Some Interventional Pain Management Procedures

Injections

Interventional pain management techniques include:

  • Epidural steroid injections
  • Transforaminal Steroid Injections
  • Facet joint injections
  • Medial branch blocks
  • Nerve blocks
  • Sacroiliac injections
  • Radiofrequency ablation
  • Spinal cord stimulation, and other neurostimulation approaches
  • Trigger point injections

Click on the following titles to explore each procedure:

Epidural Injections

The epidural space is located in the spine, above the outer layer surrounding the spinal cord and nerve roots. An epidural steroid injection is performed to help reduce the inflammation and pain associated with nerve root compression. Nerve roots can be compressed by a herniated disc, spinal stenosis, and bone spurs. When the nerve is compressed it becomes inflamed. This can lead to pain, numbness, tingling or weakness along the course of the nerve. This is called radiculopathy. The goal of the epidural steroid injection is to help lessen the inflammation of the nerve root.

Once in the procedure room, the patient may get an IV sedative to help to relax. We use and an X-ray machine to secure and accurate, safe and fast procedure. The skin will be cleaned and prepared for the injection and then will be injected with a medication to numb the area. Once the needle is in the proper space a small amount of dye may be injected to verify the position of the needle on the X-ray. After this, the mixture of numbing medication and steroid is injected in the epidural space. The needle is then removed, and a band-aid is placed over the site.

Transforaminal Injections

A transforaminal injection is an injection of long-acting steroid into the opening at the side of the spine where a nerve roots exits. This opening is known as a foramen. There is a small sleeve of the epidural space that extends out over the nerve root for a short distance. This epidural root sleeve is just outside the spinal canal

This injection is performed to help reduce the inflammation and pain associated with nerve root compression. Nerve roots can be compressed by a herniated disc, spinal stenosis, and bone spurs. When the nerve is compressed it becomes inflamed. This can lead to pain, numbness, tingling or weakness along the course of the nerve. This is called radiculopathy.

The goal of transforaminal steroid injection is to help lessen the inflammation of the nerve root using just a small dose of steroids. The long-acting steroid reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may, in turn, reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling. Also, the transforaminal injections can be used to identify a specific spinal nerve root level or levels that are the source of pain

Once in the procedure room, the patient may get an IV sedative to help to relax. We use an X-ray machine to secure an accurate, safe and fast procedure. The skin will be cleaned and prepared for the injection and then will be injected with a medication to numb the area. Once the needle is in the proper space a small amount of dye may be injected to verify the position of the needle on the X-ray. After this, the mixture of numbing medication and steroid is injected. The needle is then removed, and a band-aid is placed over the site.

Facet Joint injection

A lumbar facet joint block is an injection of local anesthetic (numbing medicine) with or without a steroid into one or more of the small joints located along the side of each vertebra on both sides of the spine in the lower part of the back.

Facet joints are the small joints located between each vertebra that provide the spine with both stability and flexibility. Facet syndrome occurs when one or more of these joints become inflamed or irritated. Arthritis occurs when the cartilage lining the joint surface shrinks and wears thin, causing stress on the bone (bone spurs) and inflammation of the joint.

A facet joint injection relieves both pain and inflammation coming from the involved joint. A successful result supports the diagnosis that the facet joint is indeed the “pain generator” and the cause of the back pain.

Once in the procedure room, the patient may get an IV sedative to help to relax. We use an X-ray machine to secure an accurate, safe and fast procedure. The skin is cleaned and prepared for the injection.  Then we will inject a medication to numb the area. Once the needle is in the proper space a small amount of dye may be injected to verify the position of the needle on the X-ray. After this, the mixture of numbing medication and steroid is injected. The needle is then removed, and a band-aid is placed over the site.

Medial Branch Blocks

Medial branch nerves are very small nerve branches that carry the pain message from the facet joints and the muscles around the joints. If the nerves are blocked or numbed, they will not be able to transfer the pain sensation from the joints to the brain.

This is a diagnostic procedure. This injection is done to confirm the diagnosis of facet joint disease and to find out if the facet joints are contributing to your pain. If you benefit from the procedure, the next step would be consideration of radiofrequency treatment of the medial branch nerves.

Radiofrequency Ablation

Radiofrequency ablation is a minimally invasive procedure that destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints. If you suffer recurrent pain and you’ve experienced good relief with a nerve block injection, you may be a candidate for radiofrequency ablation.

This procedure is most commonly used to treat chronic pain and conditions such as arthritis of the spine (spondylosis) and sacroiliitis. It is also used to treat neck, back, knee, pelvic and peripheral nerve pain. The benefits of radiofrequency ablation include: avoiding surgery, immediate pain relief, little to no recovery time, decreased need for pain medication, improved function, and a quicker return to work and other activities.

With the aid of a fluoroscope (a special x-ray), the pain doctor directs a thin hollow needle into the region responsible for the pain. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes to the desired location. Contrast may be injected to confirm correct needle location.

Once the needle is in place, the patient receives a numbing medication. Then a radiofrequency current is passed through the hollow needle to create a small and precise burn, called a lesion, about the size of a cotton swab tip. The current destroys the portion of the nerve that transmits pain and disrupts the pain-producing signal. The burn takes approximately 90 seconds for each site, and multiple nerves can be burned at the same time. The needle is then removed, and a band-aid is placed over the site.

Sacroiliac injections

The sacroiliac joints lie next to the spine and connect the bone 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.

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.

  1. A Diagnosis SI joint injection is used to confirm a suspected diagnosis of sacroiliac joint dysfunction. This is done by numbing the sacroiliac joint with local anesthetic (e.g. lidocaine). The injection is performed under fluoroscopy (X-ray guidance) for accuracy. Once the needle has entered the sacroiliac joint, contrast is injected into the joint to ensure proper needle placement and proper spread of medication. The numbing medication is then injected into the joint.After the numbing medication is injected, the patient is asked to try and reproduce the pain by performing normally painful activities. If the patient experiences 75-80% pain relief for the normal duration of the anesthetic, a tentative diagnosis of SI joint dysfunction is made. A second diagnostic sacroiliac injection should be performed using a different numbing medication (e.g. Bupivicaine) in order to confirm the diagnosis.
  2. A therapeutic SI joint injection is done to provide relief for the pain associated with sacroiliac joint dysfunction. The injection is performed using the same technique as a diagnostic SI joint injection, except that anti-inflammatory medication (corticosteroid) is included in the injection to provide pain relief by reducing inflammation within the joint.
Trigger Point Injection
Trigger point injection (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.
In the TPI procedure, your pain doctor 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.

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