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Pain Management Procedures and Conditions We Treat

Pain Management Procedures and Conditions We Treat

 

General Body

 

 

Head, Neck & Spine

 

 

Hip, Leg & Knee

 

 

Shoulder

 

 

Epidural steroid injection (cervical, thoracic, lumbar and caudal): These are used to relieve pain due to nerve irritation resulting from spinal stenosis, herniated or torn discs. It can be used to treat both axial low back pain and radicular pain. A small amount of steroid is injected where it is needed for long-term pain relief.

Cervical Epidural Steroid Injection
Cervical Epidural Steroid Injection
Lumbar Epidural Steroid Injection
Lumbar Epidural Steroid Injection

Transforaminal Epidura (Steroid Injection): Based on your medical history, physical exam and Magnetic Resonance Imaging (MRI) findings, often a specific inflamed nerve root can be identified. A Selective Nerve Root Block (SNRB) can then be placed within a specific nerve root sheath to relieve pain.

We follow evidence-based guidelines in our practice and we are conscientious about limiting our injections to no more than 3 in 6 months or 4 in a year. Excessive steroids can put a patient at risk for skeletal fractures and avascular necrosis.

Facet Injections and Medical Branch Blocks: Medial branches innervate the facet joint. The presence of arthritis on MRI does not always correlate with patient's pain. Pain relief with a medial branch block confirms that the facet joint is the source of pain. We numb the medial branches with local anesthetic at each facet joint that we target. If this relieves the patient's pain, it confirms that this is the source of pain.

Facet Joint Injection
Facet Joint Injection

Radiofrequency Lesioning (Rhizotomy): If medial branch blocks relieve the patient's pain, it confirms the source of pain. We then use radiofrequency waves to enervate the medial branches. This gives the patient long-term pain relief of 6 months to 2 years duration. The medial branches eventually regenerate and the pain may return. This approach is appropriate for a number of pain conditions such as pain of the facet joint, disc, sympathetically mediated pain, sacroiliac joint pain and nociceptive radicular pain.

Cervical Facet Radiofrequency Neurotomy
Cervical Facet Radiofrequency Neurotomy
Lumbar Radiofrequency Neurotomy
Lumbar Radiofrequency Neurotomy

Sacroiliac (SI) joint injection: The SI joint is the joint that connects the sacrum and iliac bones to form your pelvis. Pain elsewhere, causing gait changes or arthritis are common causes of SI joint pain. SI joint pain is often confused with hip pain, low back pain, gluteal pain or posterior thigh pain. SI joint pain may be responsible for up to 15 percent of patients with lower back pain. Sacroiliitis is treated with steroid injections.

Sarcoiliac Joint Steroid Injection
Sarcoiliac Joint Steroid Injection

Piriformis injection: Piriformis muscle spasms cause compression of the sciatic nerve. In Piriformis syndrome, the piriformis muscle impinges upon the sciatic nerve. Piriformis injection with ultrasound guidance is used to treat piriformis syndrome.

Nerve Blocks: Our goal is to aggressively manage pain with a series of blocks in conjunction with rigorous Physical Therapy to alter the course of disease. Blocks are used for instances of neuralgic pain caused by injury or disease, including neuropathy, surgical injuries to nerves, and other conditions.

Ultrasound-Guided Ilioinguinal Nerve Block
Ultrasound-Guided Ilioinguinal Nerve Block
Celiac Plexus Block
Celiac Plexus Block
Lumbar Sympathetic Block
Lumbar Sympathetic Block

Nerve Blocks: Our goal is to aggressively manage pain with a series of blocks in conjunction with rigorous Physical Therapy to alter the course of disease. Blocks are used for instances of neuralgic pain caused by injury or disease, including neuropathy, surgical injuries to nerves, and other conditions.

Discography
Discography

Complex Regional Pain Syndrome (CRPS) In CRPS, there is sensitivity to touch, allodynia (sensitivity to touch, light or temperature), vascular changes, edema and discoloration and severe pain that if left untreated, could result in disuse and atrophy. Stellate Ganglion Blocks are used for referral of CRPS.

Complex Regional Pain Syndrome
Complex Regional Pain Syndrome

Intrathecal Electrothermal Therapy: This is an option for patients with discogenic pain who want to avoid surgery. The heat is meant to kill the nerve fibers and toughen the disc tissue, sealing any small tears. Currently it is not covered by insurance.

Coccydynia and Ganglion Impar Block: Ganglion impar is the terminal branch of the sympathetic chain. It carries somatic nerve fibers and is used to treat pain arising from coccyx or perineal region. A nerve block of the Ganglion impar can give significant pain relief.

Trigger point Injections: These are administered to alleviate painful areas of muscle, like that of myofascial pain. It is used to separate muscle fibers and increase blood flow and dilute the pain substances.

Trigger point Injections
Trigger point Injections

Joint Injections (shoulder, hip and knee injections): These are done with ultrasound guidance. They are used as a diagnosis and treatment procedure for arthritis.

Joint Injection Shoulder
Joint Injection: Shoulder
Ultrasound-Guided Injection for Shoulder Pain
Ultrasound-Guided Injection for Shoulder Pain
Joint Injection Hip
Joint Injection: Hip
Ultrasound-Guided Injection for Knee Pain
Ultrasound-Guided Injection for Knee Pain

Bursa Injections: These are done in the shoulder, hip and knee for bursitis.

Epidural Blood Patch: This is used to treat spinal headache resulting from spinal tap, spinal injection, inadvertent Dural puncture due to epidural or surgery. We inject patient's blood into the epidural space to relieve pain.

Intrathecal Pump Implantation: Applicable for instances of chronic and intractable pain. We use opioids as a last resort for cancer pain and baclofen for severe spasticity. A programmable depot of medication is continuously delivered to the spinal space, which gives potent pain relief with minimal side effects.

Spinal Cord Stimulation: This procedure is at the forefront of interventional pain management techniques. A mild pleasant electrical sensation replaces painful sensation and minimizes the perception of pain. Small thin electrodes are passed percutaneously (via needle puncture) into the epidural space in the region corresponding to the patient's pain. A generator is implanted into patient's body. Via an external remote control, the intensity and location of the stimulus can be changed and the device can be turned on and off. In addition to low back pain and extremity nerve pain, it has many indications and can help patients with chronic pain that have exhausted other options. It can be used for lower back pain, persistent extremity nerve pain, CRPS type I & II, chronic abdominal pain, phantom limb pain, peripheral vascular disease and diabetic neuropathy.

Spinal Cord Stimulator Implant
Spinal Cord Stimulator Implant