Patient information

Accepted insurances

Accepted insurances

  • PacificSource
  • Regence (Blue Cross Blue Shield)
  • Providence Health Plan
  • Medicare
  • Aetna
  • Cigna
  • First Choice Health Network
  • United Health Care
  • Humana
  • Health Net
  • Workers Compensation
  • Personal Injury
  • Coventry/First Health/Multiplan/PHCS/BeechStreet, pending
  • US Dept of Labor & Industries
  • WA Dept of Labor & Industries
  • Medicaid (DMAP, DSHS) – Consultation only, prescription by PCP only.
  • CareOregon, pending

More insurances are being added. Please call regarding the most up-to-date list of accepted insurances.

Opioid prescription

Opioid prescription

Due to high risk of opioid abuse and overdose, please understand that all your oral opioid will be eventually converted to Buprenorphine in our clinic. It may be in the form of Butrans patch, Belbuca buccal film or Subutex tablets. We will provide comprehensive pain care to help you reduce your opioid requirement to the lowest possible dose.

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  • You must have a primary care provider (PCP).
  • While on prescribed opioids you may not use Benzodiazepines (Ativan, Valium, Xanax, etc) and Ambien, even if it is prescribed by another physician. You agree that we will be the only clinic prescribing opioid and other controlled substances.
  • All prescriptions and refills must be made with the same pharmacy.
  • You give consent for unscheduled urine toxicology screening (drug testing) on site or a third party laboratory.
  • You give consent for random pill counts with 48 hours notice.
  • You are responsible for notifying us at least three (3) business days before your narcotic medication runs out. You must call during regular office hours for your refills. Refills are not given after hours, on weekends, or on holidays.
  • You are required to attend all followup appointments scheduled for you. If you need to reschedule the appointment, you must call 48 hours in advance. If you fail to reschedule your scheduled appointment within the allotted amount of time you will be charged a noshow/cancellation fee of $50 for a follow up appointment and $100 for a procedure.
  • You may not use alcohol.
  • Failure to abide to any of the above may result in clinic discharge

Pain resources

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Pain resources

Resources for Living with Pain

This is a listing of resources relevant to those living with pain. Note: NAPI does not offer patient referrals, and links should not be construed as endorsement. NAPI is not responsible for information contained on 3rd-party sites.

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Organizations


American Chronic Pain Association

The mission of the ACPA is to facilitate peer support and education for individuals with chronic pain and their families so that these individuals may live more fully in spite of their pain, and to raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain.
http://www.theacpa.org

Australian Pain Management Association
APMA aims to offer pain-management options and information for people with persistent pain.
http://www.painmanagement.org.au/

Canadian Pain Coalition
The Canadian Pain Coalition is a partnership of pain consumer groups, health professionals who care for people in pain, and scientists studying better ways of treating pain.
http://www.canadianpaincoalition.ca/

Chronic Pain Australia
Organization dedicated to reducing the unnecessary suffering and isolation of people with chronic pain in Australia.
http://www.chronicpainaustralia.org.au/

Inspire Santé
Inspire Santé is a nonprofit that provides advocacy and education for pelvic pain disorders.
http://inspiresante.org/

Pain BC
Pain BC is a registered charity that is transforming the way chronic pain is understood and treated.
https://www.painbc.ca/

Patient Advocate Foundation
The Patient Advocate Foundation aims to provide effective mediation and arbitration services to patients to remove obstacles to healthcare including medical debt crisis, insurance access issues and employment issues for patients with chronic, debilitating and life-threatening illnesses.
http://www.patientadvocate.org

Pelvic Pain Support Network
The Pelvic Pain Support Network is a patient led organisation with a board of trustees who are all patients or carers. We are a registered charity.
https://www.pelvicpain.org.uk/

U.S. Pain Foundation
The mission of U.S. Pain Foundation is to empower, educate, connect, and advocate for people living with chronic conditions that cause pain.
https://uspainfoundation.org/

Publications and Electronic Resources

A Path Forward
The mission of A Path Forward is to raise awareness about persistent pain and to help people find effective ways to help manage their pain and live better lives.
https://www.facebook.com/APathFWD/

Adelaide Pain Support Network
The Adelaide Pain Support Network supports people with persistent pain. It is supported by the Adelaide Primary Health Network.
https://www.facebook.com/adelaide.painsupport/

eCentreClinic- Pain Course (Macquarie University)
The Pain Course is a FREE, online and internet-delivered pain management program designed to provide good information about chronic pain and to teach practical skills for managing the impact of pain on day-to-day activities and emotional wellbeing.
https://ecentreclinic.org/?q=PainCourse

eMedicine Health “Pain Management Center”
Collection of short articles about various pain related topics.
http://www.emedicinehealth.com/pain-management/center.htm

