Pacific Pain Treatment Center is a multi-disciplinary practice of pain medicine. It was established in 1987 by Dr. Elliot Krames. Most likely, you have been sent to see Dr. Elliot Krames, Medical Director of PPTC or to Dr. Carlo S. Esteves, by your referring physician, insurance representative, or representing attorney for your pain care.

You should be advised that PPTC is a teaching institution. Because we are a teaching institution, actual face-to-face care at our institution is provided by our Fellows-in-Training. Our fellows are all Board eligible or Board certified physicians in anesthesia, physical medicine and rehabilitation, family practice, internal medicine, surgery, psychiatry, or neurology. These Fellows-in-Training come to PPTC to learn pain medicine from Dr. Krames and his associates and spend two years in their training. Dr. Krames and his associates provide clinical guidance to the Fellows-in-Training regarding patient care issues and oversight regarding all patient care.

You may or may not see Dr. Krames or his associates personally, but, please know that they are involved in all patient care issues through direct discussions with Fellows and involvement in interdisciplinary care plan meetings. They review your presentation, your MRI's or Xrays, previous reports of procedures if applicable and discuss thoroughly your treatment plan at the interdisciplilnary team meeting. If you personally need more personal attention than that provided by PPTC, please advise your referring physician, insurance representative, or representing attorney that you would like to be referred a non-teaching pain care institution.

All patients referred to PPTC must have a physician or workers compensation adjuster referral. Once a referral and medical records are received by our new patient coordinator, an appointment will be made to see one of the physicians at PPTC. Patients will not be seen without appropriate medical records sent from either a referring physician or referring workers compensation adjuster. All patients, before being seen for the first time, must in a timely manner complete our first initial visit questionnaire and sign the "expectation of care" document.

If, however, you are sent to one of the doctors of PPTC to provide a nerve block or injection and not for chronic pain management, interdisciplinary evaluations will not be necessary. You will be able to be scheduled for your procedure as soon as possible.

At your first visit to PPTC, you will first be seen by a representative of our office who will ask you for insurance and personal information. You will then be seen by a Fellow-in-Training who will review your medical records and perform a structured, pain related physical examination appropriate for your pain problem. The Fellow will present your problem to Dr. Krames or one of his associates and your presentation will be reviewd.

PPTC very strongly believes that appropriate chronic pain care must be interdisciplinary, requiring the expertise of differing health care professional to provide to you, our patient, the best pain care that is available anywhere today in the USA, if not the world. If your insurance does not authorize interdisciplinary care at our center, unfortunately, we may not provide care to you at our institution. All patients must adhere to our "Expectation of Care" document (Click to read). This document was created so that all of our patients, prospective and active, understand how the clinic works and what is to be expected of our patients, while at the clinic. If you are accepted as a patient by PPTC, at one point in time, if our clinical staff and interdisciplinary care team feel that you have reached maximal pain care status, you may be referred back to your referring physician for further medication management.

Read PPTC's Expectation Of Care Document

Download PPTC's Forms and information for new patients (pdf)

Our services include a wide variety of interventions for both the diagnosis and treatment of difficult pain problems for patients with non-malignant pain and pain of terminal illness (cancer and AIDS).

The goals of our pain treatment therapies are to:

• Decrease intensity of your pain
• Improve your physical and emotional functioning
• Reduce your personal suffering
• Reduce drains on scarce health care dollars spent on diagnosing and treating difficult pain problems

Our goals are met utilizing both diagnostic and therapeutic expertise learned from 30 years of experience in treating patients with chronic pain in a logical, step-wise manner using a PAIN TREATMENT CONTINUUM. Treatment modalities used to meet our goals for treating patients with chronic pain include cognitive and behavioral therapies, functional restorative therapies, pharmacologic therapies, interventional therapies and complimentary medicine.

Because care-givers who care for patients in pain may have a different perspective on pain, have different knowledge bases or skills to diagnose chronic pain conditions and have differing capabilities or differing "tools" in their own personal tool box, patients with chronic pain must know that, depending on whom they see to manage their pain, they may be given different diagnoses and different treatment care plans. There is a saying that is appropriate here; "if you are a hammer, everything looks like a nail."

Physicians and patients, alike, should also know that not all physicians who call themselves pain physicians know all or use all of the possible "tools of the trade" to treat patients in pain. Some physicians only practice non-invasive pain management and some physicians only offer invasive therapies. Some physicians offer both non-invasive and invasive therapies in their practice. PPTC is proud of the fact that we are an interdisciplinary pain treatment center that provides, to our patients, all of the "tools of the trade," both invasive and non-invasive therapies, in a logical step-wise manner.

Thinking Algorithmically: Using a Pain Treatment Continuum

An algorithm is a step-by-step plan to achieve a goal. We, at PPTC, use an algorithmic approach to the logical use of pain treatments. This algorithm suggests using more non-invasive, less costly therapies before resorting to more invasive and more costly therapies. We call this algorithm, a PAIN TREATMENT CONTINUUM. This medical principle of using less invasive and less costly therapies before using more invasive and more costly therapies to treat patients is called the KISS principle (keep it sweet and simple). See figure 1.

Figure #1; The Pain Treatment Continuum is a suggested algorithm (step by step plan) for the appropriate use of possible pain management therapies. These therapies are listed in order of increasing invasiveness. These therapies can be used one at a time or more than one can be used at one time. An example of using more than one suggested therapy, at one time, is the patient who continues to have back and leg pain after back, spinal surgery who is on aspirin, Vicodin, an antidepressant such as Elavil, who is participating in physical therapy and a psycholgically oriented pain management program. This patient may also have had an epidural steroid injection in his/her back to allow her/him to participate in physical therapy.