Interventional Pain Management
Interventional pain management involves special procedures to treat and manage pain. "Interventional"
procedures might include an injection of an anesthetic medicine or steroid around nerves, tendons, joints or
muscles; spinal cord stimulation; insertion of a drug delivery system; or a procedure with radio-frequency
ablation or cryoablation to stop a nerve from working for a long period of time.
Below are some frequently asked questions specific to pain management.
What is an Epidural Steroid Injection?
What is the goal of the injection?
How is the injection performed?
How long does the injection take?
How many injections will I need?
What are the expected results?
What are Trigger Points?
What are Trigger Points Injections?
What should I expect after the injection?
What is Facet Joint Injection?
Who is a candidate for Facet Joint Injections?
How long does the injection take?
What can I expect after the injection?
What is Radio Frequency Lesioning?
Am I a candidate for Radiofrequency Lesioning?
How long does the proceedure take?
How is it actually performed?
What should I expect after the procedure?
What is an Epidural Steroid Injection?
Epidural Steroid Injection is a shot of Cortisone, a powerful anti-inflammatory steroid into the area that surrounds the spinal cord and the nerves that extend from it, called the epidural space. Epidural Steroid Injections are a common treatment option for chronic neck and lower back pain. They have been in use since 1952 and are still an integral part of the non-surgical management of sciatica and lower back pain.
What is the goal of the injection?
The steroid injected reduces the inflammation or swelling of the nerves in the epidural space. This may reduce pain, tingling, numbnes and other symptoms caused by nerve inflammation or swelling.
How is the injection performed?
It can be performed several ways including the patient sitting up, lying on the side or on the stomach. After a local skin anesthetic is applied to numb the injection site, a spinal needle is inserted into the epidural space. To ensure accuracy and safety, our physicians perform the procedure under fluoroscopic (x-ray) guidance, using a contrast agent to confirm needle placement. Local anesthetic and corticosteroid anti-inflammatory medication are delivered into the epidural space to shrink the swelling around nerve roots, relieving pressure and pain.
How long does the injection take?
The whole procedure takes approximately ten to fifteen minutes.
How many injections will I need?
Up to three injections may be given within a six-month time frame. Usually, the injections are performed two to three weeks apart. A set of three injections is the norm; however, you may gain considerable relief after the first or second injection. In that instance, further injections may not be necessary.
Will I be put out for this procedure?
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient? tolerance.
What are the expected results?
Epidural injections are very effective in providing pain relief. The benefit from these injections will typically occur two days following the procedure. In conjunction with chiropractic and physical therapy, many individuals enjoy a pain free lifestyle.
Trigger Point Injections:
What are Trigger Points?
A trigger point is an irritable, painful, taut muscle band or palpable knot in a muscle that can cause localized pain or referred pain. Referred pain from trigger points can mimic pinched nerves in the neck or lower back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spinal conditions such as a herniated disc. Myofascial pain syndrome is a chronic pain condition in which there may be several trigger points limited to a particular area of the body. The pain and spasm associated with trigger points can lead to a vicious pain cycle in which pain causes more spasm and spasm causes more pain.
Myofascial pain syndrome is not to be confused with fibromyalgia. Myofascial pain syndrome is a regional or localized pain syndrome in contrast to FMS (fibromyalgia syndrome) which is a widespread musculoskeletal pain syndrome
What are Trigger Points Injections?
Trigger point injections are injections of local anesthetic medication, saline, or cortisone into the trigger points. The basis for a trigger point injection is to relax the area of intense muscle spasm. By relaxing the muscle spasm, blood flow to the area is improved thus allowing the washout of irritants. Trigger point injections are an important part of treating myofascial pain syndrome and, in some cases, fibromyalgia. Many times multiple injections are performed in series. Trigger point injections can be done in an office setting or in an outpatient setting under IV sedation.
What should I expect after the injection?
You may experience soreness, bruising, or even an increase in pain for a few days until your body has time to recuperate from the injections. Pain can be relieved by alternately applying moist heat and ice for a day or two. In most cases, stretching exercises and physical therapy are performed following trigger point injections.
What is Facet Joint Injection?
A facet injection includes both a long-lasting corticosteroid and an anesthetic numbing agent. The drugs are delivered to the painful facet joint, either inside the joint capsule or in the tissue surrounding the joint capsule. Each vertebra has four facet joints, one pair that connects to the vertebra above(superior facets) and one pair that connects to the vertebra below(inferior facets) Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. The pain relief can last from days to years, allowing you to improve your spinal condition with physical therapy and an exercise program.
Who is a candidate for Facet Joint Injections?
If you have neck, arm lower 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, physical therapy or chiropractic care. The doctor may wish to perform the injection as a diagnostic test to determine if the facet joint is causing your pain. Facet injections may be helpful in treating inflamed facet joints caused by Spinal Stenosis, Sciatica, Spondylolysis, Herniated Disc or Arthritis.
How long does the injection take?
Depending on the number of facet joints being treated, the brief procedure may last fifteen-thirty minutes followed by a recovery period.
What can I expect after the injection?
Most patients can walk around immediately after the procedure. After being monitored for a short period, you can leave the office. Someone must drive you home. Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic. The doctor will follow up with you seven to ten days after the procedure to ask about your symptoms and the level of pain relief obtained.
What is Radio Frequency Lesioning?
Radio Frequency Lesioning is a procedure using a specialized computer controlled machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for six to nine months (can be as short as three months or as long as eighteen months). RF lesioning is used when other conservative therapies such as physical therapy, chiropractic care, rest and oral anti-inflammatory medications have failed. RF is only considered after a diagnostic (local anesthetic) block has been shown to be of benefit, but of short duration.
Am I a candidate for Radio Frequency Lesioning?
Radio Frequency Lesioning is offered to patients with:
- Mechanical neck or low back pain due to facet joint disease
- Occipital neuralgia (Headaches)
- Abdominal (visceral) pain responsive to splanchnic nerve block, Discogenic Pain (Low Back Pain), Nerve Root Pain (Radiculopathy / Radiculitis) (Arm or Leg Pain)
- You must have responded well to local anesthetic blocks, to be a candidate for Radio Frequency Lesioning.
How long does the proceedure take?
Depending upon the areas to be treated, the procedure can take from about twenty minutes to a couple of hours.
How is it actually performed?
Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A local anesthetic (like Novocaine) is injected to confirm proper placement. After confirmation of the needle tip position, a special needle tip is inserted.
When the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing, tingling, pain, or pressure sensation or may be like hitting your "funny bone? Because we also do motor stimulation testing, you may also feel your muscles jump or twitch. You need to be awake during this part of the procedure so you can report what you are feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Radio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently.
What should I expect after the procedure?
Initially there will be muscle soreness for a few days after the procedure. Ice packs will usually control this discomfort. After that time, your pain SHOULD be gone or lessened significantly.
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