Chronic Pain?

Relief is just a phone call away

Each Patient Has a Unique Story

At Medical Pain & Spine Care, we strive to show patients how much we care about them. Our providers take time to listen to each patient’s story and then provide an individualized treatment plan to produce maximum pain relief.

Although lower back pain is the most common condition our patients are seen for, it is just one of many chronic pain symptoms we help patients overcome and manage. The spinal cord stimulator is one of the most effective pain controlling therapies we have for patients suffering from chronic pain in the spine and upper and lower extremities. Even patients who have undergone multiple back surgeries and started to lose hope for improvement have found wonderful lasting pain reduction through spinal cord stimulator therapy.

No matter what your story, even if you have lost hope in finding pain relief, our team will listen and help you with an effective pain management treatment plan.

Pain Management Options
At Medical Pain & Spine Care of Indiana, patient treatment options may involve imaging, spine procedures, muscle and joint pain treatment, pain management device implants, medication management, chronic pain management infusions and even medical weight loss, since obese and overweight patients often experience more joint pain and lower back pain and require lower back pain relief.

Diagnostic Imaging
Depending on the location of your pain, you may need diagnostic imaging with CT scan, MRI, ultrasound, X-ray or other tests that may help diagnose the source of pain. We do not perform these diagnostic tests at Medical Pain & Spine Care of Indiana. Instead, we refer our patients to nearby facilities.

Platelet Rich Plasma (PRP) Injections for knee, hip and shoulder pain
PRP is used to treat injuries or damage to tendons, ligaments, muscles, joints and skin. Your own blood platelets contain growth factors that can trigger cell reproduction, stimulate tissue regeneration and healing. PRP can help to stimulate the healing process, decrease pain, and enable a return to activities sooner. PRP can help to curb pain and boost mobility. Early studies indicate that PRP injections may help treat osteoarthritis pain and stiffness by modulating the joint environment and reducing inflammation. Since they are made from your own blood cells, PRP injections are low-risk and do not usually cause major side effects. Ask about our
PRP injection specials for knee, hip and shoulder pain.

Physical Therapy and Home Exercises
We now offer physical therapy services in our office and refer most of our patients with pain to physical therapy or provide home exercises to help the body heal itself. The goal is to minimize long term use of opioids as much as possible.

Cervical, Thoracic, Lumbar Spine Procedures
Dr. Klim performs a variety of minimally invasive cervical, thoracic and lumbar spine procedures to relieve pain. These include:
  • Caudal epidural steroid injections
  • Diagnostic discography
  • Epidural steroid injection
  • Facet joint injections (cervical, thoracic, lumbar)
  • Ganglion block, lumbar sympathetic
  • Ganglion block, stellate medial branch nerve block
  • Radiofrequency ablation of medial branch nerves
  • Sacroiliac joint injection
  • Selective spinal nerve root block

Muscle & Joint Pain Treatment 
Muscle or joint pain is extremely common and has many possible causes. Osteoarthritis is one underlying cause often characterized by joint pain. Sports and work activities can cause muscle and joint pain through overuse, hyperextension and other types of injury/trauma. Pain-relieving treatments may include:
  • Joint injections (hip, knee, shoulder)
  • Peripheral nerve blocks
  • Trigger point injections

Pain Management Devices 
When chronic pain doesn't respond to medication, or a patient cannot tolerate drug side effects, Dr. Klim may prescribe a neurostimulator, spinal cord stimulator or intrathecal drug pump therapy. Implantable devices such as these can help you manage your pain, restore your ability to perform daily activities, decrease your need for prescription painkillers and improve your quality of life. The spinal cord stimulator is effective for controlling chronic pain that is broadly felt in the arms, back and legs.

Medication Management 
Medications to treat pain include opioid analgesics, anticonvulsants, antidepressants, topical analgesics/pain ointments, muscle relaxants and NSAIDs. Medication management helps patients avoid dangerous drug interactions while ensuring they obtain the best possible pain relief.

Some pain medications are associated with significantly more risk than others. It is important for patients to understand the risks associated with certain medications and combinations used for pain treatment and communicate the benefits and side effects of their individual pain medications to Dr. Klim.

Combining medications for pain with other therapies, including injections, physical therapy and behavioral and lifestyle counseling, usually leads to the greatest improvement in functional capability and quality of life.

