Services
We have compiled a comprehensive list of our services below. Click on a title to view more information about each one.
Pain management is a branch of medicine that applies science to the reduction of pain. It covers a wide spectrum of conditions including neuropathic pain, sciatica, postoperative pain and more.
Steroid injections are commonly used to treat a variety of inflammatory conditions of the upper extremity and typically contain a mixture of a synthetic cortisone and a local anesthetic such as lidocaine or bupivacaine. Cortisone is a steroid normally produced by the adrenal gland and is a powerful anti-inflammatory.
Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative (nonsurgical) care regimens. The most common use of discography is for surgical planning prior to a lumbar fusion.
Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain.Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin.
For more information about how Spinal Cord Stimulation works, click here.
A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.
This procedure is done on an outpatient basis, and sedation is rarely needed because it is generally not painful. You will be asked to lie on your stomach on an x-ray table. The skin over the disc involvement is prepped and numbed with a medication much like that used in dentistry. A long needle is then inserted into the numbed skin. Using a live action x-ray called fluoroscopy, the needle is guided to the epidural space. The needle is placed alongside the nerve root where it exits the spinal column, because this is where the ganglionic pain center of the nerve is located. This nexus is vital in transmitting and processing painful stimuli to the spinal cord and using the steroid and pain medication in this small area disrupts that signal. For this reason, precise placement with fluoroscopy is necessary. Often the opening is narrowed due to arthritic changes in the back, bone spurs, or protrusion of a herniated disc. In addition, if the disc has herniated, the gel inside the disc is acidic, and it can cause irritation to the nerve. This is why both steroids and an analgesic must be accurately placed in the foramen and fluoroscopy is essential to the success of the procedure. The doctor will then inject contrast dye to ensure that the needle tip is in the right place. Once placement is confirmed, approximately 2 ml of fluid is slowly injected into the space. Although the injection is not fast, you may feel some pressure in your back due to the pressure of the medication against the nerve. The needle is then removed, a bandage is placed on the insertion site, and you will be brought to a recovery area for observation.
A selective nerve root block is a minimally invasive procedure that is used to diagnose and treat cervical, thoracic, and lumbar pain, and associated extremity pain. It involves injecting a local anesthetic directly into a specific, targeted nerve root of the spine to help identify the source of a patient’s pain symptoms. Secondarily, it may also be used to provide therapeutic relief of a patient’s symptoms. When a spinal nerve root becomes irritated, inflamed, or compressed it can cause spinal pain. Furthermore, symptoms may be felt in the upper or lower extremities depending on where the irritated nerves are located. For example, cervical spine nerve irritation may lead to pain, numbness, and tingling in the neck, shoulders, or arms. Whereas thoracic spine nerve irritation can result in pain in the upper back or pain along the chest wall and ribs. Lastly, lumbar spine nerve irritation may result in pain, numbness, and tingling in the low back, hips, buttocks, and legs. The source of a patient’s pain may be difficult to identify. At times, imaging of the affected area, utilizing magnetic resonance imaging (MRI), may not show which nerve is causing the pain. In these cases, a selective nerve root block may be used to isolate the nerve root that is the source of a patient’s pain. In addition to its’ diagnostic ability, a selective nerve root block can also be used to provide effective pain relief of various conditions. A selective nerve block involves injecting a local anesthetic, often combined with a corticosteroid, into the targeted nerve root. The local anesthetic essentially numbs the nerve, while the steroid helps to decrease inflammation and associated pain. A selective nerve root block is similar to an epidural injection; however, the medication is directed at the offending nerve root and not into the epidural space. The success rate of selective nerve root blocks varies among individuals, as some nerve roots are very difficult to treat due to their location and surrounding structures.
This procedure involves injecting numbing medicine around the sympathetic nerves in the low back or neck. By doing this, the sympathetic nervous system in that area is temporarily 'switched' off in hopes of reducing or eliminating pain. If pain is substantially improved after the block, then a diagnosis of sympathetically mediated pain is established. The therapeutic effects of the anesthetic can occur, at times, longer than would be normally expected. The goal is to reset the sympathetic tone to a normal state of regulation. If the initial block is successful, then additional blocks may be repeated if the pain continues to sequentially diminish.
A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed.
Sacroiliac joint block injections are used to provide temporary relief from symptoms associated with disorders that affect the sacroiliac joints, which connect the sacrum (lower spine) to the interior edges of the ilium of the pelvis.
Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. This has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
Brachial plexus blocks are regional anesthesia techniques that are sometimes employed as an alternative to general anesthesia for surgery of the shoulder, arm, forearm, wrist and hand. These techniques involve the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity.
An occipital nerve block is an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves.
Dysfunctional tissue is ablated using the heat generated from the high frequency alternating current to treat a medical disorder. An important advantage of RF current (over previously used low frequency AC or pulses of DC) is that it does not directly stimulate nerves or heart muscle and can therefore often be used without the need for general anesthetic.
Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative (nonsurgical) care regimens
A selective nerve root block (SNRB) is an injection primarily used to diagnose spinal nerve root pain. It is used diagnostically in the event that an imaging procedure, such as an MRI, does not clearly indicate which nerve is the source of pain.
A facet joint block is the injection of a local anesthetic medication into or next to the facet joint. In most cases, a corticosteroid is injected.