Chronic pain is pain that persists longer than three months, past the point where tissue healing would normally be complete. It is not simply acute pain that lasted too long — the nervous system itself changes, becoming more sensitive and more efficient at producing pain signals. That is why chronic pain often does not respond to the treatments that work for a fresh injury.
Service overview
Chronic Pain Management in Miami, FL
Chronic pain management in Miami, FL with Lisette Portes, MD is a conservative, non-opioid-first approach to pain lasting longer than three months. Dr. Portes, a board-certified family medicine doctor, treats chronic lower back pain, arthritis, fibromyalgia, sciatica, and neuropathy using diagnosis-driven treatment, physical therapy, and coordinated specialist referral in Miami.
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What Is Chronic Pain?
An estimated one in five American adults lives with chronic pain, and it is one of the leading causes of missed work, disrupted sleep, and reduced independence in older adults. In Miami-Dade County, chronic musculoskeletal pain is among the most common reasons adults seek primary care.
Chronic Pain Conditions Dr. Portes Treats
Chronic lower back pain — including degenerative disc disease, lumbar strain, facet arthropathy, and spinal stenosis
Neck and cervical pain — including cervical radiculopathy and chronic whiplash
Sciatica — radiating leg pain from lumbar nerve root compression
Osteoarthritis — knee, hip, hand, shoulder, and spine
Fibromyalgia — widespread pain with fatigue, sleep disruption, and cognitive fog
Peripheral neuropathy and diabetic neuropathy — burning, numbness, and tingling in the feet and hands
Chronic headache and migraine
Myofascial pain and trigger points
Shoulder pain — rotator cuff disease, bursitis, adhesive capsulitis
Chronic joint pain related to inflammatory conditions
Post-injury and post-surgical pain that has not resolved on schedule
Chronic pelvic and abdominal pain requiring workup and coordination
Our Approach to Chronic Pain
Diagnose before treating. Pain is a symptom, not a diagnosis. Dr. Portes starts with a structured history, a focused physical and neurological exam, and targeted imaging or labs when they will change the plan. Treating "back pain" without knowing whether it is discogenic, facet-mediated, or radicular is how patients spend years on treatments that were never going to work.
Non-opioid first. Current national guidelines, including those from the Centers for Disease Control and Prevention, recommend non-opioid therapies as first-line treatment for most chronic pain. Dr. Portes follows that standard: physical therapy, targeted exercise, anti-inflammatory and neuropathic medications, topical agents, weight management, sleep correction, and behavioral strategies come before any consideration of opioid therapy.
Treat the drivers, not just the sensation. Poor sleep, uncontrolled blood sugar, vitamin D deficiency, deconditioning, obesity, depression, and thyroid dysfunction all amplify chronic pain. As a family medicine physician, Dr. Portes can address all of them in the same visit — an advantage a single-organ specialist does not have.
Escalate deliberately. When conservative care is not enough, Dr. Portes coordinates referral to pain medicine for interventional procedures such as epidural steroid injections, facet blocks, or radiofrequency ablation; to orthopedics or spine surgery when structural correction is indicated; and to rheumatology or neurology when the underlying disease requires it. She remains your coordinating physician throughout.
Measure results. Function is the target, not just a number on a pain scale. Progress is tracked against what you can actually do — walk, sleep, work, lift a grandchild — and the plan changes when the numbers do not move.
Chronic Pain Treatment Options
Physical therapy and exercise prescription — the single best-evidenced treatment for chronic musculoskeletal pain, with referral to Miami-area therapists and a home program you can sustain.
Non-opioid medication management — NSAIDs, acetaminophen, topical diclofenac and lidocaine, muscle relaxants for short courses, and neuropathic agents such as gabapentinoids or duloxetine when nerve pain is the driver.
Metabolic and nutritional correction — glucose control for diabetic neuropathy, vitamin D and B12 repletion, anti-inflammatory nutrition guidance, and weight reduction, which measurably reduces load-related knee and back pain.
Sleep restoration — chronic pain and insomnia reinforce each other; breaking that loop is often the fastest functional win available.
Behavioral and psychological support — referral for cognitive behavioral therapy for chronic pain, which has strong evidence for reducing disability and distress.
Interventional referral — coordinated referral for injections, nerve blocks, ablation, or surgical evaluation when indicated.
Assistive and adjunct care — bracing, orthotics, TENS, heat and cold protocols, and activity pacing.
When to See a Doctor for Chronic Pain
Schedule an appointment if pain has lasted more than three months, is interfering with sleep or work, is not improving with over-the-counter medication, is accompanied by numbness, weakness, or tingling, has caused you to reduce your normal activity, or is being managed with escalating doses of medication.
Seek emergency care immediately for new loss of bowel or bladder control, progressive leg weakness, numbness in the groin area, unexplained weight loss with back pain, fever with back pain, or pain following significant trauma.
Why Chronic Pain Belongs in Primary Care
Patients often assume chronic pain requires a pain clinic from day one. For most people, that is the expensive path to the same answer.
The majority of chronic musculoskeletal pain responds to accurate diagnosis, structured physical therapy, correction of metabolic and sleep drivers, and appropriate non-opioid medication — all of which a board-certified family medicine physician is trained to deliver. Beginning with primary care also means someone is looking at the whole patient, which matters, because uncontrolled diabetes, low vitamin D, untreated sleep apnea, and depression are among the most common reasons chronic pain treatment fails.
Dr. Portes provides that foundation, and refers to interventional pain specialists precisely when the evidence supports it rather than by default.
FAQ
Frequently Asked Questions
Chronic pain is treated by family medicine and internal medicine physicians, pain medicine specialists, neurologists, rheumatologists, and orthopedic surgeons. For most patients the right starting point is a primary care physician who can diagnose the cause, begin conservative treatment, and refer to the correct specialist if needed. Dr. Lisette Portes provides this care in Miami.
Yes. Primary care physicians manage the majority of chronic pain in the United States. They diagnose the underlying cause, prescribe non-opioid medications, order physical therapy, treat contributing conditions such as diabetes and obesity, and coordinate interventional or surgical referral when conservative care is insufficient.
The practice follows a non-opioid-first approach consistent with CDC guidance. Opioids are not the starting point for chronic pain and are considered only in narrow circumstances, after other therapies have been tried, with clear goals, monitoring, and documented benefit.
Diagnosis begins with a detailed history of the pain's location, quality, timing, and triggers, followed by a physical and neurological examination. Imaging such as X-ray or MRI and laboratory testing are ordered selectively, when the result would change treatment.
Most patients notice measurable functional improvement within six to twelve weeks of a structured plan that combines physical therapy, medication, and correction of contributing factors. Chronic pain management is ongoing rather than a one-time cure, and the goal is sustained function.
Office visits, laboratory work, physical therapy referrals, and medications for chronic pain are covered by Medicare and most commercial plans. Coverage for specific procedures varies by plan — the office will verify benefits before referral.
Some causes of chronic pain can be resolved, particularly when there is a correctable structural or metabolic cause. For conditions like fibromyalgia and osteoarthritis, the realistic goal is substantial reduction in pain and a return to full daily function, which is achievable for most patients with consistent treatment.
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Get Answers About Your Chronic Pain — Book in Miami
Call 305-328-5079 to schedule with a trusted Miami chronic pain doctor.