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PROCEDURES
Most of our procedures are aimed to reduce the sensation of pain. The procedures are done by our pain physicians. The procedures may be diagnostic, to help determine what is causing the pain, or treatments to help reduce the pain. Examples of these procedures are epidural steroid injections, facet joint injections, trigger point injections, sympathetic blocks, and peripheral nerve blocks.
State-of-the-art techniques such as: spinal cord stimulation, implanted spinal drug delivery systems, cryoanalgesia, radiofrequency ablation, and nucleoplasty are available in appropriately selected cases. Most procedures are performed on an outpatient basis, in either our office or a one-day surgery setting. Radiologic guidance is often used to accurately and precisely obtain correct needle position. Sedation is provided for operating room procedures upon request to provide improved patient comfort acceptance.
Epidural Injections
Epidural injections are done under fluoroscopic guidance and IV sedation is available if needed. This injection is given into the space between the bony outer walls of the spinal canal and the membrane, which covers the spinal cord, in addition to containing an anesthetic the injection usually contains a steroid. The anesthetic numbs the spinal cord and the steroid helps to reduce the amount of local inflammation, which has been caused by the prolapsed disc.
Facet Joint Injections
Under fluoroscopic guidance, facet joint injections are used to localize and treat low back pain that is caused by problems of the facet joints. These joints are located on each side of the vertebrae; they join the vertebrae together and allow the spine to move with flexibility. The facet joint injections form a pain block that allows the doctor to confirm that it is a facet joint causing the pain. The medication used also decreases inflammation of the joint that occurs with arthritis and joint degeneration.
Sympathetic Injections
A block that is performed to determine if there is damage to the sympathetic nerve chain and if it is the source of pain. This is a diagnostic test primarily, but it may provide relief far in excess of the duration of the anesthetic. A local skin anesthetic is given in the lumbar area of the back. A needle is then inserted into the back under fluoroscopy next to the vertebral body. The block may be performed on both sides of the spine. An anesthetic medication will be injected into the area.
Trigger Point Injections
A trigger point is a sensitive or irritable spot in the body that can be a main or associated source of pain conditions. Most often these spots are found in muscle and it’s lining (fascia) and are called "myofascial" trigger points. They can also be located in skin, ligament and tendon tissue. Trigger points can be causes for bands of pain radiating quite a distance from the actual trigger spot. Because of this "referred pain," trigger points can even mimic pinched nerves. Trigger points can arise as a result of strain or repetitive use injuries, stress and muscle tension conditions, or specific disorders such as herniated discs, pinched nerves, fractures, and surgical incision healing sites, to name only a few.
Trigger point injections have been found to be very effective in relieving pain, best used in combination with a home exercise, heat, cold and medication program.
Radio Frequency Denervation (RFD)
Radio Frequency is used to selectively destroy nerve tissue from which pain originates. First a diagnostic injection of local anesthetic is performed to identify the pain generator and to provide outcome prediction. Then electrical current is used to interrupt nerve conduction and prevent the patient from feeling pain, RF usually provides 1 - 2 years of pain relief (until the nerve regenerates) during which time the body may heal itself to prevent pain recurrence.
Spinal Cord Stimulation (SCS)
Spinal Cord stimulation works by preventing perception of pain at the spinal cord level. Placing wire electrodes into the epidural space stimulates the spinal cord resulting in a pleasant, tingling sensation, masking the pain. SCS is useful in conditions such as chronic back and leg pain following spine surgery, peripheral vascular disease, reflex sympathetic dystrophy (RSD) phantom limb pain, intractable angina and other syndromes.
RACZ Lysis of Adhesions
This is a procedure that is used to dissolve some of the scar tissue from around entrapped nerves on the Epidural space of spine, so that medications such as cortisone can reach the affected areas.
BOTOX
The injections of Botox can be useful in treating back and neck pain, as well as headaches. Botox decreases muscles tension and pain.
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