The Explain Pain Handbook: Protectometer
The Explain Pain Handbook brings the latest in pain science into an easily accessible book for patients and introduces the ‘Protectometer’ – a ground breaking pain treatment tool.
http://www.protectometer.com/

Live Move Be Yoga
Tami Link discusses the health enhancing benefits of mindful movement, yoga and Pilates.
https://livemovebeyoga.com/

Live Plan Be
Learn about the science behind chronic pain. Keep track of your symptoms and their impacts. Develop a plan for better pain management and quality of life. Connect with a like-minded community of others who live with pain.
https://www.liveplanbe.ca/

My Cuppa Jo
My Cuppa Jo is Joletta Belton’s blog about how pain science education, movement, nature, loving and being loved, mindfulness, effective communication, and being more creative have helped her to change her pain and how she thinks these things can help others, too.
http://www.mycuppajo.com/

The Mystery of Chronic Pain
We think of pain as a symptom, but there are cases where the nervous system develops feedback loops and pain becomes a terrifying disease in itself. Starting with the story of a girl whose sprained wrist turned into a nightmare, Elliot Krane talks about the complex mystery of chronic pain, and reviews the facts we’re just learning about how it works and how to treat it.
https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain?language=en

NHS Choices “Living with Pain”
Information site by the UK’s National Health Service.
http://www.nhs.uk/Livewell/Pain/Pages/Painhome.aspx

Pain Care for Life
For those living with chronic pain, the Pain Care for Life program offers guided practices that can help you manage your pain, move with more ease and get back to life.
https://lifeisnow.ca/

Pain Chats
Understanding pain, and how to treat it, is your first step to living well again. Discover the advice that helps people recover from long-term pain.
https://painchats.com/

Pain-Ed.com
The mission of pain-ed.com is to inform both the public and health care practitioners about the latest pain research and to dispel common myths about pain and provide hope for change.
http://www.pain-ed.com/

painHEALTH
Clinically supported information, tips, support and personal stories to help manage musculoskeletal pain.
https://painhealth.csse.uwa.edu.au/

Pain Management Network
This website is designed to help you gain a better understanding of your pain. The site contains information to enable you to develop skills and knowledge in the self management of your pain in partnership with your healthcare providers.
https://www.aci.health.nsw.gov.au/chronic-pain

Pain Revolution
Pain Revolution is on a mission to help all Australians access community-based pain education through the Local Pain Educator Program. Pain Revolution also holds a virtual Lived Experience Community of Practice and provides online resources for those living with pain.
https://www.painrevolution.org/

Pain Toolkit
The Pain Toolkit is a simple information booklet that could provide you with some handy tips and skills to support you along the way to managing your pain.
http://www.paintoolkit.org/

PainTrain
PainTrain’s mission is to enable chronic pain patients to summarize information about their condition and to easily share it with whoever they choose including health care practitioners, carers, family and friends.
https://pain-train.com.au/

Partnering with Your Healthcare Professional
The 2020 Global Year for the Prevention of Pain includes an infographic and fact sheet for those living with pain.

Pelvic Guru
The mission of Pelvic Guru is to provide information about pelvic health to a global community in order to improve access to skilled healthcare providers, education, and online resources while normalizing conversations and reducing shame and embarrassment for those who live with their own pelvic health issues.
https://pelvicguru.com/

Personalized Activated Care & Training
Personalized Activated Care Training (PACT) can help patients achieve long-­term healing of their pain condition before it becomes chronic and causes personal suffering, life interference, addiction, and disability. Personal toolkits for preventing chronic pain and addiction are available at www.preventingchronicpain.org.