More people die every year from overdose of prescription drugs than car accidents? The Associated Press reported that in San Francisco, more people died from drug overdose than COVID-19 in 2020.    "A record 621 people died of drug overdoses in San Francisco so far this year, a staggering number that far outpaces the 173 deaths from COVID-19 the city has seen thus far." [12/21/2020]
  • Hydrocodone
  •  Oxycodone (OxyContin)
  • Morphine
  • Fentanyl (Duragesic)
  • Hydromorphone (Dilaudid)
When combined with acetaminophen, hydrocodone and oxycodone are prescribed under the brand names Vicodin and Percocet.  Opioids are available in pills, liquids, shots, patches, and suppositories.

At Medical Pain and Spine Care of Indiana, we offer a comprehensive pain management plan, which will sometimes include prescription opioids for pain relief. 
Opioids are a class of narcotic drugs that are derived from morphine. They work with opioid receptors to disrupt pain signals sent to the brain by the nervous system to offer pain relief.  In general, opioids are most effectively prescribed for short-term, episodic pain relief from injury or illness. Conditions for which opioids may be prescribed include:

  • BACK PAIN -- including degenerative disc disease, ruptured or herniated disc, spinal stenosis, and vertebral compression fractures
  • CANCER PAIN -- especially in late-stage cancer patients
  • HIP PAIN -- with osteoarthritis and fractures as the most commonly treated with opioids
  • INFLAMMATORY BOWEL DISEASE -- such as Crohn’s disease and ulcerative colitis
  • NEUROPATHY -- including diabetic neuropathy and any other types of nerve pain
While some patients benefit tremendously from opioid therapy, recent research into the effectiveness of opioids on chronic pain has shown that opioids may do more harm than good when it comes to treating chronic pain. In 2015, an analysis by the National Institute of Health (NIH) looked at existing studies regarding the effectiveness of opioids for long-term chronic pain and found no evidence that opioids were effective at treating long-term pain. This same study found evidence that indicated a high risk of dose-dependent, serious side effects including abuse and dependence, bone fracture, and myocardial infarction.

As of 2014, an estimated 1.9 million people in the U.S. had a substance abuse disorder involving prescription opioids. From 1999 to 2008, opioid addiction rates and opioid prescription rates rose in parallel with the death rate from overdose increasing 400% during the same period. Opioids are powerful narcotics that change the structure of the brain such that it adapts to the dose and gradually requires more to feel the same pain relief. Even when taken as directed, long-term use can result in dependence.
Opioid-induced hyperalgesia, or increased pain sensitivity, is also a possibility with long-term use of opioids for chronic pain. Previously, opioid-induced hyperalgesia was thought to be a byproduct of opioid withdrawal, but new research has shown that it can occur at any stage of opioid use.

Other lesser-known side effects of long-term opioid use can include:
  •  IMMUNOSUPPRESSION making patients more vulnerable to other health issues. This can be especially difficult for those patients with other chronic, immune-related illness. 
  • DECREASED LIBIDO -- For men, long-term opioid use can result in lower levels of testosterone production (hypogonadism). In women, this same long-term use can disrupt hormone production, causing amenorrhea (lack of menstrual cycle). In both cases, this can result in a decreased sex drive. 
  • OSTEOPOROSIS developing in both men and women. 
We believe the risks associated with long-term opioid use warrant caution and restraint when it comes to prescribing these medications. Our pain management specialists focus on a comprehensive pain diagnosis and management options. To that end, we look at other treatment options before prescribing opioids.
Conventional treatments may include prescription non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and steroids. We may also look at minimally-invasive procedures, such as nerve block procedures, or more invasive techniques such as intrathecal pain pumps, spinal cord stimulation, or radiofrequency ablation. Our pain management specialists believe in a holistic approach to chronic pain and also recommend many complementary and alternative options for pain relief including physical therapy, as well as psychological and behavior interventions available at our office in Noblesville.

While we strive to utilize all other pain-relieving options prior to prescribing opioids, we recognize that for some patients in specific circumstances, opioids may be their best option for relief. Medical Pain and Spine Care of Indiana follows strict prescribing and monitoring guidelines as set forth by the federal government and works closely with patients to resolve their pain in other ways before utilizing opioids.

