The information contained here is not intended as a substitute for professional medical evaluation and management.  It should be used only as a starting point for further research.  A physician should always be consulted for any health problem.

INTERVENTIONAL PAIN MANAGEMENT

Interventional Pain Management is the discipline of medicine devoted to the diagnosis and treatment of pain related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

 

Epidural Steroid Injection (Lumbar, Cervical and Thoracic)

ESI is a procedure that places a small amount of powerful anti-inflammatory medication, cortisone, around inflamed spinal nerves, in the epidural space. It reduces the swelling, irritation, and pain caused by the pinched nerves.

ESI is used to treat pain caused by inflammation of the spine that may involve herniated discs, pinched nerves, and injured soft and connective tissues.

ESI and labor epidural are similar but different. Labor epidural uses anesthetics while ESI uses cortisone. ESI is performed with a smaller needle with the patient lying flat on the abdomen. A moving x-ray machine (C-arm) is usually used to precisely pace the needle.

With local anesthesia, most patients find ESI easily tolerated. A sedative is rarely needed. However, if a patient is anxious or is unusually fearful of needles, a sedative can be given.

ESI is performed as a series of 2 to 3 injections over several weeks. The series can be repeated in the future, or later in life, if the problem returns.

Cortisone is neither a pain medication nor an anesthetic. It is an anti-inflammatory drug. It is a compound similar to what the body normally produces at times of stress, except longer-lasting. Cortisone helps the body recover. All of your faculties and sensations will remain intact, thus you will not injure yourself without knowing.

Problems with ESI are rare. Cortisone is a steroid, but it is not the performance-enhancing anabolic steroid you’ve heard so much about. Cortisone is more likely to cause problems when it is used chronically, such as for treating rheumatoid arthritis or for asthma. A short series of ESIs rarely causes problems.

ESI can be used to treat nerves along the entire spine but lower back and neck are most common locations for the procedure.

Precise medication delivery to the injured areas is essential for good response. Training and equipment do affect how some physicians in the community practice. Our specially designed interventional suites, with the most advanced GE C-arm and multi-directional x-ray tables, set the standard. Our facility is fully accredited by AAAHC and Medicare for meeting high quality standards.
 

Selective Nerve Root Block

Spinal nerve compression whether due to disc protrusion or bony canal narrowing can produce symptoms of pain, numbness and weakness.

Collateral nerve innervation, referral pain and anatomical variations however can make diagnosis of specific nerve compression difficult especially when patients present with indistinct symptoms.

Where as MRIs frequently reveal anatomical abnormalities that are more than clinically relevant, and EMGs are prone to false positives and negatives, SNRB is diagnostically more specific and functionally correlatable.

SNRB of a single nerve-root with anesthetic and cortisone mixture is both diagnostic and therapeutic. Immediate pain relief from the anesthetic clinches that specific nerve’s involvement in patient’s pain. This helps to guide further therapy. The cortisone is beneficial when there is nerve irritation.

Facet Medical Branch Block (Lumbar, Cervical and Thoracis)

Facet joints are the paired joints that connect vertebrae in the spine. They are important for both range of motion and stability.

Over time and with physical stress these joints can erode, enlarge and become arthritic. Facet arthropathy can further cause back spasm and referred pain that are frequently indistinguishable from sciatica or discogenic radicular pain.

Facet Medial Branches are the small branches of spinal nerves that innervate these joints. Facet blocks are an important component injection technique for diagnosing and treating pain from facet arthropathy.

Facet medial branch blocks help to reduce pain from joints and muscles and facilitate physical rehabilitation. Radiofrequency thermocoagulation (RFTC) medial branch rhizotomy which is used to ablate these small nerve branches utilized for long-term pain relief.

Discography

Disc degeneration can range from annular teat to frank herniation. While disc herniation can produce nerve-impingement symptoms, annular tears can be painful for both chemical and mechanical reasons. Release of noxious chemicals from the injured discs can cause chemical neuritis of adjacent nerves and produce sciatica that is clinically indistinguishable from compressive radiculopathy.

MRI not only is not sensitive in revealing annular tears, it provides no clue as to their clinical significance when they are seen.

 Discograms are performed by injecting discs in question with dye under pressure, simulating mechanical stress. These provocative injections, with patients reporting pain levels during pressurization help separate painful from non-painful discs. Intradiscal dye and post-discogram CT further help to improve diagnostic accuracy. Discograms are particularly useful in evaluating patients for surgeries such as fusion and artificial discs.

Sympathetic Block (Stellate ganglion and Lumbar Sympathetic Blocks)

Complex Regional Pain Syndrome, or Reflex Sympathetic Dystrophy (RSD), commonly occurs after injuries to the limb but can also develop after stroke, myocardial infarction and surgery.  

The pain is termed causalgia, characterized by burning and prickly hypersensitivity. The acute stage is accompanied by swelling and reddening of the affected limb. But later as atrophy sets in, the limb becomes thin and frail along with muscles wasting and osteoporosis, rendering the affected limb painful and lifeless. 

Sympathetic blocks are performed at the stellate ganglion for upper extremities and lumbar paravertebral ganglions for lower extremities. By diminishing the vicious sympathetic hyperactive feedback, these blocks along with physical therapy and medication help restore normal limb function. Early recognition and intervention are essential for good outcome.

• Radiofrequency Lesioning

  Nerves are desensitized by using specialized radiofrequency needles for longer lasting effect than what is achieved with local anesthetics.

• Cryoanalgesia

  Ice is one of the oldest form of pain treatment.  Cryoanalgesia uses specialized machine and needle to render nerves insensitive to pain.

   

• Percutaneous Disc Decompression

  Unlike surgical disc removal that requires incision, these are needle or 'band-aid' procedures performed by inserting needle instruments into the discs to remove disc material and decompress herniated discs.

   

• Intrathecal Pumps (Morphine Pump)

  It was discovered in the mid 90s that narcotics work better when injected into the spinal fluid.  It also produces less side effects such as sedation and constipation.  Small, hockey puck sized reservoir pumps can be implanted entirely under the skin to allow potent pain control without external attachment.

   

• Stellate Ganglion Block

  (See sympathetic block above)

   

• Lumbar Sympathetic Block

  (See sympathetic block above)

   

• Celiac Plexus Block

  Nerve block used for treating pain of the viscera (inner abdominal).  It is one of the most useful procedures for treating pain from cancer of the pancreas

   

• Spinal Cord Stimulator

  Pain is controlled by gently stimulating the spinal cord through implanted electrodes.  The small amount of electricity generated from the electrode competes with pain signals in the conducting nerves, much like cars jamming freeways, to keep pain impulses from getting through.

   

• Sacroiliac Join Injections

  Sacroiliac (SI) joints are the large joints that connect the lowest portion of the spine (the sacrum) to the pelvis.  These are weight-bearing structural joints that can become painful and arthritic.
  
   

• Trigger Point Injections

  These are the focal tender points of the fatigued or injured muscles and tendons that can be injected to relieve pain