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Wow. I am glad I came across this. This would make sense why my pain management doc ended up giving me a spinal block for my ankle pain and put me on tramadol and told me to seek physical therapy. When I got the bill from pain management for the spinal block, I learned that I have to pay $288.00 for each spinal block and he wanted to do this to me every month or so. Thats's ALOT of money to pay!! I cannot afford that on top of co-pays for physical therapy!! It bad enough hosptial bills are coming in for my gallbladder surgery that lead to complications, and money is extremely tight. we shouldnt have to pay all this money in order to obain a prescription for oral pain relief. Its insane!