Treatment options.

At Comprehensive Pain Medicine, physicians with subspecialty board certification and training in controlling pain employ a variety of treatments including:

 

Disc Decompression using Stryker Dekompressor® Percutaneous Discectomy probe is a less invasive option for patients suffering from low back and leg pain due to contained disc herniations. It is performed under live x-ray using local anaesthetic and light sedation with minimal recovery time. (Read more at styker.com.)

Dorsal Column & Spinal Cord Stimulators are devices that override painful nerve signals by transmitting mild electrical impulses via a probe placed into the epidural space.

Epidural Steroid Injections are the most commonly performed injections. As with all of our outpatient procedures, these injections are performed using fluoroscopic (live x-ray) guidance to ensure correct placement of administered medications. Prior to the injection, the skin will be numbed by a local anesthetic using a small needle. In this approach, a mixture of anti-inflammatories, muscle relaxers, and small dosage of steroid medications are injected directly around the dura (the sac around the nerve roots that contains cerebrospinal fluid). The frequency with which these injections are administered varies per physician. Epidurals provide excellent relief and a high rate of success. Some physicians prefer to perform these injections in a complete series of three (3), and some prefer to save one or two injections for any potential recurrent low back or leg pain. Common symptoms after the injections include a warmth or numbness in the legs from the effects of the local anesthetic, dizziness, headache, or infection, but are exceedingly rare. Relief from an injection generally takes about three (3) days, but occasionally, occurs immediately. Some patients obtain no relief at all from the injection. Should that occur, you need to see your physician in the office to discuss other recommendations.

Facet Injections are administered both for a therapeutic and diagnostic purpose, and can, as with the epidural steroid injections, be targeted to the cervical, thoracic or lumbar areas. These injections use a contrast dye to pinpoint the source of pain within the facet joints. During this procedure you may feel some slight pressure or discomfort. Your physician will be interested in how this discomfort compares to your usual pain symptoms (this is the diagnostic aspect of the procedure). He will want you to keep track of any changes in your pain symptoms over the days and weeks following the injection. As with the epidurals, patient’s relief following a facet injection tends to vary from minimal to long-term (this is the therapeutic aspect).

Sacroiliac Joint Injection is an injection of an anesthetic with a long lasting steroid mixture into the sacroiliac joints, which are located in the back where the lumbosacral spine joins the pelvis. They are paired (right and left), are surrounded by a joint capsule like the finger joints. There steroid mixture reduces inflammation in the joint space. 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 generally last for a few hours. Your pain may return and you may have a sore back/neck for a day or two thereafter. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. Relief may not be noticeable until the third to fifth day, and can last anywhere from a few days to many months. Some possible side effects include discomfort (most common), fluid retention, weight gain, increased blood sugar (mainly diabetics), elevated blood pressure, among others. Fortunately, serious side effects and complications are uncommon. Should you have any concerns, please contact our office.

Provocative Discography is a diagnostic procedure in which a needle is placed into a lumbar or cervical disc to identify whether there is an internal disc disruption. During the procedure, performed under live fluoroscopic imaging, contrast is injected directly into the identified discs. We can then identify the internal anatomy of the disc, as well as whether there is a reproduction of the patient’s pain pattern. This procedure is very important prior to lumbar fusions to identify the exact discs that are causing the pain pattern. It is also used to determine whether or not a patient would be a candidate for any additional pain management treatments, such as Disc Decompression. CT scans are commonly ordered by your physician in conjunction with this procedure, and must be performed immediately following the discography while the contrast remains in the patient’s system.

Radiofrequency (Rhizotomy) is a proven, safe means of interruption of pain signals that are transmitted through specific nerve supplies. A very high radiofrequency current is passed down a temperature monitoring probe, which is inserted through a special needle. When the current flows through the tissue, it heats the surrounding tissue to a temperature that will eliminate specific pain signals. Once the temperature electrode is inserted, test stimulation will begin and you will be asked questions about where you feel the sensation (this will assist your physician in determining needle placement). Once this has been verified, radiofrequency heating can begin. Please note that the doctor may want to repeat the procedure on multiple levels.

Stellate Ganglion Block (Sympathetic Block) is an injection of local anesthetic into the front of the neck for pain located in the head, neck, chest or arm caused by Complex Region Pain Syndrome (CRPS), causalgia (nerve injury), herpes zoster (shingles), or intractable angina. They may be used for either therapeutic purposes, diagnostic purposes or both. The spacing of injections will be based on how long the pain relief is between injections (it will increase after each injection). You can expect one of three possible responses:

1. pain does not go away, but there is other evidence of sympathetic block (this has a diagnostic value)

2. pain does not go away, and there is not evidence of sympathetic block (this block is a technical failure)

3. pain goes away and stays away longer than the life of the local anesthetic (this block was of therapeutic value)

Note: The block will most likely have to be repeated to get long lasting benefit.