Treatments

What is a Bursa?

In many areas of the body, muscles and tendons must slide over and against one another during movement. At each of these places there is a bursa, which is a small sac of lubricating fluid, to help the muscles and tendons move without friction. When the bursa sac becomes inflamed, pain can result each time the tendon has to move over the bone. The pain may eventually be present at rest and may even cause a problem while sleeping.

What to Expect During a Bursa Injection

• Using X-ray guidance, or ultrasound the physician will insert a thin needle and inject contrast solution into the bursa thought to be causing your pain. The contrast solution is designed to highlight your anatomy to make sure the nerve thought to be causing your pain is precisely targeted.

• The physician will then slowly release a combination of anti-inflammatory (steroid) and anesthetic (numbing) medications into the area.

• You may experience some slight pressure or discomfort during the bursa injections.

• You may be asked to wait after the procedure so that the clinic staff can monitor your symptoms before you leave.

What to Expect After the Bursa Injection

• The beneficial effects of the steroids usually require two to three days to take hold, but may take as long as five to seven days.

• If an initial injection provided a certain amount of relief, a second injection might strengthen the pain relief effect. Also, if your pain subsides, but begins to return weeks or months later, additional injections are possible.

• If there is no change in your symptoms after a week, your doctor may want to investigate other possible sources for your pain.

A celiac plexus block is an injection of local anesthetic into or around the celiac plexus of nerves that surrounds the aorta, the main artery in the abdomen. Normally these nerves control basic nerve functions. In certain conditions, these nerves can carry pain information from the gut or abdominal organ tissues back to the spinal cord and brain.

What is the purpose of a celiac plexus block?

A celiac plexus block is performed to block the celiac plexus of nerves that go various organs and parts of the abdomen. This may in turn reduce pain in the abdomen. It is done as a part of the treatment of Chronic Pancreatitis and other types of Chronic Abdominal Pain.

How long does the celiac plexus block take?

The actual injection takes from 10 to 30 minutes.

What is actually injected?

The injection consists of a local anesthetic. On occasion, epinephrine, clonidine or a steroid medication may be added to prolong the effects of the celiac plexus block.

Will the celiac block hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation that makes the procedure easier to tolerate.

Will I be “put out” for the celiac plexus block?

No. This procedure is done under local anesthesia. Most of the patients also receive some sedation, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance. Some patients may have enough sedation that they have amnesia and may not remember all or parts of the procedure.

How is the celiac plexus block performed?

It is done with the patient lying on stomach. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. The celiac plexus block is performed under sterile conditions. The skin on back is cleaned with antiseptic solution and the skin is then numbed with a local anesthetic. Then X-ray is used to guide the needle or needles into the proper position along the outside of the spine. Once in place, a test dose of dye is used to confirm that the injected medication will spread in an appropriate area. If this is okay, the injection takes place gradually over several minutes. The physician will use the X-ray to evaluate the spread of the injected medication. When a sufficient area is covered, the injection will be over. When done, the needle is removed and a Band Aid is applied.

What should I expect after the celiac plexus block?

Immediately after the injection, you may feel your abdomen getting warm or feeling a bit different. In addition, you may notice that your abdominal pain may be gone or quite less. You may also notice some temporary weakness or numbness in the abdominal wall or leg, although this is actually not a desired effect of a celiac plexus block.

A cluneal nerve block is a specialized treatment method for chronic lower lumbar back pain. Pain in this region of the back often spreads to the upper buttocks. Furthermore, lower back problems are among the main health issues that afflict people in the United States. Moreover, back problems are the leading cause for missed time from work.

How Is A Cluneal Nerve Block Performed?

Preparation for the cluneal nerve block procedure involves having a patient lie facedown on a table that is equipped with X-ray machinery. The skin is then sterilized and, if an intravenous anesthetic is necessary (an IV), it is set up along with a monitor that records vital signs (e.g., heart rate, blood pressure, and breathing). Topical anesthesia is applied to the lumbar region before the procedure begins if the patient does not need intravenous anesthesia.

