Join Tame the Pain

Contact Information

1. First Name*
2. Last Name*
3. E-mail Address*
4. Phone Number
5. Address 1*
6. Address 2
7. City*
8. State* Please Select AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NV NH NJ NM NY NC ND NE OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY ---Provinces--- AB BC MB NB NL NT NS NU ON PE SK YT
9. ZIP Code*

Your pain history

By giving us some background about you and your pain, we may be able to better provide information specific to your needs.

1. Approximately how long have you been experiencing pain?*
   Less than 6 months
   6 months or more
2. Which of the following pain management treatments are you currently using? (Select all that apply.)*
   Oral medications
   Physical therapy and/or chiropractic care
   Currently between 1 and 2 months of injection therapy
   Have had more than 2 months of injection therapy
   Corrective surgery
   Neurostimulation trial/screening test
   Drug delivery trial/screening test
   Implanted with a Medtronic neurostimulation or drug delivery system
   Implanted with a non-Medtronic neurostimulation or drug delivery system
   None of the above
3. Are you satisfied with the level of pain relief you receive from your current treatment?*
   Yes
   No
4. Are you currently experiencing intolerable side effects from your current treatment?*
   Yes
   No