PAIN MANAGEMENT

Procedures

Epidural Blood Patch: Blood patches are performed for treatment of a persistent headache (spinal headache) and nausea that sometimes follows a spinal puncture. The blood patch procedure consists of an injection at the spinal puncture site of a small quantity of your own blood. The injected blood forms a clot to patch the hole in the dura (the outer membrane of the spinal cord) that was created by the needle at the time of the epidural or spinal injection.

 

Epidural Steroid Injection (cervical, thoracic, lumbar, sacral,caudal): Epidural Steroid Injection is an injection of long lasting steroid into the epidural space (the area which surrounds the spinal cord and the nerves coming out of it). The injected steroid reduces the inflammation and/or swelling of nerves in the epidural space. This may in turn reduce pain, tingling & numbness and other symptoms caused by nerve inflammation / irritation or swelling.

 

Facet Joint Injection/Medial Branch Nerve Block (cervical, thoracic, lumbar): Zygapophysial joints, better known as facet or "Z" joints, are located on the back (posterior) of the spine on each side of the vertebrae where it overlaps the neighboring vertebraes. Facet joints provide stability and give the spine the ability to bend and twist. They are made up of the two surfaces of the adjacent vertebrae, which are separated by a thin layer of cartilage. The joint is surrounded by a sac-like capsule and is filled with synovial fluid (a lubricating liquid that both reduces the friction between the two bone surfaces when the spine moves and nourishes the cartilage.) There are two reasons for having a facet joint injection: for diagnosis (to determine the source of pain) or for therapy (to treat an abnormality that has been detected.)

 

Ilioinguinal Nerve Block: The ilioinguinal nerve wraps around the rim of the pelvis and innervates part of inguinal (groin) and pubic areas. The nerve can be damaged by surgery or by subsequent scar tissue following hernia repairs and cesarean sections.

 

Implantation of implantable intrathecal or epidural infusion pumps : (baclofen, morphine, etc.)

 

Intercostal Nerve Block: An injection of medication into the painful tissue areas between the ribs.

 

Intradiscal Electrothermal Therapy/Nucleoplasty: IDET (Intradiscal Electrothermal Annuloplasty) is a minimally invasive outpatient procedure that provides an alternative to surgical procedures for patients who suffer from chronic low back pain caused by tears or small herniation of the discs. The procedure works by applying heat to the nerve endings within the disc wall to help block the pain signals.

 

Kyphoplasty: Vertebroplasty and kyphoplasty are both minimally invasive surgical procedures for treating osteoporotic fractures where a cement-like material is injected directly into the fractured bone. This stabilizes the fracture and provides immediate pain relief in many cases.

Kyphoplasty includes an additional step. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae. The goal of this step is to restore height to the bone thus reducing deformity of the spine. Most patients return to their normal daily activities after either procedure.

 

Lumbar Discography: Discography is a diagnostic procedure in which x-ray dye (x-ray contrast) is injected into the discs of the spine. After the x-ray dye is injected, an x-ray (called a "discogram") is taken of the discs. The discogram may be normal or may show tears (fissures) in the lining of the disc. Lumbar discography is considered for patients who, despite extensive conservative treatment, have disabling low back pain, groin pain, hip pain, and/or leg pain. Discography is the only test that can identify a disc, or discs, as the pain generator. The most common use of discography is for surgical planning prior to a lumbar fusion or IDET (intradiscal electrothermal) treatment. Discography is done to answer the questions "Is my back pain or neck pain from a degenerated disc?" and "Which discs -if any- are causing my pain?"

 

Major Bursa Injections (Hip/Shoulder): Bursitis simply means inflammation of a bursa. It is often, although not always, associated with pain. A bursa is a small sac filled with a small amount of fluid that is found between certain muscles, muscles and tendons, tendons and bone, etc.. Bursa sacs aid in the prevention of friction between tissues such as muscles and tendons by allowing them to slide over each other more easily. There are many bursas in the body - particularly in the areas of the shoulders, the elbows, the hips, the knees and the Achilles tendon areas. Inflammation of a bursa sac causes pain. Local anesthetic and steroid medications are injected into the bursa sac in order to provide relief of pain.

 

Major Joint Injections (Sacroiliac/Knee/Hip): Injections targeted toward a symptomatic or painful joint thought to be responsible for a patient's pain. The joint is injected with a local anesthetic (to temporarily anesthetize the joint) and a steroid medication (in the attempt to provide longer term pain relief).

 

Occipital Nerve Block: The occipital nerves travel from the cervical spine in the neck to the back of the head and scalp. These nerves can be irritated by arthritic changes in the cervical spine, by muscle spasm, or by neck injuries. The result can be headaches which typically start in the back of the neck and spread towards the forehead. Occipital nerve blocks with steroids can often help with the treatment of these kinds of headaches.

Celiac plexus (the solar plexus) is a bundle of sympathetic and sensory nerves which transmits much of the sensation from the abdominal organs. Celiac plexus blocks can be very helpful for controlling pain from cancer that involves the abdomen.

 

Peripheral Nerve Blocks (Ilioinguinal, genitofemeral, femoral, lateral femoral cutaneous, intercostal, occipital, suprascapular, etc.): The nerves outside of the brain and spinal cord are called peripheral nerves. These nerves can be irritated or injured by trauma, surgery, scar tissue, or illness. Blocks of peripheral nerves can help provide relief, especially if the underlying source of irritation can be resolved. These nerves exist throughout the body; the following are some examples of common peripheral nerve blocks.

 

Radiofrequency Lesioning/Neurolytic Procedures/Rhizotomies: Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed alongside the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain. The goal of a rhizotomy is to provide pain relief by "shutting off" the pain signals that the nerves send to the brain. The pain relief experienced by patients who have this procedure can last for months.

 

Selective Nerve Root Block (cervical, thoracic, lumbar, sacral):
An injection that is performed to determine if a specific spinal nerve root is the source of pain. Injected medications may include a steroid and will include a local anesthetic. The medications are injected into the area bathing the nerve root with the goal of reducing inflammation around the nerve root and thus relieving or decreasing pain. This procedure is performed under fluroscopy, which is a type of X-ray.

 

Sympathetic Block (stellate ganglion, splanchnic, celiac plexus, hypogastric plexus, ganglion of Impar): A sympathetic nerve block involves injecting medicine around the sympathetic nerves in a lumbar or cervical area. By doing this, the system is temporarily blocked in hopes of reducing or eliminating pain. If the initial block is successful, then additional blocks are generally repeated in 7-10 days and repeated again until the pain diminishes.

 

Trigger Point Injections: Trigger point injections are local injections of local anesthetics into areas of muscle spasm. Trigger points are areas of tight muscles bands or palpable "knots" of a muscle. Trigger points can cause localized pain and even referred pain patterns (pain which radiates away from the local site when pressure is applied). Injections can facilitate physical therapy, massage, or break a painful cycle of muscle pain. Trigger point injections are not truly nerve blocks; rather they are muscle blocks. Muscles that are chronically tense or in spasm become tender and painful. The pain triggers more spasm and pain. Physical therapy and exercise are the primary treatments, but injections into the muscle can help to break the vicious cycle.

 

Vertebroplasty: Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Vertebroplasty can increase the patient's functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Vertebroplasty is accomplished by injecting an orthopedic cement mixture through a needle into the fractured bone.