NAD+ (nicotinamide adenine dinucleotide) is a coenzyme present in every cell of the body, essential for mitochondrial ATP production, DNA repair, and the activation of sirtuins — a family of proteins that regulate cellular stress response, inflammation, and aging. NAD+ levels decline measurably with age, chronic illness, and sustained physical or neurological stress. This depletion contributes to mitochondrial dysfunction, increased oxidative damage, and reduced cellular resilience — processes that are directly relevant to chronic pain, neurodegeneration, and post-procedural recovery.
At Modal Pain Management, NAD+ infusions are prescribed and monitored by Dr. Movshis, a board-certified anesthesiologist and pain management specialist. Unlike wellness lounges that offer NAD+ as a generic “anti-aging” drip, our approach is grounded in clinical dosing, patient-specific protocols, and medical oversight throughout the infusion.
Why Physician Supervision Matters for NAD+
NAD+ infusions carry real physiological effects that require medical management. Infusion rate must be carefully titrated — too fast, and patients experience chest tightness, nausea, flushing, and significant discomfort. At therapeutic doses (250-500mg), the infusion takes 90-120 minutes precisely because the rate must be controlled to maintain patient comfort and cardiovascular stability. Dr. Movshis adjusts the infusion rate based on your tolerance, monitors vital signs, and is immediately available to manage any adverse reactions — a level of oversight that NP-run IV bars and mobile services cannot provide.
Clinical Applications
While NAD+ is widely marketed for “anti-aging” and “energy,” the more compelling clinical applications include:
- Chronic pain and neuroinflammation — NAD+ supports mitochondrial function in sensory neurons and modulates inflammatory signaling pathways (NF-κB, PARP) that contribute to chronic pain states. For patients with neuropathic pain or treatment-resistant pain conditions, NAD+ infusions may provide an adjunctive benefit alongside interventional procedures.
- Post-procedural recovery — After nerve blocks, epidural injections, or radiofrequency ablation, cellular repair mechanisms are activated. NAD+ provides the substrate these repair pathways require, potentially enhancing recovery and treatment durability.
- Cognitive clarity and neurological support — NAD+ is neuroprotective through its role in DNA repair, mitochondrial biogenesis, and sirtuin-mediated stress response. Patients experiencing brain fog, cognitive fatigue, or the neurological effects of chronic pain often report meaningful improvement.
- Metabolic optimization — NAD+ regulates key metabolic enzymes and supports healthy insulin signaling. For patients in our weight loss program or managing metabolic syndrome alongside chronic pain, NAD+ infusions complement their broader treatment plan.
Dosing Protocol
NAD+ 250mg — $400
The standard clinical dose, appropriate for patients beginning NAD+ therapy or seeking ongoing maintenance support. Infusion time is approximately 90 minutes at a controlled drip rate. Most patients tolerate this dose well and report improved energy, mental clarity, and reduced pain perception within 24-48 hours.
NAD+ 500mg — $500
The high-dose protocol for patients seeking maximum therapeutic effect — particularly those managing chronic pain, recovering from significant physical stress, or pursuing intensive cellular optimization. Infusion time is approximately 120 minutes. This dose delivers more pronounced and longer-lasting effects on mitochondrial function and sirtuin activation.
What to Expect
Before your first NAD+ infusion, Dr. Movshis will review your medical history, current medications, and treatment goals to determine the appropriate dose and protocol. During the infusion, you’ll be seated comfortably in a private treatment room. The drip rate is started slowly and increased gradually based on your tolerance. Some patients experience mild flushing, warmth, or chest awareness as the infusion progresses — these sensations are normal and resolve when the rate is adjusted. Most patients describe feeling deeply relaxed during the session and notice improved energy and clarity within the first day.
Recommended Treatment Schedule
For chronic pain patients and those seeking meaningful clinical benefit, Dr. Movshis typically recommends an initial loading phase of 2-4 weekly infusions, followed by monthly maintenance sessions. The specific schedule is tailored to your condition, response, and treatment goals. NAD+ therapy integrates naturally with our interventional pain procedures — many patients schedule their infusion on the same day as a follow-up visit.
Important Considerations
NAD+ infusions are not appropriate for patients with active malignancy, uncontrolled hypertension, or known hypersensitivity to NAD+ compounds. Patients who are pregnant or breastfeeding, or who take medications affecting mitochondrial function, should discuss this with Dr. Movshis before treatment. All patients receive a medical screening before their first infusion.