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Disclaimer Please read this agreement carefully before reading the education resources on this website. This includes but not limited to Chronic Pain Education and Prevention Program, MyPainTools and the Opioid Safety Program. Here on these resources will be referred to as: the “Website”. By accessing or using the Website, you agree that you are at least 18 years old and competent to enter into this Agreement and to be bound by the Terms and Conditions below. If you do not wish to be bound by these terms and conditions, you should not access or use the Website. Terms and Conditions.The Website is not intended for rendering medical diagnoses, advice or recommendations. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. The contents of the Website, including any and all articles, comments, or correspondence is provided for informational purposes only. The information provided is not and does not claim to be a complete list of causes, symptoms, or treatments relating to chronic and/or acute pain, prevention and treatment, nor is it meant to provide all the needed information for pain prevention and treatment. The Website does not endorse or recommend any specific treatment, procedure, or product. Its sole purpose is to be one tool in increasing awareness and education. The information provided should not be used as a substitute for consultation with a qualified healthcare provider, who can thoroughly assess your medical condition and meet your individual medical needs. Always consult a medically trained professional with questions and concerns you have regarding your medical condition. No patient-physician or patient-provider relationship is created or intended to be created by or with the Website’s creators or contributors by making this information available to you. T his information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither creator of the content, owner of the website, owner of the clinic nor their associates (including, but not limited to, its employees, sponsors, owners, and the author(s) and/or publisher(s) of any content on the Website) are in any way responsible for the consequences of any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in the Website. Neither creator of the content, owner of the website, owner of the clinic nor their associates (including, but not limited to, its employees, sponsors, owners, and the author(s) and/or publisher(s) of any content on the Website) guarantee the accuracy of the information on this website. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, one must seek the advice of his or her physician or other health care provider. Do not begin any treatment or exercise regimen without first seeking the advice of a health-care professional. Any medical condition should be brought to the attention of, and discussed with, a qualified medical professional. It is your responsibility to seek emergency care or call your doctor if you have any concerns about your medical condition. We understand that living with chronic pain may cause feelings of anger, helplessness or depression. You understand and agree that if you are experiencing these feelings, you must contact a counselor, social worker, psychologist or psychiatrist for help. If you are considering hurting yourself or have thoughts of suicide, you must immediately call 911 and seek medical care. Although we believe the information on the Website to be accurate and timely, due to the rapid advances in the field of medicine and our reliance on information provided by outside sources, we make no warranty or guarantee concerning the accuracy or reliability of the content on the Website or other sites to which we link. When clinical matters are discussed on the Website, the opinions presented are those of the discussants only. The material discussed on the Website is not intended to present the only or necessarily the best medical advice, but rather presents the approach or opinion of the discussant. The Website and the information, software and other material available on or accessible from the Website is provided on an “as is” and “as available” basis without warranties of any kind, expressed or implied, including but not limited to warranties of title, non-infringement or implied warranties of merchantability or fitness for a particular purpose. The Website does not warrant that the Website service will be uninterrupted or error-free or that any information, software or other material available on or accessible through the Website is free of viruses or other harmful components. Under no circumstances shall the owners, associates, creators, sponsors, authors, or publishers of the Website be liable for any direct, indirect, incidental, special, punitive, or consequential damages that result in any way from your use of or inability to use the Website, your reliance on or use of the information, services or merchandise provided on or through the Website, or that result from mistakes, omissions interruptions, deletion of files, errors, defects, delays in operation, or transmission or any failure of performance. The owners, associate, creators, sponsors, authors, and publishers of the Website specifically disclaim any and all liability for injury and/or other damages that result from an individual using techniques discussed on the Website, whether a physician or any other person asserts these claims. By entering the Website, you agree to defend, indemnify and hold harmless the creator of the content, owner of the website, owner of the clinic and their associates, agents, sponsors, authors, and publishers from any and all claims, demands, liabilities, lawsuits, settlements, actions, damages and expenses (including without limitation, reasonable attorneys’ fees), whether or not litigation is commenced, arising from or related to any willful or negligent breach by you of any the Terms and Conditions of this Agreement. The owners, associate, creators, and sponsors reserves the right to change or modify these Terms and Conditions at any time, and you agree to give effect to such changes or modifications upon their being posted to the Website. By entering and participating in the use of the Website, you acknowledge that you are aware of these Terms and Conditions, that you understand these Terms and Conditions, and that you agree to be bound by them. If you do not wish to be bound by these terms and conditions, you should not access or use the Website.

