Treatments

Treatments:

We understand that pain can affect all parts of our body and our life. If there is not a link for the type of pain you are experiencing, please do not hesitate to contact our office, as we can review your information to see if we can assist your pain management.

CAUDAL STEROID INJECTION

This pain management procedure is used to relieve low back, radiating leg pain and coccydynia. The steroids can reduce the swelling and inflammation caused by stenosis, radiculopathy, sciatica and herniated discs.

During the caudal steroid injection a patient lays face down and a cushion is placed under the stomach to arch the back for comfort. A physician then uses fluoroscopy to find the small opening at the base of sacrum.

A local anesthetic is used to numb the skin and tissue down to the surface of sacral hiatus. After a needle is carefully placed in the area of 1-2 cm; a contrast solution is injected to help the physician see the painful areas under fluoroscopy. Then a mixture of anesthetic and anti-inflammatory medicine is injected into epidural space, bathing the painful area in the medication. The needle is then removed and a small bandage is placed to cover a tiny surface wound.

Most patients have significant relief after one or two caudal steroid injections but it may be necessary to repeat the procedure several times to get the full benefit of the medication.

CAUDAL STEROID INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroids side effects are facial, eye, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

CELIAC PLEXUS BLOCK

The Celiac Plexus Block is used to diagnose and relieve abdominal pain caused by cancer or pancreatitis. The injection blocks the nerves serving the abdomen. An intravenous anesthetic could be used to relax the patient.

A local anesthetic is used to numb the skin and tissue down to the celiac plexus. The physician then uses fluoroscopy and contrast solution to confirm the correct location of needle tip. An anesthetic medicine is injected around the nerves to block pain signals reaching the brain.

The first injection could be a test. If pain relief appears, a permanent celiac plexus block could be used. Most patients have immediate pain relief after the injection.

CELIAC PLEXUS BLOCK SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroids side effects are facial, eye, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

DISCOGRAPHY

Discography is a provocative diagnostic procedure which is used to determine if back pain is caused by one or more discs. The procedure involves the suspicious disc, one disc above, one disc below and one healthy disc. An injection of sterile liquid is applied to induce pain or pressure in the discs.

During the procedure the patient lies on stomach or side on a table equipped with fluoroscopy and takes intravenous anesthetic medication for relaxation. It is very important for the patient to be awake enough to inform the physician about all sensations and feelings.

Local anesthetic is then used to numb the skin and tissue down to the disc area. A physician uses fluoroscopy to find the right spot and places a guide needle to the edge of the disc. A small needle is inserted through the guide needle to the center of the disc. After all the needles are placed the discs are pressured one at a time with a contrast solution. The healthy disc may feel pressure, but the damaged disc feels pain. If pain appears it is very important for the patient to compare that pain with the pain he/she has been feeling. If the pain is the same, the damaged disc is found. After X-ray pictures are taken, the needles are removed.

DISCOGRAPHY SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, and bleeding in seldom cases. During discography no steroid medication is used.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

FACET JOINT INJECTION

Facet Joint Injections are provided to confirm that the facet joints are causing the pain and to relieve back or neck pain and inflammation. Each vertebra in the spine is connected by two facet joints. A local anesthetic numbs the skin and tissue down to facet joint.

The physician then uses fluoroscopy and contrast solution to confirm the correct placement of the needle tip. A mixture of anesthetic and anti-inflammatory steroid medications is injected into the joint. Sometimes two or more injections might be needed. If the patient feels pain relief just after injection, this confirms that the facet joint was the source of pain.

However the pain may return after the local anesthetic wears off with improvement over time as the anti-inflammatory medication begins to work. Usually it takes about a week to reduce inflammation and pain. Pain relief can last up to several months.

FACET JOINT INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroids side effects are facial, eye, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.
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FEMORAL NERVE BLOCK

A Femoral Nerve Block is used to block pain in the thigh or knee after several surgeries. The femoral nerve is blocked to prevent pain signals from reaching the brain. The physician places needle close to the femoral nerve and inject a mixture of anesthetic medicine to block pain signals.

FEMORAL NERVE BLOCK SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroids side effects are facial, eye, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

Cervical Facet Radiofrequency Neurotomy



BOTOX® Injections for Chronic Migraine



Facet Joint Injections



Caudal Epidural Steroid Injection



PRP Therapy for Chronic Knee Pain



Using Opioids Safely



LUMBAR EPIDURAL STEROID INJECTION

A Lumbar Epidural Steroid Injection is the most often used epidural steroid injection. It provides such significant results that it is called “White Magic”. This injection has been used since 1950 with a wealth of experience being collected.

Lumbar Epidural Steroid Injections are used to relieve low back pain and pain radiating down the legs. The steroid medication helps reduce the swelling and inflammation caused by spinal stenosis, radiculopathy, sciatica or herniated discs.

