Procedures & Services
Epidural Steroid Injection
Epidural steroid injection is an injection performed in the back or neck in an attempt to place anti-inflammatory steroids with or without a local anesthetic into the epidural space close to the inflamed area that is causing the pain. These injections are generally done for pain involving the back and leg or the neck and arm/hand. They are usually done under x-ray guidance. There are two methods to encounter the epidural space, interlaminer and transforaminal. The interlaminar technique refers to injection into the space between the openings of adjacent vertebrae.
Transforaminal epidural refers to injection into the area where the nerve roots exit. While the interlaminar technique can be performed through paramedian or midline approaches, the transforaminal technique is performed through an oblique approach. Your physician will recommend which technique is best for you. Common side effects include soreness of the back or neck at the point where the needle enters the skin, there may be some temporary numbness in the involved extremity but persistent numbness or weakness (lasting over 8 hours) should be reported to your doctor. Epidural steroid injections may be placed in the lumbar (low back), thoracic (mid back), or cervical (neck) regions.
There are many joints and bursa in the body that may cause chronic, musculoskeletal pain secondary to inflammation or degenerative changes from arthritis. These include but are not limited to: shoulder, elbow, wrist, hip, knee, trochanteric bursa, and muscular trigger points. These injections are usually done in the office and consistent of a combination of anti-inflammatory steroids and local anesthetic.
Facet Joint Injection/Median Branch Block
The facet joints assist with movement of the spine both in the neck and back. Injection into these joints can provide relief of neck and back pain. Median branch blocks are injections used to "block" the nerves which supply the facet joints. Both facet joint injections and median branch blocks are always performed under x-ray guidance. Common side effects include soreness in the neck or back when the needle was inserted. A needle is placed in the neck or back and advanced to the level of the joint under x-ray visualization. This block is often a diagnostic block and a more long lasting injection may be indicated if you have significant pain relief from this injection.
A sacroiliac joint injection (SI) is used to either diagnose or treat low back / upper buttock pain. The SI joint in the lower spine connects the sacrum with the hips on both sides. Degenerative changes in this joint can lead to inflammation which causes pain in the lower back. SI joints injections are usually done with the aid of x-ray or ultrasound. The patient is laid on his/her stomach and the skin is numbed with anesthetic. A small needle is then guided into the joint. A small mixture of numbing medication (anesthetic) and anti-inflammatory medication (usually steroid) are then injected. The goal of this procedure is to reduce inflammation of the joint and provide substantial to complete pain relief for an extended period of time.
Abdominal Pain Injections
Celiac Plexus/Hypogastric Plexus Blocks
These blocks are generally performed to relieve pain in patients with cancer of the pancreas, intestine, stomach or other chronic abdominal pains. A needle is placed via your back that deposits numbing medicine to the area of a group of nerves called the either the celiac or hypogastric plexus. This injection is often performed as a diagnostic injection to see whether a more permanent injection may help with the pain. If it provides significant pain relief then the more long lasting injection may be done. This injection is usually performed under x-ray guidance. You will be lying on your stomach for this injection. The needle is place via the mid back and placed just in front of the spine. Contrast dye is injected to confirm that the needle is in the right spot; followed by numbing medicine.
Spinal Cord Stimulator
Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain. During spinal cord stimulation, a device that delivers the electrical signals is implanted in the body either surgically or percutaneously (through the skin). You may turn the current off and on or adjust the intensity of the signals. Most people describe the feelings from the simulator as being pleasant and tingling. Several kinds of spinal cord stimulation systems are available. The units that are more commonly used are fully implanted and have a pulse generator, which is like a battery and is usually rechargeable. Spinal cord stimulation can be an effective alternative or adjunct treatment to other therapies to manage chronic back and/or leg pain, complex regional pain syndrome (CRPS), neuropathy, or other chronic pain syndromes.
A neurostimulation screening test is used prior to implantation of a permanent device. In this screening test or trial, you will receive a temporary, external neurostimulation system for 3 to 7 days. Throughout the screening test, the external neurostimulator collects patient-use data and the patient records activities, neurostimulation settings, and degree of pain relief in a diary. After the screening test ends, percutaneous trial lead(s) are removed. Results are evaluated to determine if the patient is a candidate for a spinal cord stimulation system implant.
