Treatments

Various Nonsurgical Chronic Pain Treatment Methods

Celiac Plexus/Splanchnic Nerve Block

Overview

This injection relieves pain in the abdomen. Conditions such as cancer or chronic pancreatitis can cause pain in the nerves surrounding the main artery in the abdomen. Medication is injected to block the nerves and can relieve pain in the abdomen.

Procedure information:

  • Local anesthetic will be used on injection site to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement.

Typical Benefits/Outcomes:

The procedure is performed in our clinic and typically takes less than 30 minutes to perform. The patient can typically return to work the following day. Some patients experience pain relief immediately although, it may take up to a week. Many patients experience relief after 1 injection that lasts from a few weeks to a few years, although some patients may require 2 or more injections to experience significant pain relief.

Epidural Steroid Injection

Cervical Epidural Steroid Injection

CESI

This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. Medication is injected to decrease the swelling of these nerves. As the swelling is reduced pain, caused by the compression, will be reduced as well.

Cervical Epidural Steroid Injections may be used to treat pain caused by these conditions:

  • Herniated disc
  • Spinal stenosis

CESI’s may be used to treat the following symptoms:

  • Arm pain
  • Neck pain
  • Shoulder pain

Procedure information:

  • Sedation may by used
  • Local anesthetic will be used on the back of neck to keep the patient comfortable during the procedure
  • Fluoroscopy will used to insure accurate needle placement
  • Contrast will be used to insure medication is applied to the correct area

Benefits/typical outcomes

The procedure takes less than an hour to perform. Many patients experience relief after 1 injection, although some patients may require 2-3 injections to experience significant pain relief.

Facet Joint Injections

Overview

A Facet Injection is a procedure performed outpatient used to diagnose and treat pain in the neck and back caused by arthritic joints in the spinal column. Conditions such as facet joint disease and spinal stenosis can compress these tiny nerves, causing inflammation and pain. Medication is injected into the joint to decrease the swelling of these nerves. As the inflammation is reduced, caused by the compression, pain will be reduced as well.

Procedure information:

  • Local anesthetic will be used on the treatment area to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement

Typical Benefits/Outcomes:

The procedure is performed in our clinic and typically takes less than an hour to perform. The patient can typically return to work the following day. The extent and duration of pain relief may depend on the amount of inflammation, though some patients experience pain relief immediately, it may take up to a week. Many patients experience relief after 1 injection, although some patients may require 2-3 injections to experience significant pain relief.

Ganglion Impar/Coccygeal Nerve Block

Add information: Ganglion Impar/Coccygeal Nerve Block

This injection is used to reduce the symptoms of chronic pelvic or rectal pain by blocking nerve impulses. The ganglion impar is a cluster of nerve cells in front of the joint between the sacrum and the coccyx, commonly referred to as the tailbone.

Procedure information:

  • Local anesthetic will be used to inject in the joint to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement.

Joint and Bursa Injections (Knees, Hips, Shoulders, etc.)

Overview

This injection relieves pain in the major joints of the body such as the shoulder, hip, and knee.  Conditions such as osteoarthritis, bursitis, avascular necrosis, and tendonitis can cause inflammation and pain in the joint.  Medication is injected into the joint to decrease the swelling and pain. 

Procedure information:

  • Local anesthetic will be used to inject in the joint to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement.

Typical Benefits/Outcomes:

The procedure is performed in our clinic and typically takes less than an hour to perform. The patient can typically return to work the following day. The extent and duration of pain relief may vary. Some patients experience pain relief immediately though it may take up to a week. Many patients experience relief after 1 injection, although some patients may require 2-3 injections to experience significant pain relief.

Kyphoplasty

Add information: Kyphoplasty

Overview

When a patient develops a fracture on one or more of the large bones in their back (vertebrae), their spine can become very painful in any position.  A kyphoplasty is a minimally invasive procedure that can be performed as an outpatient procedure.  Using fluoroscopic guided x-ray, the physician will carefully inject a cement paste into the vertebrae that has the compression fracture to help the fracture stabilize and heal at a faster rate than if it was left untreated.

