epidural (ep-e-do-ral) steroid injection technique involves

the physician feeling the patient's spine in order to guide

the placement of the needle between the spinal vertebrae.

A newer technique involves using x-ray fluoroscopy to

guide the needle directly into the neural foramen; the point

where the affected nerve root exits the spinal canal.

Injections of steroids into the lumbar epidural space are

particularly useful to alleviate pain that radiates from the

lower back into a leg. This pain may be caused by disc

herniation or spinal stenosis, which triggers nerve root

irritation, inflammation, and pain. Similarly, ESIs are used

to treat neck pain that extends into the arms.

 

Sacroiliac (SI) Joint Injections. An SI joint injection is

the injection of medication into the sacroiliac joint in your

buttock region. This may be done if you have a certain type

of low back/buttock pain. Fluoroscopy may be used to

guide placement of a needle into the SI joint, and inject a

local anesthetic or local anesthetic/steroid solution.

 

Facet Joint Injections involve the injection of steroid

medication into the affected spinal facet joint (fah-set joint)

to reduce inflammation and pain. Injections into these

joints or blocks of the nerves that feed the facet joints can

often be very helpful to relieve pain. This problem is more

common in the lumbar spine, but does occur in the cervical

spine too.

 

Trigger Point Injections are muscle blocks. Muscles

chronically tense or in spasm become tender and painful.

The pain triggers more spasm that can develop into a

vicious cycle. Injections into the muscle can help to break

the cycle.

 

Spinal Cord Stimulator (SCS) or Dorsal Column

Stimulator (DCS) is an implantable medical device used to

treat chronic pain of neurologic origin. An electric impulse

generated by the device near the dorsal surface of the

spinal cord provides a paresthesia ("tingling") sensation

that alters the perception of pain by the patient. A pain

medicine specialist or a surgeon introduces the spinal cord

stimulator lead into the epidural space either by

percutaneous approach or by surgical laminectomy or

laminotomy. A pulse generator or RF receiver is implanted

in the abdomen or buttocks. A wire harness connects the

lead to the pulse generator.

 

Radiofrequency Facet Rhizotomy. A facet rhizotomy

destroys facet nerve(s) either in the lower back (lumbar) or

the neck (cervical) region, using radiofrequency (heat)

waves. This procedure is done if you have pain due to

disease in the facet joints of your spine, and you have had

pain relief from your facet nerve blocks. You will be placed

in the prone position. Your back or neck will be cleaned

with an antiseptic solution and the skin area will be

numbed with a local anesthetic. Fluoroscopy is used to

guide the placement of the needle probe to the area of the

facet nerve. Radiofrequency waves are transmitted to lesion

(destroy with heat) the involved nerve(s). This temporarily

stops sensation from that area, which may last for an

average of 6 months or more.

 

Occipital Nerve Block. An occipital nerve block is the

injection of local anesthetic around the occipital nerves,

which are located in the back of your neck near the base of

the skull. This may be useful in the diagnosis and treatment

of headache and jaw pain. A needle is inserted around your

occipital nerve and a local anesthetic or local anesthetic

steroid solution is injected.

 

Nerve Blocks are injections of medication onto or near

nerves. The medications that are injected include local

anesthetics, steroids, and opioids. Blocks are used to

control acute pain (e.g. shot at the dentist or an epidural

block for the surgical delivery of a baby). X-ray fluoroscopic

guidance is sometimes used for accurate needle placement.

Blocks can provide periods of dramatic pain relief, which

can help reduce nerve and joint inflammation, and the

abnormal triggering of signals from injured nerves.

Further, blocks are used to provide diagnostic information

such as helping to determine the pain source.

 

 

Peripheral Nerve Blocks affect the peripheral nerves;

nerves beyond the brain and spinal cord. These nerves

transmit sensation and motor (movement) signals.

 

Sympathetic Nerve Blocks. Chronic pain conditions

often involve sympathetic nerve malfunctions. These nerves

regulate blood flow, sweating, and glandular function. For

example, blocks administered in different areas of the spine

help to reduce pain that involves the face, arm, hands, legs,

and feet.

 

 

Intrathecal Pump Implant ("Spinal Morphine Pump") An

Intrathecal Pump is a specialized device, which delivers

concentrated amounts of medication(s) into spinal cord

area via a small catheter (tubing). What is an Intrathecal

Pump Implant ("Spinal Morphine Pump")?

An Intrathecal Pump is a specialized device, which delivers

concentrated amounts of medication(s) into spinal cord

area via a small catheter (tubing).

 

Kyphoplasty. Kyphoplasty is a minimally invasive spinal

surgery procedure used to treat painful, progressive

vertebral compression fractures (VCFs). A VCF is a fracture

in the body of a vertebra, which causes it to collapse. In

turn, this causes the spinal column above it to develop an

abnormal forward curve. VCFs may be caused by

osteoporosis (an age-related softening of the bones) or by

the spread of tumor to the vertebral body. Certain forms of

cancer can also weaken bone and cause the same

problems.

 

Celiac Plexus/Hypogastric Plexus Block. These blocks

involve the injection of a local anesthetic into the area of a

group of nerves which supply the abdominal organs, called

celiac plexus nerves. These blocks are performed most

commonly for the treatment of upper abdominal pain due

to chronic pancreatitis, cancer and pelvic pain. Fluoroscopy

is used to guide the placement of needle to the area. After

the needle is in the proper area, local anesthetic will be

injected in the area of the celiac plexus nerves.

 

Botulinum Toxin Injection. An injection of botulinum

toxin into the muscle/muscle group causing you pain.This

toxin causes temporary paralysis of these muscles. This

injection may be done if you have dystonia, a disorder

characterized by cramping muscles, certain headaches or

other conditions where muscles are in chronic spasm

causing pain. The dosage of botulinum toxin is very small.

The relief effect takes time to notice. It may take 2-3 days

before muscle relaxation is achieved. This effect generally

lasts months, but requires follow-up before a repeat

injection is recommended. If a poor response or no

response occurs with a previous injection, the value of

proceeding with further injections should be reviewed first.

 

Anti-Depressant Medications. There is considerable

evidence that tricyclic anti-depressants are effective for the

treatment of a variety of pain conditions such as migraine

headache and neuropathic pain.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

are valuable analgesics (pain relieving medications). These

drugs do not alter the patient's cognitive functions, cause

respiratory depression, or nausea. However, NSAIDs are

associated with significant side effects especially with long-

term use.

 

Physical Therapy (PT) addresses body mechanics

(posture), building strength and flexibility through exercise,

injury prevention, and utilizes many modalities. Modalities

include electrical stimulation, heat and ice therapy,

hydrotherapy, ultrasound, and massage.

 

Biofeedback is used to treat many types of conditions

including chronic pain, migraine headache, spinal cord

injury, and movement disorders. It is a type of relaxation

training and behavior modification. Biofeedback works to

control physiological reactions such as muscle tension,

body temperature, heart rate, brain wave activity, and other

life responses. The therapy requires the patient's intense

sensors, attached to monitoring equipment, are applied to

special points on the patient's body. The monitoring

equipment feeds back the patient's progress. The

biofeedback therapist teaches the patient mental and

physical exercises, visualization, and deep breathing to treat

their specific disorder (e.g. low back muscle spasms).