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Pain Management

There are many different aspects of pain management from prescription medication to psychological components.  We fully identify the pain and begin from there.  We have many tools in our arsenal including.

  • Prescription medication
  • Diagnostic and therapeutic nerve blocks
  • Epidural steroidal injections (ESI)
  • Facet injections and medial branch blocks
  • Sacro-Iliac (SI Joint) injections
  • TENS
  • Trigger Point Therapies
  • Large and small joint injections ranging from shoulders and knees to fingers and toes

One of the most important tools in our arsenal are spinal injections.  As you can see in the list above, we can perform a number of types of injections in the cervical, thoracic and lumbar sections of the spine.  Here is a more in-depth description of each of the major injections.

The image below depicts a herniated disc that is impinging on the nerve root.  Notice that there is a round sack or lining around the spinal canal.  That protective shield is called the dura.  The space between the dura and nerves within the spinal canal is called the epidural space.  The epidural space is where the steroid injection is performed.

The procedure starts with a local numbing agent injection used to locally numb the skin.  Using real-time x-ray for guidance, the doctor will guide a needle into the epidural space.  Once the doctor is sure the needle is in the correct position, the steroid material is injected.  Patients are typically monitored up to 30 minutes after the injection.

The patient may feel immediate pain relief and numbness in the local area for up to 6 hours.  However, your pain may return after this short pain-free period or may even be a little worse for a day or two.  This is normal.  This increase in pain can be caused by needle irritation.  Depending on the amount of inflammation, an injection could offer several months or pain relief.  However, even if this procedure does not have the desired pain relief, it can be used as a diagnostic procedure to further narrow the cause of pain and subsequent treatment.

In order to understand how a medial branch block works, you must envision the facet joints of the spine.    As depicted in the illustration below, each vertebrae has facet joints on both sides of the structure and interface with vertebrae above and below.  Medial branch nerves, located near facet joints, transmit pain signals from the facet joints to your brain.

The procedure and expectations are very similar to an ESI, including real-time x-ray positioning; however, the injection is given near the medial branch nerve.  If you pain goes away for a short time and then returns, you may be a candidate for radio frequency ablation (RFA).  This procedure provides a more permanent disruption of pain signals.

In order to understand how an SI joint injection works, you must envision the SI joint itself.  As depicted in the illustration below, the SI joint joins the sacrum (tailbone) with the hips (ilium).  This joint moves very little but is very important for proper bio mechanics and a dysfunction in the joint can cause significant pain.

The procedure and expectations are very similar to an ESI or a medial branch block, including real-time x-ray positioning; however, the injection is given near the SI joint.  Sometimes an injection can bring several months of pain relief, and then more treatment is needed.  Other times, particularly if there is no underlying bone or joint problem, one injection brings long-term pain relief.  If you pain is caused by injury to more than one area, only some of your symptoms may be helped by one injection.