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Pain Management

Trigger point injections

Trigger point injection (TPI) are used to treat intense pain in the muscles containing trigger points. Trigger points are tight bands or knots that are formed when the muscle fails to relax after the contraction. A trigger point may also cause referred pain (pain in another part of the body) by irritating the adjacent nerves.

Trigger point injections can be used to relieve pain in conditions such as myofascial pain syndrome when other treatments are a failure, fibromyalgia, and tension headaches.

During this procedure, nerve block will be administered by the orthopedist or pain specialist to numb the area of needle penetration and keep you comfortable during the procedure. Further, a small needle containing local anesthetic (lidocaine, procaine) which may or may not containing corticosteroid is directly injected to the trigger point. This makes the trigger point inactive and the pain is relieved.

This is a short procedure and may just take a few minutes. The injection may cause mild pain for a short time. If you are allergic to the local anesthetic medication, a dry-needle technique (without medications) is used.

Numbness at the site of injection may persist for about an hour after the procedure. A bruise may even form at the site of injection. Applying moist heat and ice alternatively to the area for two days relieve the pain. Your orthopedist may also recommended stretching exercises and physical therapy after trigger point injections.

Epidural Injections

Epidural injections contain a strong anti-inflammatory agent called corticosteroid and an aesthetic for pain relief. It is not the same as an epidural anesthesia given before birth to decrease labor pain. Epidural injections are given to relieve pain in the neck, back, arm and leg due to inflammation of spinal nerves from conditions such as spinal stenosis, spondylolysis, herniated disc, degenerative disc and sciatica.

Epidural injections are administered into the epidural space of the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5mm wide and is filled with spinal nerve roots, fat and small blood vessels.

Indications

Epidural injections are recommended based on pain patterns and used to treat pain primarily from the spine.

Procedure

You will be taken to the pre op area where trained nursing staff will get you ready for the procedure, by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lay, usually, face down or on a table.

The injection site is then cleaned and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.

A thin hollow needle is then inserted into the epidural space. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.

A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.

When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.

You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. The procedure takes about 3-5 minutes to complete.

Risks and Complications

With the use of live imaging though X-ray machines, contrast dye, and physicians trained in the latest interventional techniques, complications are rare. But with all medical procedures, complications may occur. To help minimize risk please follow all directions given to you by your care provider. Have all your treatment options explained, so you are aware of the risks and benefits of these procedures.

Some complications may include:

Spinal Headache: If spinal fluid leaks out of the intra-thecal space, you may have a headache that gets better when you lay down. This headache usually gets better by lying flat in bed for 12 to 24 hours and drinking caffeine. However on occasion, headaches may last longer and need further evaluation.

Infection: Your pain physicians clean and sterilize your back before every procedure to prevent this from occurring. On rare occasions oral antibiotics may be needed.

Allergic Reaction: This may occur if you have allergies to any medication used. Typically this is pretreated and on occasion your physician may recommend medications for you to take after the procedure. If you experience difficulty breathing and observe any rashes, consult your doctor immediately.

Worsening pain:

This may occur after the procedure due to the needle puncture and can last from 3 days to a week. Usually this pain resolves and does not cause any lasting impact.

There are many side effects of corticosteroids. However, by limiting the cumulative dose of medication used, these risks are reduced. However, some symptoms you may feel include:

  • Insomnia
  • Heart Palpitations
  • Mood changes

Epidural injections may take 2-7 days to show any effect. They may need to be repeated. And as always, follow the instructions of your care provider and have your questions answered prior to the procedure

Facet Joint Injections

Facet joint injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. They are given to relieve pain in the back, neck, arm and leg and even headaches caused from inflammation of the facet joints. Inflammation of the facet joints may occur due to:

  • Degenerative disease of the spine such as spinal stenosis, spondylolysis, herniated disc, arthritis and sciatica
  • Postoperative acute pain after discectomy and spinal decompression
  • Trauma to facet joint because of whiplash injuries of the neck as in a motor vehicle accident or some other traumatic event

Facet joint injections are administered into the inflamed painful facet joints. These are the joints connecting each vertebra of the spine to the vertebra below it and above it. Each vertebra has four facet joints, one pair connects to the vertebra above and the second pair connects to the vertebra below. Thus they are present on both sides of the spine from the neck to the lower back providing flexibility and smooth movement to both the neck and the spine.

Indications

Facet joint injections are recommended based on pain patterns and are used to treat pain primarily from the lumbar spine (lower back), thoracic spine (middle-back) and cervical spine (neck).

Procedure

You will be taken to the pre op area where trained nursing staff will get you ready for the procedure by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lie, usually face down, on a table.

The injection site is cleansed and injection of a local numbing agent is given in the area so that you won’t feel pain during the procedure.

A thin hollow needle is then inserted through the skin and muscles to the nerves in the facet joint. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.

A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.

When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.

You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. One or more facet joints’ may be injected depending on the location of the pain. The time for the procedure will thus depend on the number of facet joint injections required to relieve pain.

Nerve block

Coming soon…

Botox for headache and muscle pain

Coming soon…

Radiofrequency Ablation

Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique of treating pain. This technique employs radiofrequency waves to produce heat and the heat produced damage the nerves transmitting pain signal to the brain. This procedure is performed to treat painful facet joints in the spine that usually cause chronic low back pain and neck pain.

Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints and this is confirmed by performing a diagnostic facet joint injection. Facet joint injection relieves pain for a short duration whereas radiofrequency ablation can keep you pain-free for a longer period of time.

Radiofrequency ablation is a minimally invasive technique and therefore administration of general anesthetic is not required. You will be conscious throughout the procedure and lying on your stomach. Only a small area over your back which requires treatment is cleansed and numbed. This procedure is performed under the guidance of fluoroscopy. The fluoroscope is a special kind of X-ray machine that helps doctors to visualize the placement of the needle electrode in invasive procedures.

During the procedure, your doctor will direct a special radiofrequency needle electrode close to the facet joint in such a manner that the needle tip lies almost near to the medial branch nerve. The needle tip is then heated so that the nerve gets cauterized and destroyed thereby reducing the pain. This procedure may last for about an hour or two.

Sacroiliac Joint Radiofrequency Ablation

Coming soon…

Lumbar Sympathetic Block

Coming soon…

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