Part of working closely with our patients includes discussing and signing a pain management agreement form. This form follows the Centers for Disease Control’s updated opioid prescribing guidelines and includes the following provisions:
  1. The agreement acknowledges that opioid therapy is just one part of a patient’s comprehensive treatment plan. 
  2. Patients are to follow all parts of the holistic, comprehensive pain management plan designed with their doctors to include a number of different therapies. This may mean making lifestyle changes as well as undergoing counseling and other complementary therapies tailored to each individual patient. 
  3. Our pain management specialists prescribe the lowest effective dose and will not increase the dose without thoroughly re-evaluating the patient. 
  4. Patients agree to regular follow-up visits, monthly urine screenings, and pill counts within 24 hours if requested by the doctor. 
  5. Doctors and patients work closely together with all other specialists and physicians to avoid over prescription or concurrent benzodiazepine or opioid prescriptions. Each part of this opioid agreement form was designed to protect the patient while undergoing opioid therapy. 
Our goal at Medical Pain and Spine Care is to develop the best possible pain management plan for every patient that improves their quality of life. We work as a pain management team to provide comprehensive diagnostic and therapeutic services. We utilize an extensive array of treatment options specifically designed for each patient. When one of these options is opioid therapy, we provide the support and guidance needed for safe, effective pain relief.

For more information on all of our pain management options, including opioid therapy, please call 317-776-7028 to schedule an appointment.

Happy patients are the best referral sources!

At Medical Pain and Spine Care, we are concerned not only about the physical pain our patients experience but also the long term effects that chronic pain has on a person's emotional health.  
We have partnered with American Behavioral Counseling to provide individual counseling service.

Working one-on-one with a professional counselor, you will have a safe, caring and confidential space to explore your feelings, beliefs, and behaviors. The counselors will work with you to help identify triggers in your life that may be contributing to depression or anxiety related to your chronic pain. They can help you set personal goals and work towards achieving a better future.

Call American Behavioral Counseling at (317) 282-3088 to schedule an appointment.

J Peter Klim, DO

Haylee Goad, FNP

Nurse Practitioner


Theresa Mull, PT

Physical Therapist

  • Medical Pain and Spine Care of Indiana
  • 18077 River Road #200, Noblesville, IN, USA

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.   Under state and federal law, a patient may ask a health care provider or facility for a Good Faith Estimate of the price they will be charged for nonemergency health care, including costs such as medical tests, prescription drugs, equipment, and hospital fees. The Good Faith Estimate will be in writing and provided within the timeframes stated below: 

  • Any patient may request a Good Faith Estimate of expected charges for nonemergency health care services. When requested, you will receive a copy of this Good Faith Estimate within 3 business days of the request (when uninsured or self-pay) and 5 business days (when insured). 
  • Uninsured Patients. Federal law requires health care providers to provide a Good Faith Estimate in advance of scheduling or upon request if you are uninsured or self-pay (not using your insurance to pay for the item or service). 

Good Faith Estimates will be provided within 3 business days of scheduling nonemergency health care services or within 1 business day if nonemergency health care services are scheduled to be performed within 3 business days. You may ask for a Good Faith Estimate before scheduling an item or service. Uninsured or self-pay patients may dispute the actual charges if they exceed the Good Faith Estimate by at least $400.00. 

TO REQUEST AN ESTIMATE, please call our office at 317-776-7028.  For questions about the Good Faith Estimate, visit or call 1-800-985-3059.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. 

What is “surprise billing” or “balance billing”)? When you see a health care provider, you may owe certain out-of-pocket costs, such as a copay, coinsurance, and/or deductible. You may owe the entire bill if you see a provider or visit a facility that is not in your health plan’s network. 

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agrees to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more money than in-network costs for the same service and might not count toward your annual out-of-pocket limit. 

“Surprise billing” is an unexpected bill. This may happen when you cannot select who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

The most an out-of-network provider may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not seek your consent to be balance billed. 

If you get other services at these in-network facilities, out-of-network providers cannot balance bill you unless you give written consent and give up your protections. An out-of-network provider must give notice at least 5 business days before the services are scheduled to be provided, and include a notice summarizing your balance billing rights, including a good faith estimate of the charges for such services. The provider is obligated to explain any charges that exceed the good faith estimate. You are never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:  You are only responsible for paying your share of the cost (copayments, coinsurance, and deductibles) that you would pay if the provider or facility was in-network. Your health plan will pay out-of-network providers and facilities directly. Your health plan must: 

  • Cover emergency services without requiring you to get approval for services in advance (prior authorization). §Cover emergency services by out-of-network providers. 
  • Base what you owe the provider or facility on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. 
  • Count any amount you pay for emergency services or out-of-network services  toward your deductible and out-of-pocket limit. 

If you believe you’ve been wrongly billed, you may contact the Indiana Department of Insurance by calling (317) 232-8582 or visit their website ( for more information about Indiana’s balancing billing laws.  Visit for more information about your rights under federal law.