The clinician uses the X-ray to guide the injection needle into the lower back. The X-ray is called a fluoroscope and it provides an image of what is occurring in real-time. Once the needle has been correctly positioned, a dye is administered so that the region it circulates to can be observed. This step ensures that the steroid and anesthetic that are to be injected will be delivered as closely as possible to the affected cluneal nerves. The cluneal nerve roots are the target of the block procedure. The steroid targets the inflamed nerves and the anesthetic relieves the persistent pain.

Cluneal-Nerve-1A recently reported study described the effect of nerve block procedures that were performed to treat painful cluneal nerve entrapment. The nerve blocks were administered to 25 individuals who presented medial and superior cluneal nerve entrapment symptoms. All of the patients were treated with a single nerve block consisting of a steroid and an anesthetic. At a one-year check-up examination, each patient was asked about their level of pain and they all stated that they experienced pain relief.

As with other forms of treatment, this type of nerve block may result in certain complications although the occurrence is rare. Possible complications that may occur include tingling and numbness in the extremities, bleeding, an infection, and the possible puncturing of a nerve during the needle insertion.

Cervical,Thoracic & Lumbar

When patients suffer from nerve impingement that causes them to experience pain in their legs or lower back, sometimes an epidural steroid injection can be an effective treatment that is also minimally invasive. When nerves become compressed, the patient can feel pain. Anti-inflammatory medications such as Cortisone can be placed in exactly the right spot to help interrupt the cycle of irritation. Once this procedure is done, some patients will experience sensations of warmth or numbness due to the anesthetic. Though the effects can take place anywhere from immediately to up to a week, about three days is when most people experience relief. Among those who have not had back surgery before, 70% report having relief. This relief is sometimes permanent, although many patients’ pain returns after weeks or months, and some people get no relief at all.

also know as Epidural Neurolysis can help identify epidural adhesion. It is usually an outpatient procedure which is done lightly sedated with x-ray guidance, although some of the variations on the procedure involve inpatient treatment and various medications. Speak with your physician to determine the best fit for your situation.

This procedure is otherwise known as epidural lysis of adhesions or the “RACZ” procedure after the physician who first performed the procedure. It has been found that after trauma or surgery of the spine, scar tissue forms around the nerves in the spinal canal. It has also been shown that the presence of scar tissue compounded pain associated with nerve roots by adhering the nerve roots to one position and thus increasing the nerve root to tension or compression. This active insult to nerve roots cause significant intraneural edema, or swelling in the nerve root itself. Pain can also result from the nerve endings found throughout the spinal canal and associated structures. Sometimes after spinal surgery or trauma, scar tissue can build up in the spinal canal, compressing the nerve roots and causing pain.

A medial branch block is an injection of local anesthetic and cortisone placed outside the joint space near the nerve that supplies the joint called the medial branch. You may require multiple injections depending upon how many joints are involved. Facet medial branch blocks are typically ordered for patients who have pain primarily in their back coming from arthritic changes in the facet joints or for mechanical low back pain. A facet block or medial branch block may be therapeutic and/or diagnostic. One of three things may happen.

• The pain does not go away, which means that the pain is probably not coming from the blocked facet joints. This has diagnostic value

• The pain goes away and stays away for a few days to a week but the original pain comes back. This would mean the block was also of diagnostic value and the pain is probably coming from the joints.

• The pain goes away after the block and stays away for a few weeks to a few months. This means that the block was of therapeutic value and the steroid had a long lasting effect on the pain.

If you get good, lasting benefit from the facet injections, the block may be repeated. If you get good, short-term benefit another procedure (radiofrequency lesioning) may be done which may last months to years.

What are the risks of the procedure?

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Some short-term side effects may occur. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for 1-2 weeks.

Will the injection hurt a lot?

Most patients also receive intravenous sedation, which means the procedure is easy to tolerate, but every person’s response can be different.

What happens during the actual procedure?