People in Pain Network
People in Pain Network is a non-profit organization that promotes well-being for people living in persistent pain and those who care about them, by strengthening self-management programs, access to resources, and community support.
https://www.pipain.com/

PhysioYoga
PhysioYoga Therapy is an approach to rehabilitation that combines evidence informed Physical Therapy and yoga therapy, resulting in a holistic or biopsychosocial approach to your rehabilitation experience.
https://physioyoga.ca/

PubMed Health “How to read health news”
Brief article about how to critically examine health news in order to separate facts from hype.
http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/how-to-read/

Retrain Pain
Retrain Pain was founded by three New York based physical therapists who teamed up to build an organization devoted to free online pain education.
https://www.retrainpain.org/

Tame the Beast
Starting with the incredible knowledge of the human pain system, the creators wanted to communicate hope and give people evidence-based direction to guide their recovery from pain.
https://www.tamethebeast.org/

This Way Up: Chronic Pain-Reboot
This is an online Chronic Pain Course developed in conjunction with the Department of Pain Medicine at St Vincent’s Hospital, Sydney for adults who have been experiencing chronic pain. The course takes a multidisciplinary approach to pain management and is based on the effective Cognitive Behavioural Therapy (CBT) model. In this course you will learn CBT skills to help better manage your chronic pain and improve your quality of life.

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Procedural information

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Procedural information

Lumbar epidural steroid injection

Learning About Lumbar Epidural Steroid Injection

What is a lumbar epidural steroid injection?

A doctor may give you a lumbar epidural steroid injection to try to decrease pain, tingling, or numbness in your back, buttock, or leg. These might be the result of a back or disc problem.

The injection goes directly into your epidural space. This is the area in your back around your spinal cord. This procedure is similar to the epidural injection when women give birth.

This injection may have both a local anesthetic and a steroid medicine. Or it may only have a steroid. Local anesthetic medicines numb your nerves right away for a short time. Steroids reduce swelling and pain. But they take a few days to start working.

Some people get a series of these injections over several months.

How is a lumbar epidural done?

The doctor may use MRI imaging test before your injection. These tests can show where your nerve problems are.

During the day of epidural steroid injection, your doctor will use X-ray to locate the ideal location for injection based on the X-ray finding.

After finding the right spot, the doctor may inject a numbing medicine into the skin where you will get the steroid injection. Then he or she puts the needle for the steroid into the numbed area. You may feel some pressure. You could feel some stinging or burning during the injection.

It takes about 10 to 15 minutes to get this injection. You will probably go home about 20 to 30 minutes after you get it. You will need someone to drive you home.

What can you expect after a lumbar epidural?

If your injection had local anesthetic and a steroid, your legs may feel heavy or numb right after. You will probably be able to walk. But you may need to be extra careful. Take care not to lose your balance and be sure to follow your doctor’s instructions.

If your injection contained local anesthetic, you may feel better right away. But this pain relief will last only a few hours. Your pain will probably return. This is because the steroids have not started working yet. Before the steroids start to work, your back may be sore for a few days.

These injections don’t always work. When they do, it takes 1 to 5 days. This pain relief can last for several days to a few months or longer.

You may want to do less than normal for a few days. But you may also be able to return to your daily routine.

Some people are dizzy or feel sick to their stomach after getting this injection. These symptoms usually do not last very long.

If your pain is better, you may be able to keep doing your normal activities or physical therapy. But try not to overdo it, even if your back pain has improved a lot. If your pain is only a little better or if it comes back, your doctor may recommend another injection in a few weeks. If your pain has not changed, talk to your doctor about other treatment choices.

Side effects from an epidural steroid injection include headache, fever, or infection. Serious side effects are rare. But they can include stroke, paralysis, or loss of vision.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Lumbar medial branch block and radiofrequency ablation

Learning About Medial Branch Block and Radiofrequency Ablation

What are medial branch block and radiofrequency ablation?

Just like shoulders and knees, your back is connected by many joints, called facet joints. Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic (long-term) pain in the neck or back. They can also sometimes affect the shoulders, arms, buttocks, or legs.

Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

Radiofrequency ablation of the medial branch is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to numb the nerves in your neck or back so that they can no longer send pain messages to your brain.

Before your doctor knows if a radiofrequency ablation will help you, they will do a medial branch block to find out if certain nerves are the ones that are a source of your pain. You will need two separate visits to the outpatient center or hospital to have both procedures.

How is a medial branch block done?

The doctor will use a tiny needle to numb the skin where you will get the block. Then they puts the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, the doctor injects medicine onto one or more nerves to make them numb.

If you get relief from your pain in the next 4 to 6 hours, it’s a sign that those nerves may be contributing to your pain. The relief will last only a short time. You may then have a medial branch radiofrequency ablation at a later visit to try to get longer relief. Please inform your physician how much pain relief you had from the procedure so that it can be documented and proceed with the radiofrequency ablation if indicated.

It takes 20 to 30 minutes to get the block. You can go home after the doctor watches you for about an hour. You will get instructions on how to report how much pain you have when you are at home.

