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The ENSO Pain Management Program is ideal for chronic back pain. Participants in the ENSO program will receive a non-invasive neuromodulation device along with coaching, monitoring and support.

If you are an adult (over 18) and have had chronic back pain for more than 6 months, you will be evaluated across a number of criteria. Please fill out the questions below as an initial assessment of your eligibility for the program.

1

On a scale of 0-10, what is the severity of your daily average pain without pain medications?

No pain at all

Worst pain

0=No pain at all, 10= worst pain

2

On a scale of 0-10, what is the severity of your daily average pain while taking medications?

No pain at all

Worst pain

0=No pain at all, 10= worst pain

3

What prescription and over-the-counter (OTC) medications do you currently take for your low back pain? Please type “none” if you do not take any medications for your low back pain.


4

Do you own a smartphone (Android or an iPhone) that you are comfortable using?


Yes
No

5

Which of the following have you been diagnosed with?

Degenerative disc disease
Sciatica or cervical radiculopathy
Scoliosis
Spinal stenosis
Spinal or joint instability
Spondylolisthesis
None of these

6

Do you have any of the following?

Pacemaker
Severe epilepsy
Implanted defibrillator
Any other electronic implanted device
Acute nerve impingement
None of these

7

If applicable, are you currently pregnant or planning to be in the near future?


Yes
No
N/A

8

Are you able to go from sitting in a chair to standing with ease without experiencing too much discomfort? How about going from standing position to sitting in a chair?


Yes to either one
No to both

9

If you were to describe your low back pain, which of the options below would best match your description?

Dull, achy, pressure-like pain
Radiating, shooting, stabbing pain
Both

10

If you answered “both” to the previous question, what percentage of your total low back pain is dull, achy, pressure-like pain?


%

11

What type of spine surgery, if any, have you had?

Spinal fusion
Laminectomy
Discectomy
Other spine surgery
None of these

12

Have you had any spinal injections/nerve block/epidural injections? If so, when?

In the last month
Between 1-3 months
More than 3 months ago
I have NO history of spinal injections

13

In the last 5 years, have you been diagnosed with any mental health condition, or have you been treated for any? For example, depression, panic attacks, trauma, etc. Please, indicate and describe.


14

In the last month have you found yourself to be stressed from life events outside of your chronic back pain?


Yes
No
Not sure

15

Do you have any difficulty falling or staying asleep BECAUSE of your low back pain?


Yes
No
Not sure

16

Do you have any upcoming/scheduled procedures, therapies, or new medications to treat your low back pain?


Yes
No

17

What interests you most about ENSO? (select all that apply)

Better pain control
Better sleep
Increased productivity
Better social life
Improved physical function
Reduced pain medication use
Other interests

18

What is the name of your health insurance provider (e.g. Kaiser, Medicare, Blue Cross, etc)? Please, type NONE if you do not have any health coverage.


Please fill in the missing fields above before submitting.

By clicking submit, you agree to being contacted by ENSO in regards to eligibility.
If you do not qualify, we will retain your information for potential future programs.

You also agree to our terms of service and privacy policy.