Pain management includes varied procedures to control pain, inflammation and swelling, performed by doctors trained specifically to administer this treatment.
Our doctors are trained to treat various pain syndromes including:
- Herniated discs of the lower back and neck
- Numbness and tingling of the limbs
- Reflex sympathetic dystrophy
- Knee and hip pain
Using cutting edge fluoroscopy and x-ray for advanced diagnostics, we perform:
- Epidural steroid injections
- Nerve block radiofrequency ablation
- Facet blocks
- Sacroiliac joint injections
- Sympathetic blocks
- PRP (Platelet Rich Plasma Therapy)
Epidural Steroid Injection
Epidural Steroid Injection is an injection of long lasting steroid (“cortisone”) in the Epidural space which is the area which surrounds the spinal cord and the nerve roots.
The steroid injected 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 and swelling.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (Depo-medrol®, Celestone-Soluspan).
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”) so, there is very little discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the Epidural needle. Also, the tissues in the midline have less nerve supply, so usually you feel pressure and not much pain
What should I expect after the injection?
Immediately after the injection, you may feel your legs slightly heavy and may be numb. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a “sore back” for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 3rd day or so.
What should I do after the procedure?
We advise the patients to take it easy for a day or so after the procedure. Perform activities as tolerated by you. If you feel relief after the epidural we caution you not to jump into full activity immediately but go through some rehabilitation to strengthen weakened areas first.
Can I go back to work the next day?
You should be able to unless the procedure was complicated. Usually you will feel some back pain or have a “sore back” only.
How long the effect of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 5 days and its effect can last for several days to a few months.
How many injections do I need to have?
If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. Similarly If the second injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a third injection.
Can I have more than three injections?
In a six month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get nay further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.
Will the Epidural Steroid Injection help me?
It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have “radicular symptoms” (like sciatica) respond better to the injections than the patients who have only back pain. Similarly, the patients with a recent onset of pain may respond much better than the ones with a long standing pain. Also, the patients with back pain mainly due to bony abnormality may not respond adequately.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involve spinal puncture with headaches, infection, bleeding inside the Epidural space with nerve damage, worsening of symptoms etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin, Plavix) we will have you contact your cardiologist and get permission to stop taking these drugs for 1 week prior to your epidural, or if you have an active infection going on, you should not have the injection.
This injection procedure is where a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating the facet or sacroiliac joint pain.
A medial branch neurotomy affects the nerves carrying pain from the facet joints, and a lateral branch neurotomy affects nerves that carry pain from the sacroiliac joints.
These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs so there is no danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.
Success Rates of Radiofrequency Neurotomy for Pain Relief
Before this procedure is undertaken, the joints and branch nerves will have already been proven to be painful by a diagnostic form of spinal injection, and will not have responded to other treatment methods. If effective, the neurotomy should provide facet or sacroiliac joint pain relief lasting at least six to fourteen months and sometimes much longer. After this period of time, however, the nerve will regenerate, and the facet or sacroiliac joint pain may return.
Success rates vary, but typically about 30% to 50% of patients undergoing this procedure will experience significant facet or sacroiliac joint pain relief for as much as two years. Of the remaining patients, about 50% will get some pain relief for a shorter period. Some patients do not experience any relief from facet or sacroiliac joint pain as a result of this procedure.
A facet injection is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain (arthritis, injury, degeneration) is not well understood and can be similar in nature to disc pain. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from your facet joints. Second, it can be used as a treatment to relieve inflammation and pain caused by various spine conditions. The effects of facet injections tend to be temporary – providing relief for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.
Who is a candidate for facet injection?
If you have neck, arm, low back, or leg pain (sciatica) stemming from inflammation of the facet joints you may benefit from a facet injection. Typically, it is recommended for those who fail to respond to other conservative treatments, such as oral anti-inflammatory medication, rest, back braces or physical therapy. The doctor may wish to perform the injection as a diagnostic test to determine if the facet joint is causing your pain.
Sacroiliac Join Injection
The Sacroiliac joint (SI) is actually fused together by ligaments, and doesn’t move. A SI joint injection is performed if your doctor suspects that your pain may be originating joint injection.
This is an injection of local anesthetic (like Novocain) and anti-inflammatory steroid (not muscle building) into and around the Sacroiliac Joint in your pelvis. The SI joint is actually not like any other joint. Other joints in your body are pivot points that allow movement. The SI joint is a non-moveable joint that is held together by very strong ligaments and muscles. The local anesthetic numbs the joint and also numbs and relaxes the muscles around the joint, which can result in sustained pain relief. If you achieve partial sustained relief following the first SI joint injection, then a series of injections may give you even a greater degree of sustained relief.
The procedure will take about 10-15 minutes.
Spinal Cord Stimulation or Neuromodulation
Treatment of chronic pain using Spinal Cord Stimulation (SCS) is on the forefront of interventional pain management techniques. Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps you to better manage your pain and potentially decrease the amount of pain medication. It may be an option if you have long-term (chronic) leg or arm pain, and have not found relief through traditional methods. A small battery-powered generator implanted in the body transmits an electrical current to your spinal cord. The result is a tingling sensation instead of pain. By interrupting pain signals, the procedure has shown success in returning some people to a more active lifestyle.
What is a spinal cord stimulator?
A spinal cord stimulator (SCS), also known as a dorsal column stimulator, is a device surgically placed under your skin to send a mild electric current to your spinal cord (Fig. 1). A small wire carries the current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. Your pain is reduced because the electrical current interrupts the pain signal from reaching your brain.
Patients selected for this procedure usually have had a disability for more than 12 months and have pain in their lower back and leg (sciatica). They’ve typically had one or more failed spinal surgeries.
You may be a candidate for SCS if you meet the following criteria:
- Conservative therapies have failed
- Your source of pain has been verified
- You would not benefit from additional surgery
- You are not seriously dependent on pain medication or other drugs
- You do not have depression or other psychiatric conditions that contribute to your pain
- You have no medical conditions that would keep you from undergoing implantation
- You have had a successful trial stimulation
An SCS can help lessen chronic pain caused by:
- Chronic leg (sciatica) or arm pain: ongoing, persistent pain caused by degenerative conditions like arthritis or spinal stenosis, or from nerve damage.
- Failed back surgery syndrome: failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure.
- Complex regional pain syndrome (CRPS): a progressive disease of the nervous system in which patients feel constant chronic burning pain, typically in the foot or the hand. Formerly called reflex sympathetic dystrophy (RSD).
- Arachnoiditis: painful inflammation and scarring of the meninges (protective layers) of the spinal nerves.
- Other: stump pain, angina, peripheral vascular disease, multiple sclerosis, spinal cord injury.
If your pain is caused by a correctable condition, then this must be fixed first. You cannot have a Spinal Cord Stimulator if you have a cardiac pacemaker.