Notice of Privacy Practices - Aviso de Practicas de Privacidad Please read this agreement carefully before reading the education resources on this website. This includes but not limited to Chronic Pain Education and Prevention Program, MyPainTools and the Opioid Safety Program. Here on these resources will be referred to as: the “Website”. By accessing or using the Website, you agree that you are at least 18 years old and competent to enter into this Agreement and to be bound by the Terms and Conditions below. If you do not wish to be bound by these terms and conditions, you should not access or use the Website. English Spanish Notice - Aviso Notice of Privacy Practices Aviso de Practicas de Privacidad

Health Insurance Plans Accepted Updated 7/29/24 Medical Groups (HMO): Scripps Coastal Medical Group Sharp Arch/Graybill Scripps Mercy Physician Partner Aetna HMO, EPO, POS, PPO Alignment Health PPO Anthem Blue Cross HMO, POS, PPO, Medicare Advantage HMO Beech Street PPO Blue Shield PPO, Covered CA, 65, CalPersEPO, Care Trust & Choice Care, HMO, Medicare, POS, Trio Cigna EPO, HMO, POS, PPO, Great West Coventry PPO First Health/CCN PPO GEHA PPO HealthNet HMO, POS, Medicare/Medi-Cal HMO, PPO, Covered CA CommunityCare Humana Choice Care PPO Integrated Health PPO, Medicare Medi-Cal, Medicare Assignmet Kaiser PPO Medicare/Medi-Cal Must be Medicare Primary patient eith Medi-Cal secondary only Mertian Health PPO MultiPlan PPO Optum Care Network <-- Accepted Health Plans PacifiCare . Private Healthcare Systems . St.Paul PACE . San Diego PACE . San Diego County Schools Fringe Benifits Consortium . SCAN Medicare Advantage HMO Scripps Employee HMO, EPO, PPO TRICARE Prime HMO/ CHAMPUS TriCare ExtraPPO, Prime HMO, Select PPO, Reserve PPO, TriCare for Life, Champus VA UMR PPO United Healthcare Choice POS, Commercial, HMO, Medicare Advantage HMO, PPO, EPO, NPPO, NPP, POS Personal Injury Lien Dr. Patel, Miller, Bonsal only

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Our nervous system is the most complex organs in our body. Because of this pain is very complex. Throughout our bodies are pain receptors, called nociceptors. These receptors are stimulated due to release of various chemicals by damaged tissue such as histamine, substance P, serotonin, bradykinin and prostaglandins. When stimulated, the nociceptors transmit the pain signal along sensory nerves to the spinal cord. In the spinal cord the impulses are processed by the dorsal horn and sent to the brain. Sometimes signals sent to the spinal cord communicate directly with motor nerves, to cause for example ones arm to quickly withdraw after touching a hot plate. This is called an automatic reflex and does not involve the brain or conscious thought. Most of the times pain signals are sent upwards in the spinal cord from the dorsal horn via ascending nociceptive tracts, such as the Spinothalamic tract. These tracts terminate in the medulla, midbrain and thalamus. Further processing in the thalamus leads to signals being sent to areas in the brain that control things such as heart rate, blood pressure and emotions. Thalamic neurons also project to regions of the cortex including the somatosensory cortex, were fine discrimination of pain occurs. We experience pain everyday when we get a paper cut, stub our toes or hit our funny bone. You may not want to believe it but pain is a protective mechanism. It tells us to pull away from a potentially damaging situation, like a hot pan. It warns us to take it easy and thus protects a damaged body part while it heals. Most of the time pain goes away once we remove the stimulus. Unfortunately sometimes pain persists despite removal of the stimulus. Other times pain starts in the absence of any detectable injury or stimulus. When pain last for prolonged periods of time and is uncontrolled it can start having a more devastating effect on ones quality of life that is far more destructive than the discomfort of the pain itself. But what is the difference in acute and chronic pain? Often acute pain has a sudden onset and is usually sharp in nature but can have other forms. It can be mild or severe in intensity and last a few seconds to months. Most of the time acute pain last less than 3 months and usually goes away once the underlying cause is treated or heals. When acute pain last longer than 3 months it is often considered chronic pain at this point. Chronic pain often persists besides the fact that there is no longer an identifiable stimulus. Pain signals in the nervous system remain active, and these effects can lead to both physical and emotional manifestations. Physically one can feel nausea, fatigue, muscle aches, decreased energy, and insomnia, among other things. Emotionally people can experience wide mood swings, depression, anger, anxiety, and a sense of being overwhelmed. These physical and emotion changes soon start affecting one’s ability to work, enjoy life, and perform activities of daily living. Patients soon become deconditioned and unable to functional.

Your doctor may often ask about changes in your function along with changes in your pain scores throughout your treatment. Often patients may report no improvement in pain scores, but when questioned further they will show a significant improvement in function, due to the treatments they received. As a patient it is important to evaluate yourself for improvement in function and not just improvement in pain. Increase in function can be a goal to focus on when deciding on treatment options to improve your overall quality of life. Having goals relating to increase in function can create more structure to ones management, as well as justification for use of medications and treatments. Goals that you set should be simple and reasonable, such as being able to complete a favorite hike, or being able to take one’s grandchildren fishing, etc.