During the procedure the patient lies face down on a cushion placed under the stomach area to arch the back for easier access to the epidural space. A local anesthetic is then used to numb the skin and tissue down to the lumbar vertebra. Fluoroscopy is used to help the physician ensure correct placement of the needle tip. The physician then places a thicker needle between vertebras and uses the contrast solution to see the painful areas. Then a mixture of anesthetic and steroids is injected to reduce the pain and inflammation.

LUMBAR EPIDURAL STEROID INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.
It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.
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LUMBAR RADIOFREQUENCY NEUROTOMY

Lumbar Radiofrequency Neurotomy, which is also called radiofrequency rhizotomy, is used to reduce or eliminate pain in the spinal facets and eliminating the pain signals that travel through the medial nerve branches. A light electrical discharge is used to cut off the nerve, which joins the painful facet joint. Lumbar Radiofrequency Neurotomy is a short, minimally invasive procedure done under local anesthesia. A tube-like needle, called a cannula is introduced with the help of fluoroscopy near the appropriate medial nerve branch.

A radiofrequency electrode is inserted through the cannula. Then to make sure that electrode is in correct position, a small electrical signal stimulates the site. If the stimulation causes only pain without other any muscular effects, then the electrode is in right position. To cut the nerve; electricity is conducted through the electrode, which warms up the nerve. After the radiofrequency neurotomy is complete, the physician will repeat the procedure for any remaining nerves. At the end of the neurotomy both cannula and electrode are removed.

During a week after Lumbar Radiofrequency Neurotomy the pain may increase, but by the end of the month the patient will be fully relieved. Successful radiofrequency neurotomy may last longer than a steroid block.

LUMBAR RADIOFREQUENCY NEUROTOMY SIDE EFFECTS:

Possible side-effects are comparable with side-effects of a simple injection: patient may have allergic reactions, bacterial infection or bleeding, which occurs rarely.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

LUMBAR SYMPATHETIC BLOCK

Sympathetic nerves bring pain impulses to the brain. A Lumbar Sympathetic Block is carried out to eliminate leg pains caused by complex regional pain syndrome, which can arise as a result of joint or limb damage. Generally we have to make a series of injections to solve the problem completely. During a Lumbar Sympathetic Block the patient lies on their side or stomach on a table equipped with a special fluoroscopic machine, and intravenously takes a relaxing anesthetic.

A local anesthetic is administered to numb the skin and all tissue up to the sympathetic nerve through which the needle is introduced. Then contrast is injected to help visualize the fluoroscope and to guide the needle into the painful area. The doctor then injects a mixture of anesthetic, saline and anti inflammatory drug which prevents the conduction of pain signals to the brain. Infrequently, the patient may feel weakness in legs which will disappear in several hours after the procedure. It may be necessary to repeat the procedure once a week to achieve full pain relief. The procedure is not permitted for patients who receive ‘blood thinning’ agents or have inflammations in the site of sympathetic nerve injections.

LUMBAR SYMPATHETIC BLOCK SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

LUMBAR TRANSFORAMINAL EPIDURAL STEROID INJECTION

Lumbar Transforaminal Epidural Steroid Injections are carried out to remove pain in the lower back as well as pain radiating down the legs. Steroid medications reduce swelling and inflammation caused by spinal channel narrowing, radiculopathy, sciatica and vertebral disc protrusion. In some cases it is necessary to repeat Lumbar Transforaminal Epidural Steroid Injection up to three times to get the maximum effect from the medication; however, most of the patients get substantial pain relief after one or two injections.

During the Lumbar Transforaminal Epidural Steroid Injection the patient lies face down with a soft pad under the stomach for comfort and to help relax the spine. Positioning of the spine gives easy access to the epidural cavity. The addition of fluoroscopy helps to find the specific lumbar vertebrae and nerve roots. At the injection site a local anesthetic is used first, which numbs the tissue down to the surface of the vertebra. Under fluoroscopy the doctor introduces a thin needle in the foraminal space near the nerve ending. Contrast is then injected to help verify the correct position of the needle. Then a mixture of steroids and anesthestics is introduced into the foraminal epidural cavity which soothes the painful nerve ending. After the needle is removed a small band-aid covers the injection site.

LUMBAR TRANSFORAMINAL EPIDURAL STEROID INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

PERIPHERAL NERVE BLOCK

Peripheral nerve block is an injection of a local anesthetic and steroid medication into or near a peripheral nerve to prevent pain signals from reaching the brain. This pain management procedure can help those who suffer from neck pain ,low back pain, sciatica resulting from herniated discs, lumbar canal stenosis, complex regional pain syndrome (reflex sympathetic dystrophy), pain arising from peripheral vascular disease, shingles pain, myofascial pain syndrome or cancer pain.

Peripheral nerve blocks can be performed as a single injection, or series of injections. This procedure may relieve pain for several hours to several months. In many cases, peripheral nerve blocks are performed together with a rehabilitation program.