Intrathecal Drug Pump
Pain relief through spinal drug delivery systems, also called intrathecal drug delivery systems, involves implanting a small pump that delivers medication directly to the spinal cord, where pain signals travel. In many cases, spinal drug delivery systems are used to treat people who have cancer pain or chronic pain. Spinal drug delivery systems increase pain relief and comfort for people with severe pain with less medicine. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain. People who have extreme pain can improve their quality of life and become more involved in daily activities with the help of the systems. The drug pump delivers pain medication directly to the fluid around the spinal cord, in an area called the intrathecal space. The drug pump is connected to a thin, flexible tube called a catheter. Both the pump and the catheter are fully implanted under the skin. Because the pump releases medication directly to the pain receptors near the spine instead of going through your circulatory system, pain relief can be achieved with a small fraction of the oral medication dose. Studies have also reported that drug delivery therapy provided pain relief in many patients who could not achieve adequate control even with high doses of oral pain medications. Realistic expectations are essential to satisfaction with any pain treatment. Drug delivery therapy cannot eliminate the source of your pain or cure any underlying disease, but it may help you to better manage your pain.
Drug delivery therapy offers several advantages over other therapies for chronic pain.
- A screening test serves as a temporary evaluation period so you can see if drug delivery therapy relieves your pain before committing to long-term therapy;
- It does not have to be a permanent procedure like back surgery. The system can be turned off or surgically removed;
- Unlike oral medications, drug delivery therapy releases medication directly into the fluid surrounding your spinal cord rather than traveling throughout your body in your bloodstream. This may lead to fewer side effects, such as nausea and constipation;
- Drug delivery therapy may provide relief when other treatments - like medications or injections - have not.
Lumbar Sympathetic Block
A lumbar sympathetic nerve block is performed for pain in the leg that is thought to be caused by complex regional pain syndrome (CRPS) or other neuropathic pain syndromes. These injections are performed under fluoroscopic (x-ray) guidance. Local anesthetic is placed near to the lumbar sympathetic chain in order to relieve the pain. Your leg will likely become warm immediately following the injection: this is an expected effect and not a complication. Back soreness is one of the more common side effects. If you feel any sharp pains down your leg or to your groin during the injection, you should let the physician know immediately.
There may be some temporary numbness following the injection but if there is persistent numbness or weakness (> 8 hours) the doctor should be notified. The injection is done from the back, in the lower aspect of the back. A needle is placed, often under x-ray guidance, to a spot just to the side and approaching the front part of the spine where the ganglion is located. A small amount of dye is injected to make sure the needle is in the right spot. After the doctor is satisfied that the contrast dye is in the right place, he/she will inject numbing medicine then remove the needle.
Radiofrequency ablation (RFA) or rhizotomy is a procedure used to reduce pain where an electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic low-back and neck pain and pain related to the degeneration of joints from arthritis. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years. More than 70% of patients treated with RFA experience pain relief. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. Your doctor can advise you about your particular risk. The main side effect of RFA is some discomfort, including swelling and bruising, at the site of the treatment, but this generally goes away after a few days.
Stellate Ganglion Block
A stellate ganglion block is an injection that can be performed for the diagnosis of complex regional pain syndrome (CRPS) or other neuropathic pain syndromes of the arm or hand. It can also be used to help to improve blood flow to the hand or arm in certain conditions that result in poor circulation of the hand. Side effects may include soreness in the neck where the needle was placed. In some instances the side effects may include droopiness of your eyelid on the side that is injected, along with a temporarily stuffy nose and sometimes temporary difficulty in swallowing. This injection can be performed with x-ray or ultrasound guidance. You will be lying on your back for this injection with your mouth slightly open. It is very helpful to the doctor if you try not to swallow during the injection. If this injection is performed under x-ray the doctor will first inject a small amount of contrast to confirm the placement of the needle then inject some numbing medicine.