Epidural Steroid Injection (Cervical, Thoracic, and Lumbar)
An epidural injection is a minimally invasive treatment for neck, arm, mid-back, low-back and leg pain. The doctor will place a small amount of steroid and local anesthetic into the epidural space within the spine to relieve pain – back pain, leg pain, or other pain – caused by irritated spinal nerves.
Medial Branch Block (Cervical, Thoracic, and Lumbar) and Medial Branch Radiofrequency Ablation
Small joints between the vertebrae (spine bone) called facet joints can cause neck pain, mid-back pain and/or low back pain when inflamed/arthritic. A medial branch block is an injection of medication outside the joint space near the medial branch nerve which carries the pain signal from the facet joint. If pain relief is achieved, the facet joint generating the pain has likely been identified. The pain relief is short lasting (usually around 12-24 hrs) but is also indicative of the ability to treat the nerve with radiofrequency ablation.
Radiofrequency Ablation (RFA), Rhizotomy, Neurotomy
Once the pain generating nerve has been identified from a diagnostic nerve block (such as medial branch block) radiofrequency ablation (rhizotomy or neurotomy) uses a special type of needle to apply heat to a painful nerve, in turn allowing the nerve to regress for a prolonged period of time. There are mainly two types of RFA.
Thermal RFA: A radiofrequency current is converted from energy to heat. This heat creates a small lesion on the nerve which prevents it from transmitting a pain signal to your brain.
Pulsed RFA: A higher voltage is used to deliver a pulse of energy, which creates less heat. This particular type of RFA leaves the nerve intact, but changes the signaling of painful fibers in the nerve.
Sacroiliac (SI) Joint Injection
The sacroiliac joint is often a cause of low back and leg pain. By injecting anti-inflammatory steroid and local anesthetic into the sacroiliac joint, relief of low back and leg pain will be more significant. This will also help the doctor make a confirmed diagnosis of sacroiliitis.
Celiac Plexus Block
A celiac plexus block is a commonly performed sympathetic nerve block for individuals suffering from abdominal and/or flank pain caused by cancer or pancreatitis. A needle is placed under fluoroscopic guidance from the back to the celiac plexus located in front of the vertebra. Local anesthetic and a steroid are injected to relieve pain. Several injections may be needed for longer lasting relief.
Discogram / Discography
A discogram is a test used to determine which disc is causing pain. It is a diagnostic test often conducted before a spine surgery to determine which disc to target for surgery. Needles are placed under fluoroscopic guidance to several discs in question. Then, contrast is injected within the disc, which can show damaged disc shape and/or identify the cause of pain.
Ganglion Impar Block
A ganglion impar block is a sympathetic block used to treat pelvic, genital, perineal and anal pain. This injection is used in the treatment of sympathetically-mediated pain, as well as pain secondary to malignancy, neuropathic pain, and post-surgical pain. A small needle is placed in the buttock under fluoroscopic guidance and a mixture of local anesthetic and steroid are given.
Genicular Nerve Block
Genicular nerve block is a new treatment option for chronic knee pain in patients wanting to postpone surgery or treat residual pain after knee surgery. After a successful nerve block, radiofrequency ablation is performed on the genicular nerve to obtain lasting pain relief.
Hypogastric Plexus Block
A hypogastric plexus block is a minimally invasive sympathetic nerve block used to treat vague pelvic and genital pain refractory to other conventional treatment. A needle is placed under fluoroscopic guidance from your back to the celiac plexus located in front of your vertebra. Local anesthetic and steroid are injected to achieve pain relief. Several injections may be needed to achieve longer lasting relief.
Intercostal Nerve Block
An intercostal nerve block is a procedure used to treat pain in the chest and upper abdomen. A needle is placed under ultrasound and/or fluoroscopic guidance to the small nerve and a local anesthetic with steroid is injected to achieve pain relief. It is commonly used to treat pain occurring from rib fracture and post-herpetic neuralgia.
Intrathecal Pump (Pain Pump, Spinal Pump)
An intrathecal pump can provide the best relief for around-the-clock pain unresponsive to conventional methods such as oral pain medication. After a successful trial period, a decision is made to implant a pump which delivers pain medications (to include opioids, local anesthetics, and/or many more) directly into the cerebrospinal fluid. Your doctor can easily program the pump to adjust the dose of medication flowing in order to better control pain.
Kyphoplasty is a minimally invasive procedure for compression fractures of the spine, which provides almost immediate pain relief. A filler material is injected within a compressed spine to stabilize the fracture. Patients usually notice immediate pain relief.
Lumbar Sympathetic Block
A lumbar sympathetic nerve block is a procedure used to mainly treat conditions in the leg that are difficult to treat such as complex regional pain syndrome (CRPS, also known as RSD). Local anesthetic and steroid is injected within the sympathetic chain, under fluoroscopy, to alleviate pain.
Stellate Ganglion Block
A stellate ganglion block is a sympathetic nerve block used to treat chronic pain syndromes in the head, neck and upper extremities, and is often utilized to treat complex regional pain syndrome (CRPS). Local anesthetic and steroid is injected to the sympathetic chain under fluoroscopy or ultrasound, to alleviate pain.
With time and age, many joints in our body become arthritic and cause pain. These joints include but are not limited to the hip, knee, shoulder, and elbow. Often, dramatic pain relief is achieved with simple injection of local anesthetics and steroids. In some cases, viscoelastic supplements (lubricant) can be injected.
Occipital Nerve Block
There are two nerves located in the back of the head – the greater and lesser occipital nerve, which are involved in occipital headache. Blocking this nerve with simple local anesthetic and steroid can dramatically lessen headache symptoms and frequency.
Sphenopalatine Ganglion Block
A sphenopalatine ganglion block is a procedure often used to treat headaches, head pain, and facial pain. Local anesthetic is injected within the back of the nose using a special device. This can achieve dramatic relief of pain.
Spinal Cord Stimulation
Spinal cord stimulation (SCS) has been around for many years but continues to develop with cutting edge technology. Electrodes are placed in the epidural space and change pain signals going to your brain. This can treat many different chronic pain in the body including the arms, neck, back, legs, and many more. Patients can opt for a “trial period” where only electrodes are placed, temporarily, for approximately one week. If the trial is successful, the electrode and stimulator (which houses the battery) is implanted within the body.
Carpal Tunnel Injection
Carpal tunnel is a very common condition caused by compression and inflammation of the median nerve in the wrist. Local anesthetic and steroids can be injected under ultrasound guidance within the wrist to alleviate symptoms of carpal tunnel.
Cluneal Nerve Injection
Low back pain is often difficult to treat, and cluneal nerve neuralgia is an under-diagnosed cause of low back pain. Local anesthetic and steroid are injected to the cluneal nerve and a diagnosis of cluneal neuralgia is given should significant pain remain. This injection can also be therapeutic with the injection of a steroid as well.