Pain Assessment

 

The following is an interactive tool to provide Dr. Pappolla with key information regarding your current condition and medical history. The St Michael's clinic staff will then be able to contact you with probable differential diagnoses for your pain or headache problem and treatment options. Dr. Pappolla will review and study the information you provide. We will personally respond to each intake form. If for any reason you are unwilling to provide any personal information, please feel free to contact us directly at (832) 448-0706 and we will be happy to send you a copy of our free pain report.

Please fill out this form to the best of your abilities. If you are having any difficulties or have any specific questions contact Dr. Pappolla's office at (832) 448-0706 for assistance. If you are experiencing an emergency, DO NOT use this form and call 911 or go to the nearest emergency room.

This is for educational purposes only and should not be used in place of a formal medical examination. By participating in this activity you agree to release Dr. Pappolla of any liability whatsoever. This is a free service to our community and you have no further obligation.

* Required fields
Name *
E-mail Address *
Age *
Best Phone Contact *
Address 1
Address 2
City
State
Zip Code
Occupation
Date When Pain Began *
Where Is Your Main Pain Located *
Was Pain Related to Trauma *
Does Pain Radiate to Arms or Legs *
Describe your pain using these options *
Average pain level from 0 to 10 *
Medical History *
 *
 *
Describe your symptoms in 50 words or less *


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*Common conditions treated include at our clinics: back and spine pain caused by disk degeneration,neck and lower back pain caused by facet disease and arthritis or spondylosis (a synonym of arthritis or degenerative joint disease), back pain due to injuries,back pain due to trauma,leg pain due to sciatica also called radiculopathy,back and spine deformities associated with pain,complex back pain syndromes (co-existence of various causes for your pain sometimes associated with deconditioning, gait or balance abnormalities), lumbago, disk herniation, disk protrusion, slipped disk, root compression or pinched nerves,cervical or neck pain,fibromyalgia, back pain due to osteoporosis,low back pain and spine pain due to fractures,neck pain due to neurological disorders such as dystonia, neck or back pain following prior failed surgeries (failed back syndrome), back pain and neck pain associated with fibromyalgia, back and neck pain associated to myofascial pain syndrome, sciatica, slipped disks, degenerated disk, herniated disks, nerve compressions, carpal tunnel syndrome, neck pain or back pain associated with rigidity due to neuromuscular disorders such as parkinsonism and others. Neuropathy associated with metabolic disorders or diabetes. Migraine and refractory headaches, daily headaches, daily migraine, atypical migraine syndrome and atypical facial pain. Complex regional pain syndrome also called RSD or regional sympathetic dystrophy. Post-herpetic neuralgia. Trigeminal neuralgia.  For more information on these conditions we recommend downloading and reading our Free Pain Report or visiting the web sites of reputable non profit organizations which provide unbiased information of the efficacy of various treatments available for your condition (some of the organizations we recommend are listed on the "links" page in this site.

For your protection

The internet is one of the greatest informational tools of our time. However, the abundance of information obtained, sometimes ambiguous or unverified, can lead to confusion or misinformation. For additional education on the mentioned terms (below) related to spine conditions we recommend that you also visit the LINKS page which will direct you to highly reputable non-profit organizations where you can do your own additional research independent of any bias. To this end, we also prepared a Pain Report for educational purposes.  The information retrieved on searches using these terms is sometimes unverified by clinical trials or other evidenced-based medicine standards. For education on these terms, we highly recommend also (in addition to visiting the medical societies as mentioned above) to obtain information from other reputable sources such as the National Institutes of Health web site, WebMD or the American Medical Association website. You can then make an educated decision for yourself as to which information will conform with current standards of medical care in this country. Finally, note that most patients will use the term "doctor" on their searches. Remember to visit our page "about us". Therein, we describe what is considered acceptable regarding the credentials of a treating doctor. Often, your own primary care physician can be the best source for the answers to your questions.Common terms used by the public in the internet for searching information related spinal conditions frequently include: back pain doctor,back pain injuries,back pain trauma, spine doctor. Similar terms like lumbar back pain,pain orthopedics,pain specialist,back strain or back surgeons are frequently used in searches. Please use the listed non profit organizations to find additional information also when searching for "cervical pain or neck pain ,fibromyalgia,neuropathy, pinched nerve, slipped disk or back problems".

Thank you for your attention.

Discogenic Pain | Degenerative Disc Disease | Herniated Disc | Nucleus Pulposus | Spinal Stenosis | Spondylolysis |   Spondylosis | Fibromyalgia Syndrome | Osteoporosis | Vitamin D Deficiency | Sacroiliac Joint Dysfunct | Sciatica Pain | Chronic Pain Management | Epidural Injections | Joint Injections | Facet Joint Injections | Discography | Prolotherapy | Physical Therapy | Trigger Point Injections | Neck Pain | Platelet Rich Plasma

 

HOUSTON: 2646 S. Loop West Fwy. Suite 104. Houston, Texas 77054. Phone: 713-661-0300
PASADENA: 5413 Crenshaw, Pasadena, Texas 77505
 

Miguel Pappolla included in America's Top Physicians REQUEST AN APPOINTMENT (we will contact you within 24 hr. or on Mondays for appointments made on weekends) 

DO NOT USE THIS FORM FOR EMERGENCIES.

 

 

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