You will need someone to drive you home.

How is medial branch radiofrequency ablation done?

The doctor will use a tiny needle to numb the skin where you will get the neurotomy. Then he or she puts the radiofrequency needle into the numbed area. You may feel some pressure. Using fluoroscopy (live X-ray) to guide the needle, the doctor sends radio waves through the needle to the nerve for 60 to 90 seconds. The radio waves heat the nerve, which damages it. The doctor may do this several times. And he or she may treat more than one nerve.

It takes 20 to 40 minutes to get a neurotomy, depending on how many nerves are heated. You will probably go home 30 to 60 minutes later.

You will need someone to drive you home.

What can you expect after a radiofrequency ablation?

You may feel a little sore or tender at the injection site at first. But after a successful neurotomy, most people have pain relief right away. It often lasts for 6 months or longer. Sometimes the pain relief is permanent.

If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Cervical Medial Branch Block/Radiofrequency Ablation

Learning About Medial Branch Block and Radiofrequency Ablation

What are medial branch block and radiofrequency ablation?

Just like shoulders and knees, your back is connected by many joints, called facet joints. Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic (long-term) pain in the neck or back. They can also sometimes affect the shoulders, arms, buttocks, or legs.

Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

Radiofrequency ablation of the medial branch is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to numb the nerves in your neck or back so that they can no longer send pain messages to your brain.

Before your doctor knows if a radiofrequency ablation will help you, they will do a medial branch block to find out if certain nerves are the ones that are a source of your pain. You will need two separate visits to the outpatient center or hospital to have both procedures.

How is a medial branch block done?

The doctor will use a tiny needle to numb the skin where you will get the block. Then they puts the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, the doctor injects medicine onto one or more nerves to make them numb.

If you get relief from your pain in the next 4 to 6 hours, it’s a sign that those nerves may be contributing to your pain. The relief will last only a short time. You may then have a medial branch radiofrequency ablation at a later visit to try to get longer relief. Please inform your physician how much pain relief you had from the procedure so that it can be documented and proceed with the radiofrequency ablation if indicated.

It takes 20 to 30 minutes to get the block. You can go home after the doctor watches you for about an hour. You will get instructions on how to report how much pain you have when you are at home.

You will need someone to drive you home.

How is medial branch radiofrequency ablation done?

The doctor will use a tiny needle to numb the skin where you will get the neurotomy. Then he or she puts the radiofrequency needle into the numbed area. You may feel some pressure. Using fluoroscopy (live X-ray) to guide the needle, the doctor sends radio waves through the needle to the nerve for 60 to 90 seconds. The radio waves heat the nerve, which damages it. The doctor may do this several times. And he or she may treat more than one nerve.

It takes 20 to 40 minutes to get a neurotomy, depending on how many nerves are heated. You will probably go home 30 to 60 minutes later.

You will need someone to drive you home.

What can you expect after a radiofrequency ablation?

You may feel a little sore or tender at the injection site at first. But after a successful neurotomy, most people have pain relief right away. It often lasts for 6 months or longer. Sometimes the pain relief is permanent.

If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Cervical Epidural Injection

What is a cervical epidural injection?

A cervical epidural injection is a shot of medicine in your neck. The injection goes into the area around the spinal cord in your neck.

A doctor may give it to you to help with pain, tingling, or numbness in your neck, shoulder, or arm.

This injection may have both a steroid, which reduces swelling and pain, and a local anesthetic, which numbs the nerves. Or it may only have a steroid.

Some people get a series of these injections over weeks or months.

How is a cervical epidural done?

The doctor will use a tiny needle to numb the skin where you are getting the injection.

After the skin is numb, your doctor will use a larger needle for the epidural injection. He or she may use X-ray or ultrasound to help guide the needle. You may feel some pressure. But you should not feel pain.

It takes about 10 to 15 minutes to get this injection. You will probably go home about 20 to 30 minutes after you get it. You will need someone to drive you home.

What can you expect after a cervical epidural?

If your injection included local anesthetic medicine, your neck, shoulder, arm, or hand may feel heavy or numb right after the shot.

With a local anesthetic, your pain may be gone right away. But it may return after a few hours. This is because the steroid hasn’t started working yet. Before the steroid starts to work, your neck, shoulder, or arm may be sore for a few days.

These injections don’t always work. When they do, it takes 1 to 5 days. The pain relief can last for several days to a few months or longer.

