An Individualized Method For Interventional Pain Management

Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain.   The pain may radiate to other areas such as into the arms or down the legs.  Epidural injections are outpatient treatments to reduce pain in the arms, shoulders, and neck of the patient (for cervical epidurals) and to reduce pain in the legs, hips and low back (for lumbar epidurals). By injecting steroid medication, the swelling and inflammation of the nerves are reduced helping to eliminate pain.  Epidural steroid injections may be performed in the cervical, thoracic, or lumbar regions of the spine.

An intra-articular injection is one that is primarily intended to relieve pain in the knees, shoulders, ankles, and hips. Intra-articular injections come in a variety of forms, such as  hyaluronic acid, local anesthetics, platelet-rich plasma (PRP), and corticosteroids. These injections are used for many forms of pain alleviation and inflammation issues, and each has a unique function.

A medial branch block is a diagnostic procedure that is performed to identify a painful facet joint.  The facet joints are the joints between the vertebra in the spine.  They allow the spine to bend, flex and twist.  In addition to relieving pain temporarily medial branch blocks aid in diagnosis. The nerves that emerge from your spine’s facet joints and provide pain signals to the brain are known as medial branch nerves. When a branch block is applied and the pain subsides, the cause of the pain is identified and verified. If successful, you may be a candidate for radiofrequency ablation. 

A sacroiliac (“SI”) joint injection, like the majority of our other injections, aims to identify the cause of low back pain and reduce any discomfort. The process entails numbing the joint, the SI joint injection, and an injection with contrast for precision. If there is a discernible reduction in discomfort, the sacroiliac joint is most likely the source, and anti-inflammatory medicine should be taken. When combined with physical therapy and rehabilitation, these injections can assist the patient in lessening chronic pain.

If diagnostic medial branch blocks successfully alleviate facet joint mediated pain for a brief amount of time, youls may then be a candidate for radiofrequency ablation.  During this minimally-invasive procedure, the physician uses heat from radio waves to treat the painful facet joints.  This procedure is also called radiofrequency rhizotomy.  It can treat pain that has not responded to medications or to physical therapy.  Radiofrequency ablation may provide six months to two years of relief of painful facet joint symptoms.

A sympathetic nerve block can be performed to diagnose or treat pain involving the nerves of the sympathetic nervous system (a series of nerves that spread out from your spine to your body to help control several involuntary body functions, or body functions that you have no control over such as blood flow, digestion, and sweating).   The location of your pain usually determines where you’ll receive the nerve block.  The main condition this treats is complex regional pain syndrome.  Long COVID symptoms (loss of smell) and post-traumatic stress disorder, and other conditions may be relieved with a stellate ganglion block (sympathetic block in the cervical spine.)

Spinal cord stimulation (“SCS”) uses electrical impulses to relieve chronic pain of the back, arms, and legs.  It is believed that electrical pulses prevent pain signals from being received by the brain.  SCS candidates include people who suffer from neuropathic pain as well.  Conservative treatments such as medication, physical therapy, chiropractor, home exercise must be tried first prior to considering this.  Before permanent implantation of the SCS, patients undergo a trial to determine if the implant will be effective for them.

Kyphoplasty is a minimally-invasive procedure used to treat compression fractures.  Bone cement is injected into the vertebra to fill the fractured areas and strengthen and stabilize the spine.  One of more vertebrae may need to be treated.