Common Procedures at The Pain Treatment Center
Epidurals are perhaps the single most useful intervention available in the modern pain clinic. These epidurals can now be done in a lesion-specific approach by the translaminar, caudal or transforaminal approach.
Epidural injections provide a safe, low risk, nearly painless means of delivering a variety of medications directly to the nervous system. An example of a condition which is responsible for a large percentage of low back pain is a disc herniation and inflammation. An outward movement of the disc nucleus (bulging or leaking) may cause severe swelling and inflammation around the confined spaces of the spinal column. Epidural steroid and local anesthetic injections may effectively decompress the spinal area, reverse inflammation and relieve symptoms without surgery while the body reabsorbs herniated disc material over time. Spinal injections can be considered an extension of conservative care.
Epidurals may be helpful in a number of painful conditions:
• Intervertebral disc injury (bulging discs or internal disc disruption, IDD)
• Acute herpes zoster
• Post-herpetic neuralgia
• Sympathetic mediated pain (RSD or causalgia)
• Radicular pain of pregnancy
• Cancer pain
• Spinal Stenosis
• Post-surgical pain
• Failed Back Syndrome
Transforaminal epidural steroid injection at L4.
Joint pain caused by inflammation or arthritis may be reduced by performing a joint injection. The injection typically includes a local anesthetic and a steroid medication. A lubricating fluid is another option for treating painful knee arthritis.
Shoulder pain is common and may be caused by repetitive activities or a fall. Common conditions affecting the shoulder include inflammation in the bursa or rotator cuff, as well as arthritis. An injection may be performed to lessen the pain and inflammation and allow an appropriate exercise treatment program to work more effectively.
Spinal Facet Injections
The strength and flexibility of the spine is due to the disc in the anterior part of the spine and facet joints in the posterior part of the spine. Facet joints (also called zygopophyseal joint) are true synovial joints which are found bilaterally in the cervical, thoracic and lumbar spine. These joints can be a source of chronic neck pain (common after whiplash injury) and back pain.
Just as epidurals are useful for disc-associated disease, facet injections are helpful to diagnose and treat pain emulating from facet joints. Injections for facet-mediated pain can be into the joint directly or by blockage of the sensing nerve to the joint (medial branch block). Cervical facet syndrome is the most common cause of headaches after whiplash-type injuries.
This procedure is indicated once the patient receives the appropriate pain relief from a diagnostic block (medial branch block).
Imagine a procedure that could treat your back pain, potentially as an outpatient, and allow you to return quickly to your normal activities. All of this is possible using the radiofrequency technology. Radiofrequency (RF) lesioning is a safe, proven means of interrupting pain signals. Radiofrequency current is used to heat up a small volume of nerve tissue, thereby interrupting pain signals from that specific area. Clinical data shows that radiofrequency lesioning can effectively provide lasting pain relief. A small RF current will travel through the electrode into the surrounding tissue, causing the tissue to heat and eliminate the pain pathways. Radiofrequency treatment of tissue usually blocks pain signals for a prolonged period of time. However, the human body may regenerate pain pathways over time.
If the pain is located in the facet joint and more conservative treatments haven’t been effective, radiofrequency lesioning could be an option.
Radiofrequency treatment will not limit your day-to-day activities. You should be able to resume your normal activities, including work, as soon as you feel able. Cervical radiofrequency has been a tremendous benefit to post-whiplash injuries for neck pain and headache.
Sacroiliac Joint Disease
One thing we have learned as pain-treating practitioners is that physical exams and history are helpful, but differential blocks of the spine may be the best method of detecting the source of back pain. Studies now show around 15-20% of back pain may be from the sacroiliac joint.
One method to confirm where back pain is coming from is to systematically block different parts of the spine to determine if the blocked area abolishes pain. The sacroiliac joint is easily blocked under fluoroscopy by placement of the spinal needle into the joint and confirmed by dye movement throughout the joint. This may be both diagnostic and therapeutic.
Before dye injection.
Dye outlining the sacroiliac joint after dye injection.
Cervical or Lumbar Medial Branch Blocks
A common diagnostic procedure to help determine the area of the spine that may be responsible for causing pain. When inflammation or arthritis of the spine result in back or neck pain, providing the appropriate amount of pain relief through this block may enable a subsequent procedure to be performed that usually provides longer lasting pain relief.
Radiograph shows needles positioned for controlled medial block procedure in L3, L4 and L5.