After signing a consent form and checking your blood pressure the procedure will be done in the fluoroscopy (x-ray) room with you lying on your stomach. For procedures in the neck an intravenous is started. The back is then cleansed with an antiseptic soap. Sterile drapes are placed. Using x-ray guidance, needles are then advanced to the appropriate locations. Once the needles are in the proper location local anesthetic with steroid is injected through the needles and the needles are removed. Your skin will be cleansed and bandages will be applied. (The bandages can be removed on the next morning). Your blood pressure will be checked and you will be discharged to leave with your ride after M.D. authorizes discharge.

A ganglion of impar block is safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain. This injection is considered to be a type of sympathetic block that can be used in the treatment of sympathetically-mediated pain, pain secondary to malignancy, neuropathic pain and post-surgical pain. Patients who will benefit from this blockade will frequently present with vague and poorly localized pain in the “seat” region, which is burning in character and frequently accompanied by sensations of urgency with urination and/or defecation.

Procedure

Ever since Plancarte et al. (1990) introduced and described their approach to performing the impar ganglion block via the horizontal approach through the anococcygeal ligament, researchers to date continue to introduce modified techniques that attempt to maximize the ease of performing this block, while maintaining patient safety and increasing the chance of maximal pain alleviation for their patients. A successful ganglion impar block is marked by profound pain relief. Local anesthetic is usually administered for diagnostic ganglion impar blocks or for patients with noncancer-related pain. For patients who have a documented response to the administration of local anesthetic onto the ganglion impar, a therapeutic block is preformed with administration of the neurolytic agent like phenol. Radioablation of the ganglion impar is also another treatment modality for longer-lasting pain relief. The procedure usually takes less than 15 minutes. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure.

The knee is one of the main weight-bearing joints of the body. As a result, it undergoes a lot of wear and tear throughout our lives. Injuries, diseases, failed surgeries, and the normal effects of aging can eventually cause significant knee pain that worsens as we age.

Anyone with chronic knee pain knows how big of an impact it can have on activities of daily living. For people with advanced knee osteoarthritis, pain often persists even with sitting or laying down.

As osteoarthritis progresses in the knee joint, pain and knee stiffness can become unbearable. Lifestyle changes such as weight loss may provide initial relief, but as arthritis progresses, the pain always returns. Eventually, it may stop responding to traditional treatments. At this point, many patients elect to explore newer and more advanced non-surgical treatment options such as nerve block or nerve ablation.

The word “genicular” refers to the small sensory nerves originating from the tibial and common peroneal nerves that supply the knee. During the genicular nerve block procedure, your doctor will target the superior medial, superior lateral, and inferior medial nerves surrounding the knee. 

Following genicular nerve block patients typically have a substantial yet temporary relief of their pain. After confirming the genicular nerves as the cause of a patient’s knee pain a radiofrequency ablation procedure is performed with radiofrequency needles placed in the same location as the diagnostic blocks.

Osteoarthritis, distinct from many other diseases, is amenable to local intra-articular injections, treatment as well as systemic treatment. Though most efforts so far have concentrated on development of systemic treatments, the agents used bear considerable risk of systemic side effects, such as the cardiovascular events and gastrointestinal adverse effects observed in association with most non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors for treatment of joint pain (Petit-Zeman, 2004; Topol, 2004). The chronic nature of the disease requires development of drugs suitable for chronic systemic treatment with minimal side effects, which is a challenging goal. Local drug application, i.e., injection of drugs directly into the affected joint, is an option for treatment of osteoarthritis which is already frequently used and has the potential to deliver the desired profile. In summary, progression of knee osteoarthritis results from local factors, which include synovial membrane inflammation, chondrocyte activation, and bone remodeling. Therefore, it appears logical to favor an intra-articular route for treatment of knee (as well as hip and shoulder) osteoarthritis.

When patients suffer from vertebrogenic pain, the Intracept procedure can be an effective treatment that is also minimally invasive.

WHAT IS VERTEBROGENIC PAIN

Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates, the tissue that covers the top and the bottom of each vertebral body and separates it from the disc. Disc degeneration, and the wear and tear that occurs with everyday living, produces stresses on the endplates that damage them, leading to inflammation and vertebrogenic pain. The basivertebral nerve (BVN), found within the vertebrae, carries pain signals from the inflamed endplates to the brain.