Procedure information:

  • Local anesthetic will be used to inject in the back to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement.

Typical Benefits/Outcomes:

The procedure usually takes less than an hour to perform. Many patients experience relief within a few days after the procedure, although some patients may experience some pain and discomfort for a few weeks. The patient can typically return to work the following day.

Medication Management

Nonsteroidal Anti-Inflammatory Drugs

Some of these are available over the counter while others are available by prescription. All of these relieve pain by reducing inflammation.

Steroids

Steroids are available in oral form and injections used to eliminate inflammation that is causing pain. They are typically used on a short-term basis.

Muscle Relaxants

These are prescription medications that reduce muscle spasms and thereby can reduce pain.

Anticonvulsants

These prescription medications reduce pain by lessening the sensitivity of the nervous system.

Sleep medications

Pain can often disrupt sleep and make it more difficult for a person to cope with their pain. Sleep medications are prescribed to improve restorative sleep.

Antidepressants

Chronic pain patients often experience symptoms of depression. Antidepressants can improve mood and make it easier to tolerate pain. They can also have a direct effect on reducing pain.

Opioids –These prescription medications can be used to treat acute or chronic pain. Due to their side effects, these medications are closely regulated and are not suitable for everyone.

Medial Branch Blocks

Overview

This injection relieves pain in the neck and back. Conditions such as facet joint disease and spinal stenosis can compress these tiny nerves, causing inflammation and pain. Medication is injected outside the joint to decrease the swelling of these nerves. As the swelling is reduced, caused by the compression, pain will be reduced as well.

Procedure information:

  • Local anesthetic will be used on the back or neck to keep the patient comfortable during the procedure
  • Fluoroscopy, a type of x-ray, will used to insure accurate needle placement.

Typical Benefits/Outcomes:

The procedure takes less than an hour to perform. Many patients experience relief after 1 injection, however if the pain returns, the patient may be a good candidate for a radiofrequency ablation. The patient can typically return to work the following day.

Occipital Nerve Block

This injection relieves headache pain. They help treat conditions such as Episodic migraines, Chronic migraines, Episodic cluster headaches, Chronic cluster headaches, Tension headaches, Occipital neuralgia. Medication is injected near the occipital nerve to help block pain signal transmission to the brain, thereby reducing headache pain.

Procedure information:

  • Local anesthetic or neurolytic agent will be used on injection site to numb the area that is causing discomfort.

Typical Benefits/Outcomes:

The procedure takes less than 15 minutes to perform. Many patients experience relief that may last up to several months. The patient can typically return to work the following day.

Peripheral Nerve Block

This injection works by injecting an anesthetic near a nerve or nerve bundle, which control(s) sensation of an extremity. It offers long-term pain control and is commonly used to block pain in an extremity.

Procedure information:

  • Local anesthetic or neurolytic agent will be used on injection site to numb the area that is causing discomfort.
  • Typical Benefits/Outcomes:
  • The procedure takes less than 30 minutes to perform. Many patients experience relief that may last up to several months. The patient can typically return to work the following day.

Radiofrequency Ablation

Radiofrequency Ablation

Overview

Radiofrequency ablation is a pain management technique that utilizes heat to disable nerves from transmitting pain signals. For this procedure a needle-like tube or cannula is inserted under the guidance of an X-ray (fluoroscopy) along the nerves. A Radiofrequency electrode is inserted through the cannula and a small electrical current is emitted which should recreate the patient’s usual pain. This ensures that the needle is next to the appropriate nerve. A numbing medication is administered before more radiofrequency waves are emitted through the to tip of the needle where the waves are converted into heat. The heat slowly disrupts the nerves ability to transmit pain signals. There is no risk of paralysis or weakness from this procedure.

List of conditions commonly used to treat:

  • Arthritis Pain
  • Chronic Lower Back Pain
  • Chronic Neck Pain
  • Facet Joint Pain

Typical Benefits/Outcomes:

Nearly 70 percent of Radiofrequency ablations performed result in good block of the intended nerve.

