Botox Injection
Botox® is used in pain management to extend the duration of relief obtained by trigger point injections, as well as treatment of migraines and some other conditions. A series of
diagnostic blocks typically precede Botox injection.
Caudal Epidural Steroid Injection
This injection administers a small amount of anti-inflammatory steroid into the bottom portion of epidural space (outside the spinal cord, in the low back area). This procedure has the capacity of providing pain relief by decreasing the inflammation or irritation of the spinal structures (spinal cord, discs, or spinal nerves). This approach is desirable in patients who already had lower back surgery with deranged anatomy requiring pain relief at the vicinity of their surgical site. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Celiac Plexus Block
A celiac plexus block is a procedure to diagnose and treat certain types of abdominal pain. Pancreatic cancer and pancreatitis are indicators that a patient might benefit from this procedure. for this procedure. If the patientreports significant but temporary relief after this block, a more long-acting block using phenol or alcohol can extend the duration of relief. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Diagnostic Facet Joint Block
Spinal facet joints (coupling structures behind spine) are a common cause of spine pain. When inflamed (facet disease, spondylosis) they can cause spine pain sensed by medial branches. Blocking these nerves can confirm this condition by providing pain relief. If these blocks wear off, the patient then might benefit from a more definitive procedure, radiofrequency ablation. Radiofrequency ablation involves using a special needle connected to a machine to 'burn'; (desensitize) the tiny pain fibers in charge of pain sensation of these joints. The effect might last anywhere from 6-24 months and can be safely repeated. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Discography
Provocative discography is a solely diagnostic procedure that is performed before spine surgeries to isolate the painful disc when diagnosis is not clear (equivocal exam and inconclusive imaging). It entails pressurizing the suspicious disc for a few seconds and looking for temporary worsening of the patient’s usual day to day pain while looking at live X-ray. Sedation is optional.
Epidural Blood Patch
An epidural blood patch is performed when a person seems to be suffering from a spinal headache, which usually has resulted from a tear or puncture (intentional or unintentional) of the dura (tissue layer) lining the spinal canal. An intentional hole is made when performing a spinal anesthetic or a spinal tap. The headache is caused by the leakage of spinal fluid through the hole.
An epidural blood patch is the injection of blood that was drawn from the patients in sterile technique and immediately reinjecting it into their epidural space. The procedure typically takes less than 30 minutes. The headache usually subsides shortly after the injection.
Epidural Lysis of Adhesions
This procedure is used to dissolve the scarring and adhesions in the epidural space that seems to be causing spine or limb pain. Typically, this pain is sharp and burning in nature. Using live X-ray a caudal approach is used to send a special catheter toward the suspected level to destroy and dissolve the scar tissues. The procedure might take 30-45 minutes.
Epidural Steroid Injection
This is the classic type of epidural injection using a small amount of anti-inflammatory steroid into the epidural space (outside the spinal cord, in the low back area). This procedure has the capacity of providing pain relief by decreasing the inflammation or irritation of the spinal structures (spinal cord, discs, or spinal nerves). This approach is desirable in patients who have limp pain originating from spine. Epidural injection can be done in lower back, thoracic area, or neck. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Ganglion Impar Block
This is a diagnostic/therapeutic procedure to inject local anesthetic into a network of nerves controlling the pain in the perineum, distal rectum and anus, vulva, and distal third of the vagina. This network of nerves is called Ganglion Impar. If effective, the duration of block can be extended by Radiofrequency ablation, or injecting alcohol or phenol. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Intercostal Nerve Block
Intercostal nerve block is injecting local anesthetic (like Novocain) in the area between two ribs where the intercostal nerve is located. An intercostal block is performed for the diagnosis and treatment of upper back, flank, or chest pain that may be neuropathic (nerve) or somatic (muscle, bone) in origin like the pain from shingles or after chest surgeries. If effective, the duration of block can be extended by Radiofrequency ablation, or injecting alcohol or phenol. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Lumbar Sympathetic Block
This procedure is performed in patients who suffer from lower extremity pain mediated by sympathetic plexus pain fibers (RSD, CRPS) or pain related to decrease in blood flow to the legs due to vascular disease. A successful block is invariably characterized by an increase in temperature in the side the block was performed. If effective, the duration of block can be extended by Radiofrequency ablation, or injecting alcohol or phenol. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
M.i.l.d.