HOW IS VERTEBROGENIC PAIN TREATED?

The basivertebral nerve (BVN) enters the bone at the back of the vertebral body (the bones in your spine) and “branches” to the endplates (that are located at the top and the bottom of each vertebral body). When endplates are damaged, these nerve endings increase in number and “pick up” pain signals that are then sent to the brain through the BVN. The Intracept® Procedure relieves vertebrogenic pain by heating the basivertebral nerve (BVN) with a radiofrequency probe to stop it from sending pain signals to the brain.

HOW DOES THE INTRACEPT® PROCEDURE WORK?

The Intracept Procedure is a minimally invasive, implant-free procedure that preserves the overall structure of the spine. The Intracept Procedure is a same-day, outpatient procedure. Patients are under anesthesia, and the procedure generally lasts an hour. The procedure is FDA-cleared and is proven in multiple studies to be safe, effective, and durable.,

HOW LONG DOES PAIN RELIEF LAST FOLLOWING THE INTRACEPT® PROCEDURE?

Clinical evidence demonstrates the majority of patients experience significant improvements in function and pain 3 months post-procedure that are sustained more than 5 years after a single treatment.

HOW DO I KNOW IF I’M A CANDIDATE FOR INTRACEPT®?

The Intracept® Procedure is indicated for patients who have had:

• Chronic low back pain for at least six months,

• Who have tried conservative care for at least six months, and

• Whose MRI shows features consistent with Modic changes – indicating damage at the vertebral endplates has led to inflammation.

The Intracept Procedure, as with any procedure, has risks that should be discussed between the patient and medical provider.

Kyphoplasty/vertebroplasty are techniques used for treating vertebral compression fractures, small breaks in the thick mass of bone that makes up the front part of the vertebra (called the vertebral body). Vertebral body fractures lead to the collapse or compression of a vertebra, causing the spine to shorten and curve forward. This can result in pain and a kyphotic (hunched-over) deformity. Thinning of bones, or osteoporosis, is the main cause of vertebral compression fractures. Pathologic fractures related to spinal tumors may also be a cause of fractures. During the procedures, the patient will lie on his or her stomach. The doctor will then insert a hollow needle, called a trocar, through the skin and into the vertebra. A type of X-ray, called fluoroscopy, is used to guide the trocar into proper position. Once the trocar is in place, either cement (vertebroplasty) or an inflatable balloon-like device (kyphoplasty) are inserted into the vertebra through the trocar. During a kyphoplasty, as the balloon is inflated, it opens up a space to be filled with bone cement. In addition to stabilizing the vertebra and relieving pain, kyphoplasty/vertebroplasty attempt to restore the height of the vertebra, thereby straightening out the spinal curve.

Who is a candidate for these procedures?

Kyphoplasty/vertebroplasty are generally reserved for people with painful progressive back pain secondary to osteoporotic or pathologic vertebral compression fractures. Candidates for these procedures often experience significant decreases in mobility and function as a result of the fractures. To be a candidate for a kyphoplasty/vertebroplasty, a patient’s pain must correlate to the vertebral fracture, and must not be due to other problems, such as disk herniation, arthritis, or stenosis. Imaging tests – such as spinal X-rays, bone scans, and computed tomography (CT) or magnetic resonance imaging (MRI) scans – might be ordered to confirm the presence of a vertebral fracture. What type of anesthesia is used during a kyphoplasty/vertebroplasty? Kyphoplasty/vertebroplasty are considered minimally invasive procedures that are most often performed using general anesthesia, depending on the doctor and the needs of the patient. In most cases, this procedure is performed as an overnight stay, although many patients do go home the same afternoon.

Is kyphoplasty painful?

Patients may feel sore in the area where the trocar was inserted. However, this should resolve within a couple of days. Applying ice to the area can help relieve any soreness.

How effective is kyphoplasty/vertebroplasty?

Kyphoplasty/vertebroplasty usually provide pain relief and improved mobility within 48 hours of the procedures. In some cases, however, patients feel pain relief immediately. The majority of patients are satisfied with the results, with many returning to all their usual activities they were performing before the vertebral fracture occurred.

Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative (nonsurgical) care regimens. The most common use of discography is for surgical planning prior to a lumbar fusion.

How is Discography performed?

The procedure is done in the Operating Room with fluoroscopic (x-ray) guidance. For lumbar discography (discs in the low back), it is done with you lying on your stomach.

There will be a nurse present during the procedure to monitor you and administer intravenous sedation to help you be comfortable and relaxed. You are watched closely with an EKG monitor, blood pressure cuff and blood oxygen-monitoring device. The skin over the injection site(s) is cleaned with an antiseptic solution and then the injections are carried out. After the injection, you are placed on your back or on your side.

What will I feel during the injection?

When a normal disc is injected, you will feel a sense of pressure, but not pain. When an abnormal disc is injected, you will feel pain. It is important to try to tell if the pain you are feeling is your usual pain or different. With each disc injected, you will be asked if it is painful, where you feel the pain and whether it is in the same area as your usual pain.

How many discs will be injected?

Based on your symptoms and your MRI, we will identify which discs we suspect are causing your pain. These discs will be injected. In addition, we inject a normal disc to serve as a reference point.

How long does Discography take?

Discography takes about 30 to 45 minutes, depending on how many levels are injected.

What is actually injected?

The injection consists of x-ray dye (x-ray contrast). It is usually mixed with some antibiotics to prevent infection.

An occipital nerve block is an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.

What is the purpose of an occipital nerve block?

The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the nerves and surrounding structures. Typically, headaches over the back of the head, including certain types of tension headaches and migraine headaches, may respond to occipital nerve blocks.

How long does the occipital nerve block take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic and a steroid medication.

Will the occipital nerve block hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle during the performance of the block.

Will I be “put out” for the occipital nerve block?

No. This procedure is done with a small thin needle, usually without any sedation. There is local anesthetic within the injection.

How is the occipital nerve block performed?

It is done with the patient seated or lying down. The skin and hair of the back of the head are cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the occipital nerve block?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have a sore head for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing a more lasting pain relief starting the third day or so.

What should I do after the occipital nerve block?

You will rest for a while in the office. Most patients can drive themselves home. We advise the patient to take it easy for several hours after the procedure. You may want to apply ice to the injected area. You can perform any activity you can tolerate

Radiofrequency thermocoagulation (RTFC), also known as rhiztomy is a treatment utilizing radiowaves and heat to destroy tissue, in our case a nerve, for pain relief. Radiofrequency has also been used for treating fast heartbeats and tumors with great success.

Radiofrequency thermocoagulation of the spinal facet joints provides significant pain relief in well selected patients with facet joint syndrome.

What happens during the actual procedure?

RFTC is an outpatient procedure performed under local anesthesia. Intravenous sedation is used to help the patient relax. During the procedure, radiofrequency waves are transmitted through the tip of a specialized needle placed into the facet joint under x-ray guidance. The heat generated from the needle coagulates the nerve and renders it non-effective for transmitting pain impulses, thus providing pain relief.

After the procedure, the patient will be taken to the recovery room for a brief period of monitoring, and for instructions before discharge.

What are the risks of the procedure?

RFTC is a safe, non-surgical treatment. There are a few possible complications related to RFTC but the risk is low. Your doctor will gladly explain the procedure and the risks to you in detail and answer any question that you may have.

How will I feel after the injection?

You may experience an increase in pain and/or muscle spam for the first several days following the procedure. Additional pain medications or muscle relaxants may be necessary to help you stay comfortable.

You may notice some swelling and bruising at the needle sites. Using a cold pack will ease the discomfort.

You will be given an instruction sheet on what to do and whom to call should you have any question or concern.

Your doctor will arrange a follow-up appointment or phone consult within three to four weeks after the procedure to see how you are doing.

The degree of pain relief varies from person to person. The maximum decrease in pain may take up to three or more weeks to occur. You can eventually expect 50 percent or greater pain relief. Pain relief can last from six to12 months, or longer. The nerves do repair themselves and your pain may return. The procedure can be repeated if the pain returns some later time.