Some people are dizzy or feel sick to their stomach after getting this shot. These symptoms usually don’t last very long.

You may want to do less than normal for a few days. But you may also be able to return to your daily routine.

If your pain is better, you may be able to keep doing your normal activities or physical therapy. But try not to overdo it, even if your pain has improved a lot. If your pain is only a little better or if it comes back, your doctor may want you to get another injection in a few weeks. If your pain has not changed, talk to your doctor about other treatment choices.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Occipital nerve block

What is an Occipital Nerve Block?

An Occipital Nerve Block is a procedure used to diagnose and treat pain. A local anesthetic and steroid are injected into the nerves at the back of the head, just above the neck. These nerves may play a role in pain in the back, top, or front of your head.

Why do I need an Occipital Nerve Block?

It helps to diagnose the source of your pain.

It gives temporary pain relief.

It improves your ability to complete your physical therapy sessions.

What are the possible risks?

Bleeding and bruising. You may need to modify your medication routine before the procedure. Please review the list of drugs that may increase the risk of bleeding.

Headache.

Steroid-related side effects which include:

Weight gain.

Increased blood sugar, especially in people with diabetes.

Water retention.

Cortisone production stopping in the body.

Rash/allergic reaction to drugs and soap used for the procedure.

Temporary increase in pain.

The following side effects may also occur, but are rare:

Infection

Nerve damage

What should I expect?

The main objective is to diagnose the source of your pain.

Pain relief can last 3 hours or much longer.

Afterwards, to evaluate your response to the procedure, you will be asked to perform activities that caused you pain before the procedure.

You will be asked to keep a Pain Diary to record pain levels.

How can I prepare for this procedure?

What can I expect during the procedure?

An ultrasound machine will be used to locate the injection site.

Your skin will be marked and numbed with a local anesthetic. The anesthetic may sting for a few seconds.

You will be asked to keep still until after the injection is complete.

Using the ultrasound for guidance, the doctor will insert the needle, targeting the nerve.

You may feel an increase in pain, indicating the needle is in the right place.

Medicine is injected through the needle.

You may feel a temporary increase in pressure or pain during the procedure.

What should I expect after the procedure?

You should notice the pain is reduced fairly quickly.

You will be asked to do activities that normally cause pain (such as head movement or walking) as soon as possible. You’ll note your pain and functioning in the diary.

A responsible adult must drive you home.

You may feel numbness and tingling in your legs. It should go away in a few hours.

If have pain at the injection site, apply ice for 10-15 minutes up to 5 times a day.

Do not soak in a bath for 24 hours to allow for healing. You may take a shower or sponge bath.

Do not do any vigorous activity on the day of the injection. Light activity is okay. You can resume your normal activities the day after the injection.

Follow your healthcare provider’s recommendations for physical therapy, prescription medications, and behavioral therapy.

Trigger point injection

Trigger point injection

What are trigger point injections?

A trigger point is a painful knot in a tight band of muscle. A trigger point often causes pain to be felt in other areas, too. For example, a trigger point in the neck or upper back can cause pain in the head.

Trigger point injections are shots of medicine into these knots to help relieve the pain. The medicines are usually local anesthetics like lidocaine.

Trigger point injections are often part of plan that includes other treatments, such as muscle stretching and strengthening.

How is a trigger point injection done?

Your doctor first locates a trigger point by pressing around the painful area. This may cause your muscle to hurt or twitch. This tells the doctor that he or she has found the spot to do the injection.

The area is cleaned. Your doctor then injects the medicine into the trigger point. He or she may inject the medicine in more than one direction within the trigger point. The doctor may change direction without removing the needle.

If you have more than one trigger point in the muscle, your doctor may repeat the process.

Your doctor may stretch the area to help the muscle relax. He or she may also show you how to move and stretch the muscle yourself.

The procedure takes about 10 to 30 minutes. How long it takes depends on how many trigger points are treated. But an injection itself takes only a few moments.

What can you expect after a trigger point injection?

The area may feel a bit numb for a few hours. It may also feel sore. Other problems from trigger point injections are rare. There is a chance of skin infection at the injection site. And if injections are done in the chest area, there is a small risk of puncturing the outer lining of the lung (pneumothorax).

Trigger point injections may reduce some or all of your pain. But the pain can come back after the medicine wears off. If your pain comes back, your doctor may suggest more shots or other treatment for longer-lasting relief.

Follow your doctor’s instructions carefully. And tell your doctor about any new or unusual symptoms, such as chest pain or shortness of breath.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

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