accurate diagnosis is the foundation of success in your outcome; we will spend considerable time and effort to identify the source of your pain. Many patients in pain suffer as a result of their pain, and one of our goals together will be help you cope with it so that — together — we can improve your daily life. I refer patients to psychiatrists, psychologists and medical social workers to assist with the unavoidable emotional and social effects of your pain.

Summary: VPS Puts You First

It is important to me that you understand that everything about my practice of medicine is to put the patient first in a way that is uncommon in healthcare these days. From how much time we spend together, how my approach to treatment plans includes not just your physical medical issue, but how it affects your whole life, to how we collaborate in working for the best possible outcome — all of this is about you. This is different, but you'll find you'll get used to it.

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