Procedures

Back and Neck Pain

  • Epidural Steroid Injection – This medication decreases swelling and inflammation in the affected tissues in the spinal column to help relieve pain. Your legs may be weak or numb for several hours. The following day, you may resume your activies and therapies as tolerated. Drink plenty of fluids the afternoon and evening following the procedure to help prevent a possible headache that may occur after the injection. Follow your normal diet.

  • Facet Injection – Just as you can have arthritis in your knees or hips, you can also develop arthritis in your back. There are a series of joints in your back called facet joints which can become “worn out” as we age. Steroid injections into these joints can decrease inflammation and improve your ability to do the activities you enjoy.

  • Radiofrequency Ablation (RFA) – If you get good response to the facet injections, then RFA may be an option for you. This procedure involves using heat to disrupt the nerves that supply sensation to the facet joint. This can take several weeks to be fully effective, but can give long-lasting relief from pain.

  • Spinal Cord Stimulation (SCS) – In patients who have failed extensive conservative therapy and who continue to have debilitating pain, SCS may be an option. This therapy is particularly beneficial for patients with radiating neck/arm or back/leg pain. It involves permanently implanting a small device similar to a pacemaker under the skin and leads in the epidural space. This helps block out the pain signals by supplying a different sensation to the painful area (such as tingling).

Muscle Pain

  • Trigger Point Injection – This medication numbs the nerve endings. This helps to relax the tense muscle and break the pain cycle. Occasionally a steroid medication is used with the numbing medication. The steroid will decrease swelling and inflammation along the nerve to relieve the pain.

Cancer Pain

  • Intrathecal Pain Pump – This therapy tends to be reserved for patients with intractable cancer pain. Like the SCS, it involves the implantation of a small device which infuses pain medication such as morphine directly around the nerves in the back. Like SCS, it is commonly reserved for patients who have failed more conservative therapy or who are having severe side effects from oral pain medications.

  • Celiac Plexus Block – This injection is a two-part injection to help people dealing with pain from pancreatic cancer. The celiac plexus controls the pain sensations that arise from the pancreas. The first step is an injection of local anesthetic to determine if the pain is relieved by blocking these sensations. If there is a positive result with the first injection, a second injection is done using a medication that “kills off” the nerves. This can provide 6 months or longer of pain relief.

  • Superior Hypogastric Block – This injection is similar to the celiac plexus block except it is used to treat cancer pain from pelvic organs and rectum.

  • Ganglion Impar Block – This injection is used to treat pain of the perineum. This pain can be from a malignant origin such as perirectal pain from tumor involvement.

Trigeminal Neuralgia

  • Trigeminal nerve block – Patients who suffer facial pain in the distribution may receive a diagnosis of trigeminal neuralgia. This injection initially consists of a mixture of local anesthetic and steroid medication placed around the affected branch of the trigeminal nerve. Further injections or other interventions are done based on the results of this injection.

Other Injections

  • Blood Patch – Occasionally a spinal headache will develop after an epidural injection. Blood drawn from your arm is used to seal the hole from the spinal needle puncture in the epidural space. After the procedure keep activity to a minimum and avoid straining, sneezing, coughing, lifting anything over 10 to 15 pounds and driving for the first 24 hours. These activities may increase the pressure of your cerebrospinal fluid, causing the blood patch to dislodge and your headaches to recur. After 24 hours you may resume your activities and therapies as tolerated. You may feel the sensation of a slight headache when sitting or standing for the next few days as your body replenishes its cerebrospinal fluid to the normal level.

  • Stellate Ganglion Block – The stellate ganglion is part of the sympathetic nerve system composed of the lower cervical and first thoracic ganglia. This ganglion receives input from the sympathetic chain and sends messages to the head, neck and upper extremities. It has been implicated in the cause of chronic pain states such as Complex Regional Pain Syndrome (CRPS) [formerly Reflex Sympathetic Dystrophy (RSD)], herpes zoster, Raynaud's or vascular insufficiency of the upper extremities due to arterial spasm. Local anesthetic is injected around the ganglion to “turn off” the input to the affected area for a length of time.

  • Lumbar Sympathetic Block – Like the stellate ganglion block this is an injection around the sympathetic nerves in the lower extremities. This injection can be used to treat CPRS or RSD of the lower extremities, vascular insufficiency due to arterial spasm, or herpes zoster.

  • Intercostal Block Injection – This medication numbs the nerve. As the medication wears off and the nerves “wake up” the goal is that they will reset at a lesser pain level. Occasionally a steroid medication is used with the numbing medication. The steroid will decrease swelling and inflammation along the nerve to help reduce the pain. Limit your activities the rest of the day. Normal activities and therapy may resume the next day as tolerated. Any shortness of breath or difficulty breathing after the procedure should be reported to your doctor.

  • Occipital Nerve Block – An occipital nerve block is an injection of local anesthetic and steroid around the greater and lesser occipital nerves in the back of the head. This injection can help reduce pain and swelling in this area. It can be used for diagnosis and treatment of occipital neuralgia, which causes a distinct headache.