You have probably hear the common saying, “You’re more likely to get in a car accident…” and the unfortunate thing is, car accidents are more common than any other risk you put yourself in every day. While most car accidents are minor, most people do not know the right steps to take if it happens. We compiled the step-by-step list for you so that you can be prepared if this unfortunate disaster happens to you or your loved ones. 1. STOP YOUR CAR If you can, pull over to the side of the road, do not leave your car or the scene of the accident in which you or your car are involved. If you leave, or fail to stop, you could be held liable for leaving the scene of a crime. No matter how slight the collision, or if it was not your fault. Also, if safely possibly, you will want to do whatever is necessary to warn oncoming traffic, in order to prevent further accidents. 2. ASSIST THE INJURED (FIRST AID ONLY) CALL 911 if anyone has been injured, and if you are able, provide first aid but only if you are qualified. Otherwise, leave it to the paramedics as you could do more harm than good. 3. CALL THE POLICE The police are trained to handle car accidents and report the facts. You will want to find out how you can obtain a police report from the investigating officer as it might help you in the long run once a liability claim is made. 4. IDENTIFY THE DRIVER This is one of the most important steps: Obtain the other driver’s name, address and registration number of the vehicle that he or she is driving. Also ask to see his or her driver’s license. If possible, obtain the name of the insurance companies and the policy numbers covering the other car(s) in the accident. They legally must provide this information or they could face a penalty. 5. WITNESS/ES If there are any witnesses, you will want to obtain their information as well. This could help your case down the road. 6. TAKE NOTES AND PICTURES You will likely forget details as time goes on. You will want to take notes, either in your phone note pad, or record yourself on your phone. Take pictures of the street, your car, and the other care if possible. 7. REPORTING TO THE DMV This step some times isn’t known by most people, but anything greater than $500 in damage must be reported to the DMV within 10 days! 8. SEEK TREATMENT You should definitely seek treatment right away! The pain could sneak up on you later as your body goes into a natural state of “numbing” immediately after trauma. Get medical attention as soon as you can, as well as your passengers. 9. CONSULT WITH AN ATTORNEY Call an attorney before giving any statements. Most insurance companies assume that individuals will not seek legal help and will offer a low-ball compensation for your losses. We have some amazing referrals in San Diego, Orange, Riverside, and Los Angeles counties if you would like one. Call our Personal Injury Coordinator at 760-681-4330 to discuss your case. In California, the statute of limitations for car accidents is two years. It is the same as that for other personal injury cases. … The two-year time period starts on the date of the accident, unless the accident resulted in the death of the victim. If the car accident did cause the death of the victim, then the statute of limitations starts on the date of the victim’s death.

As common as motor vehicle accidents are, the body was not designed to deal with force that occurs during a motor vehicle accident (MVA). Sadly, MVA’s are the leading cause of death in the 18-29 year old age range. Fortunately, they are not always deadly, but can leave lasting damage on the body that must be handled under the care of a medical professional. One of the most common injuries we see as a result of these accidents is back and neck pain, and are most of the time, acute circumstances. We begin by analyzing images on an MRI and the mechanisms of which the force originated from such as the twisting, bending and trauma of the incident. There are two categories of pain: radiating and non-radiating. Radiating would mean that the pain spreads throughout the buttocks or legs, whereas non-radiating means the pain remains in the area. The reason for separation is because they are treated differently. Non-radiating pain tends to lend itself to a less invasive treatment plan such as the services we provide at Coastal Pain, whereas radiating pain could lead to a surgeon’s treatment plan. We can refer our patients to a local and well-respected surgeon in the area if the need arises. The sorts of treatments that we do are more for non-radiating such a nerve and disc injections; for radiating we will do joint injections. If the pain remains after the injections have been performed, an evaluation of the patient and recommend more conservative therapies such as chiropractic or physical therapies. Our goal is to get our patients moving as soon as they are able. If things still do not improve after these measures have been taken, then a MRI may be in ordered to reevaluate the pain and do another series of injections. Finally a surgeon can get involved, if necessary. New emerging technologies for treating low back pain and regenerative medicine, include platelet rich plasma injections (PRP), which is a scientifically proven treatment that we do offer our patients in our clinics. Stem cell injections are typically done for big back surgeries and only a few commercial products offer this. We are hoping to have this available for our patients with radicular and acute low back pain and disc problems in about 1-2 years. To learn more about the treatments that we offer for our patients and discuss the right one for you, please visit us at one of our two clinic locations in Carlsbad and Mission Valley/San Diego.

The recent COVID-19 pandemic has caused many people to experience an increase in anxiety, confusion, and fear of the unknown. Many patients do not feel comfortable coming into the clinic to be seen, which is very understandable as a lot of our patients, in particular, are considered high-risk for contracting the virus. As an essential business in healthcare, we have made special accommodations to our patients and staff to make sure that we are creating a safe environment for everyone that enters our building including a screening tent, sending urine tests to patients’ homes, providing telehealth appointments for follow ups and prescription refills, social distancing of staff and patients, and extra sanitary measures and time in between patients for cleaning. Screening tent for all patients outside of our building is open 7am-4pm, Monday-Friday. Extra sanitary and cleaning measures are being performed in between patients.