Mild (Minimally Invasive Laminotomy Decompression) procedure is a newly FDA approved technique designed to address neurogenic claudication (back pain that happens ONLY during activity and resolves with rest) without major surgery. This procedure is not indicated for treatment of radicular pain (sciatica) or disc diseases. Mild fills the gap between procedures like epidural steroid injections on one end of the spectrum and minimally invasive or more advanced surgeries on the other end. Mild does not involve any incision and is done through a few small holes in the back. The recovery duration is comparable to radiofrequency ablation. Mild treats only central spinal stenosis patients in which predominant pathology is ligamentum flavum hypertrophy.
Rhizotomy-Radio Frequency Ablation
Radiofrequency ablation (Rhizotomy) involves 'burning' (or deactivating) of nervous structures. It is commonly used for spinal facet joint pain but it can also be used in a variety of different nerves including occipital nerves involved in certain types of headache. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Sacroiliac Joint Block
The sacroiliac joint is one of the few joints in the body that does not move. This Joint connects the spine to the pelvis/hip areas, and can become painful by trauma, pressure, wear and tear, or other factors. Sacroiliac joint pain can radiate to groin and legs therefore it can mimic inguinal hernia or even sciatica. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Spinal Cord Stimulation - Neuromodulation
Spinal cord stimulation has been successful in pain management of a subgroup of patients with back or limp pain that do not respond to or have failed minimally invasive procedures such as epidural injections and are not candidates for spinal surgical interventions. This modality has also been successfully used in patients with Failed Back Surgery Syndrome, Neuropathies/Neuralgias, Peripheral Vascular Disease, Arachnoiditis, Phantom Limb Pain, and Complex Regional Pain Syndromes. Prospective candidates receive educational material in the form of a DVD and brochure to familiarize with this concept, its pros, and cons. Spinal Cord Stimulation is performed in two stages: The first step that does not involve an incision involves using a temporary spinal cord stimulator for a duration of a week. If the patient reports satisfactory relief without side effect he/she is now a good candidate for permanent implant after a psychological evaluation that is required by all insurances. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Stellate Ganglion Block
This procedure is performed in patients who suffer from upper extremity pain mediated by sympathetic plexus pain fibers (RSD, CRPS) or pain related to decrease in blood flow to the legs due to vascular disease. A successful block is invariably characterized by an increase in temperature in the side the block was performed. If effective, the duration of block can be extended by Radiofrequency ablation, or injecting alcohol or phenol. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Superior Hypogastric Block
Most of the pain the pelvic area is mediated by the superior hypogastric plexus. The superior hypogastric block has just been recently been introduced for the treatment of pelvic pain, either to nonmalignant or malignant pain. The plexus lies anterior to the body of the L3 to L5 vertebra. This plexus controls the sensation of the vagina, rectum, bladder, perineum, vulva, prostate, testes, and uterus. Therefore, pain felt to originate from any of these structures could theoretically be treated by blockade of this plexus. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Transforminal Epidural Steroid Injection
This form of epidural injections involve in targeting selected nerve roots for diagnostic and/or therapeutic purposes. It is also very helpful in patients with previous spine surgeries who have deranged spinal anatomy. Live X-ray guidance (fluoroscopy) is always used to confirm proper needle placement and medication spread. Sedation is optional.
Trigger Point Injection
Chronic muscular pain can results from an injury to a muscle and over time, it can escalate by posturing and non-use of the muscle, causing a vicious cycle. This condition is called myofascial pain syndrome. TPI’s are intra-muscular (IM) injections of local anesthetic (like Novocain), into the muscle sites as a part of myofascial pain syndrome treatment. It is usually used when conservative approaches like, oral medications (anti-inflammatory and muscle relaxants) and rest have failed.
TPI’s temporarily numb and relax the muscle sites involved in the pain process. This provides a break in the vicious cycle of pain and allows the patient to participate in a more effective physical therapy and stretching of these muscles, and may also increase blood flow through that muscle. Injection of Botox can extend the duration of relief.