  • Reduction or relief of pain
  • Improved range of motion
  • Short recovery time
  • Reduction in pain medication
  • Longer lasting pain relief in comparison to steroid injections

Sacroiliac Joint Injections

Sacroiliac Joint Injections

Overview

Sacroiliac Joints are next to the bottom of the spine and connect the sacrum (a triangular bone at the base of the spine) with the pelvis. There are two sacroiliac joints, one on each side, that lie between the lumbar spine and coccyx (tailbone). When inflammation or dysfunction due to too much or too little movement occurs in this area, pain may result.

List of conditions commonly used to treat

  • Sacroiliac Joint Dysfunction
  • Low back pain
  • Leg pain

Typical Benefits/Outcomes

  • Reduction or relief of pain
  • Improved function and mobility
  • Reduction in pain medication

Sphenopalatine Ganglion Block

Overview

This injection relieves facial and refractory head pain, including trigeminal neuralgia, headaches, RSD and other sympathetic pain conditions. The procedure works by injecting the nerve bundle located deep in the face, behind the root of the nose.

Procedure information:

  • Local anesthetic or neurolytic agent will be used on injection site to numb the area that is causing discomfort.
  • Typical Benefits/Outcomes:

The procedure is performed in our clinic and typically takes less than 30 minutes to perform. The patient can typically return to work the following day. Some patients experience pain relief immediately although, it may take up to a week. Many patients experience relief after 1 injection, although some patients may require 2 treatments.

Spinal Cord Stimulation

Spinal Cord Stimulation

Overview:

Spinal cord stimulation is a type of electrical nerve stimulation that uses an electrical current to treat chronic pain. There are two steps to nerve stimulation. A temporary electrode will be inserted percutaneously (through the skin) for a trail run and then, if successful, a permanent electrode will be inserted. The electrode is connected to a patient controlled electrical stimulator. Both the electrode and small wire leads are inserted under the skin. The wire leads go directly into the spinal cord. Once the stimulation device is in place the best pulse strength will be determined based on the patients pain. When the stimulation is in use, the patient will feel a tingling sensation.

List of conditions commonly used to treat:

  • Chronic back and neck pain
  • Peripheral neuropathy
  • Refractory angina
  • Failed Back Surgery Syndrome

Typical Benefits/Outcomes:

  • Few side effects
  • Easily reversible
  • Minimally invasive
  • Relief of pain
  • Ability to adjust stimulation settings with changes in pain
  • Reduction in pain medication

Stellate Ganglion Block

Stellate Ganglion Block

Overview

A Stellate Ganglion Block involves the injection of a local anesthetic in the front of the neck to block the sympathetic nerves in the neck on either side of the voice box. The purpose of the procedure may be therapeutic, providing pain relief or diagnostic, locating the source of pain. The injections are typically repeated to provided long lasting pain relief. How often the injections are given varies from patient to patient depending on how long each injection relieves their pain. Each injection takes approximately 5-10 minutes and the anesthetic typically takes 10-20 minutes to take full effect

List of conditions commonly used to treat

  • Sympathetically maintained pain (Reflex Sympathetic Dystrophy)
  • Causalgia (Nerve Pain)
  • Pain related to Herpes Zoster (Shingles)
  • Intractable Angina (Heart Pain)

Typical Benefits/Outcomes:

  • Neck, head, chest, or arm pain relief
  • Improvement in mobility
  • Reduce swelling in upper extremities
  • Reduce sweating changes in upper extremities
  • Improvement in blood flow in patients with circulatory issues

Trigger Point Injections

Overview

Muscles and surrounding tissues can become inflamed due to repetitive motions and other minor injuries.  This injection helps relieve the tension and tightness in the different tissues in the body to alleviate pain and inflammation.

Procedure information:

  • Local anesthetic will be used on the back or neck to keep the patient comfortable during the procedure

Typical Benefits/Outcomes:

  • The procedure takes less than 15 minutes to perform. Many patients experience relief after 1 injection, although some patients may require 2-3 injections to experience significant pain relief. The patient can typically return to work the following day.

Vertebroplasty

Vertebroplasty

This minimally-invasive treatment is used to repair spine fractures caused by osteoporosis or cancer. It stabilizes the spine, providing rapid back pain relief and helping prevent further weakening of the spine