Why is rehabilitation important after RFTC?

It is important that you start a program of conditioning, strengthening, and range of motion exercises after radiofrequency ablation. Ideally, increased muscle strength around the arthritic joints will make pain relief more prolonged after radiofrequency ablation. With rehabilitation, when the nerves do regenerate, you will not likely experience the same intensity of pain as before the procedure.

You may be prescribed a formal physical therapy program after undergoing the RFTC procedure.

A sacroiliac (SI) joint injection, also called a sacroiliac joint block, is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction. The sacroiliac joints lie next to the spine and connect the sacrum with the hip on both sides. There are two sacroiliac joints, one on the right and one on the left. Joint inflammation and/or dysfunction in this area can cause pain. Read more about Sacroiliac Joint Dysfunction. The purpose of a sacroiliac joint injection is two-fold: to diagnose the source of a patient’s pain, and to provide therapeutic pain relief. At times, these are separated and a patient will undergo a purely diagnostic or therapeutic injection, although often the two are combined into one injection.

The Sacroiliac Joint Injection Procedure

The Sacroiliac Joint injection procedure is usually performed in an operating room or a dedicated procedure room. The entire procedure usually takes only minutes, and the patient goes home the same day. The following outlines the typical injection procedure:

• After informed consent has been obtained, the patient lies face down on his or her stomach on the radiography table. A pillow might be placed under the hips for patient comfort.

• The patient’s vitals (e.g. pulse rate and blood pressure) are monitored throughout the procedure.

• Depending on the physician and the patient’s preference, an intravenous line may be inserted to deliver medication to help the patient relax.

• To maintain sterility, the skin overlying the sacroiliac joint injection is cleansed using an iodine based solution (e.g. Povidine-Iodine) or an alcohol-based antiseptic (e.g. chlorhexidine 0.5% in 70% alcohol). Sterile gloves are used throughout the entire injection procedure.

• For the patient’s comfort, the needle insertion site is often numbed using local anesthetic. Once the needle enters the sacroiliac joint under fluoroscopy guidance, contrast – ‘dye’ that shows up under X-ray – is injected to verify needle placement within the sacroiliac joint and to verify spread of solution within the joint.

• Once the needle has been guided into the joint successfully, diagnostic and/or therapeutic medications are injected into the joint.

• Two types of medications are typically injected:

• A local anesthetic (usually lidocaine or bupivacaine) is typically injected into the joint with the goal of determining immediate pain relief to confirm the sacroiliac joint as the source of the patient’s pain. This solution is used for a diagnostic sacroiliac joint injection.

• An anti-inflammatory medication (usually a corticosteroid) may help reduce inflammation within the joint, which in turn could help alleviate the pain over a longer period of time (typically for several months, up to a year). This solution is injected for a therapeutic sacroiliac joint injection

In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root. Success rates vary depending on the primary diagnosis and whether or not the injections are being used primarily for diagnosis. While there is no definitive research to dictate the frequency of SNRBs, it is generally considered reasonable to limit SNRBs to three times per year. Technically, SNRB injections are more difficult to perform than epidural steroid injections and should be performed by experienced physicians. Since the injection is outside the spine, there is no risk of a wet tap (cerebrospinal fluid leak). However, since the injection is right next to the nerve root, sometimes an SNRB will temporarily worsen the patient’s leg pain.

A Sphenopalatine Ganglion block is a minimally invasive procedure used to treat head and facial pain. While the procedure itself is short and performed in your doctor’s office, it requires a great deal of technical proficiency and very few physicians are trained on how to do it. A sphenopalatine ganglion block is an established treatment method of a wide variety of pain syndromes:

• Trigeminal Neuralgia

• Sphenopalatine neuralgia

• Migraine headaches

• Cluster headaches

• Atypical facial pain

• Cancer pain of the head and neck

• Tongue and mouth pain

• Temporomandibular joint (TMJ) pain2

• Sluder’s neuralgia

• Paroxysmal hemicrania

Other possible therapeutic uses reported in literature include:

• Herpes Zoster

• Postherpetic neuralgia

• Vasomotor rhinitis

• Complex regional pain syndrome (CRPS)

• Reflex Sympathetic Dystrophy (RSD)

• Post-traumatic headache

Benefits

The Sphenopalatine ganglion block is a safe, effective and established procedure for treating refractory head and face pain. Any patient suffering from facial pain, chronic headaches, trigeminal neuralgia and the like will attest to how debilitating their pain can be. Classically, these types of pain are treated with a series of medications, cycling from one to another based on trial and error. Most medications are ineffectual and those that are effective either have intolerable side effects or are the fourth or fifth medication tried. This life changing procedure can offer immediate relief and potentially allow pain sufferers to avoid the nuisance of daily medications.

Approved by the FDA in 1989, spinal cord stimulation (SCS) has become a standard treatment for patients with chronic pain in their back and or limbs who have not found pain relief from other treatments. While the treatment does not work for everyone, most patients who qualify for neurostimulation therapy report a 50 to 70% reduction in overall pain, as well as an increased ability to participate in normal family and work activities. Many patients find that they can decrease or stop taking painkillers or other pain medications after undergoing spinal cord stimulation. Given these benefits, there has been ongoing investment and advances in spinal cord stimulation technology, and many individuals suffering from chronic pain find that neurostimulation positively impacts the quality of their lives.

Electrical Stimulation Blocks the Pain Signals

In general, neurostimulation works by applying an electrical current to the source of chronic pain. This creates a pleasant sensation that blocks the brain’s ability to sense the previously perceived pain. There are two related forms of electrical stimulation commonly used to treat chronic pain:

• Spinal cord stimulation (SCS). In spinal cord stimulation, soft, thin wires with electrical leads on their tips are placed through a needle in the back near to the spinal column. The leads are placed through a needle inserted in the back (no incision is required). A small incision is then made and a tiny, programmable generator is placed in the upper buttock or abdomen (under the skin) which emits electrical currents to the spinal column.

• Peripheral Nerve Field Stimulation (PNFS). Very similar to spinal cord stimulation, peripheral nerve field stimulation involves placing the leads just under the skin in an area near to the nerves involved in pain.

In both approaches, the generator can be programmed in a way similar to using a remote control to adjust the television. The area or intensity of electrical stimulation can be changed, and the system can be turned on and off or adjusted as necessary to provide optimal pain relief. Although programming is initially done at the physician’s office, patients can learn how to control the stimulation on their own and adjust it to their pain levels.

A Stellate Ganglion Block is an injection of local anesthetic in the “sympathetic nerve tissue”, the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of the voice box, in the neck.

What is the purpose?

The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving upper extremity or head and face.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and cortisone.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

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.

How is the injection performed?

It is done either with the patient laying flat. The chin is slightly raised. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the front of the neck, next to the “voice box” is cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the injection?

Immediately after the injection, you may feel your upper extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice “a lump in the throat” as well as hoarse voice, droopy and red eye, and some nasal congestion on the side of the injection. You may also develop a headache.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.

A Sympathetic Nerve Block is an injection of local anesthetic and cortisone in the “sympathetic nerve tissue”, the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back.

What is the purpose?

The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, and Complex Regional Pain Syndrome.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and cortisone.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

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.

How is the injection performed?

It is done with the patient lying on stomach. The patients are monitored with a blood pressure cuff and blood oxygen-monitoring device. The skin on back is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.

What should I expect after the injection?

Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some weakness and/or numbness in the leg, which is temporary.

Trigger point injections (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin.
Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.

What Happens During a Trigger Point Injection?

In the TPI procedure, a health care professional inserts a small needle into the patient’s trigger point. The injection contains a local anesthetic or saline, and may include a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in a doctor’s office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain drug, a dry-needle technique (involving no medications) can be used.

When Is Trigger Point Injection Used?

TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. The technique is also used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments. However, the effectiveness of TPI for treating myofascial pain is still under study.

Our team can provide medication assisted treatment programs to patients struggling with opioid dependency or addiction.