PERIPHERAL NERVE BLOCK SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

Cervical Transforaminal Epidural Steroid Injection



Lumbar Epidural Steroid Injection



PRP Therapy for Chronic Back Pain



Joint Injection: Hip



PRP Therapy for Hip Arthritis



Joint Injection (Therapeutic, Shoulder)



SACROILIAC JOINT STEROID INJECTION

Sacroiliac Joint Steroid Injections are done to eliminate pain, caused by sacroiliac joint (a joint which connects the spine and thigh-bone) articulation arthritis. The steroid medication injected reduces swelling and inflammation. During this procedure the patient lies face down with a soft pad under their stomach for comfort and to help relax the spine.

A local anesthetic is administered at site of injection which numbs the tissue down to the sacroiliac joint.Then a steroid-anesthetic mixture is injected into the painful area.

SACROILIAC JOINT STEROID INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.
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SPINAL CORD STIMULATOR IMPLANT

Spinal cord stimulator are implanted to eliminate pain in the lower back and sciatic nerve. It uses electrical impulses to prevent pain signals from reaching the brain. Usually Spinal cord stimulator are used for patients that haven’t responded to conservative treatment and surgery. Using a local anesthetic the physician numbs the local area and makes a small incision. Then one or more small electrodes are placed near the spinal cord which prevents pain signals from a needle through a small incision near the spinal cord physician places one or more electrodes, which prevent pain signals from reaching the brain. Patient helps doctor to determine, where the electrodes have to be placed, by feeling where the stimulation blocks pain.

The electrodes are connected to temporary spinal cord stimulator, which will be used for several days to determine if spinal cord stimulator helps the patient. If during the approbation period pain reduces by 50%, a permanent system may be placed. Second procedure is usually carried out under general anesthesia. Temporary electrodes are removed and through a needle or incision permanent electrodes are placed. Receiver is implanted subcutaneously in the breech or abdominal cavity. Power supply for the implant may be internal (impulse generator) or external (transmitter or antenna). Electrical impulses of the implant are controlled with an external device, which lets patient to turn the system on or off and change intensity, frequency and length of impulses.

After implantation the patient may feel moderate discomfort and swelling in the incision site for several days. With time electrodes may move or be damaged by intense using and may need replacement.

SPINAL CORD STIMULATOR (SCS)/IMPLANT SIDE EFFECTS:

Possible side-effects are comparable with side-effects of a simple injection: patient may have allergic reactions, bacterial infection or bleeding, which occurs rarely.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.
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STELLATE GANGLION BLOCK

This pain management procedure is used to diagnose or/and treat pain, that comes from sympathetic nerves. Stellate Ganglion Block is treatment for Complex Regional Pain Syndromes and shingles. Shingles is a painful rash that can affect your head, face, neck and arms. Usually a series of injections is needed to get long term pain relief.

During the procedure the patient lies on his/her back on a special table equipped with fluoroscopy. A physician uses fluoroscopy to confirm that the needle tip is in the correct location. The patient takes intravenous anesthetic for relaxation and a local anesthetic is provided to numb the skin and tissue down to the ganglion nerves. Then a mixture of anesthetic and anti-inflammatory medicine is injected to block pain signals that travel to the brain via the ganglion nerve. If the first injection alleviates the pain then more injections can follow over time. Pain relief usually lasts longer after each injection.

STELLATE GANGLION BLOCK SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.

TRIGGER POINT INJECTION

Trigger point injections are used to treat extremely painful areas of a muscle. Normal muscle action contracts and relaxes when it is active. A trigger point is a knot or tight band of muscle within the muscle that can be felt under the skin and forms when the muscle fails to relax.

The trigger point can irritate surrounding nerves and cause referred pain felt in another part of the body. Over time scar tissue, the loss of range of motion, and weakness may develop.

Trigger Point Injections take approximately 30 minutes. Before performing aTrigger Point Injection, the physician may give the patient a local anesthetic to prevent pain from needle penetration.
A small needle is then inserted into the trigger point and a steroid-anesthetic mixture is injected. The injection of medication inactivates the trigger point and thus alleviates pain. Sustained relief usually is achieved with a brief course of treatment. The injection may cause a twitch or pain that lasts a few seconds to a few minutes.

Numbness from the anesthetic may last about an hour and a bruise may form at the injection site. Pain can be relieved by alternately applying moist heat and ice for a day or two. In most cases, stretching exercises and physical therapy are performed following Trigger Point Injections.

Also, Trigger Point Injections are used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. Additionally, Trigger Point Injections can be used to treat fibromyalgia and tension headaches.

TRIGGER POINT INJECTION SIDE EFFECTS:

Possible side effects could be compared with common injection side effects, i.e. allergic reaction, bacterial infection, or bleeding in seldom cases. Steroid side effects are facial, eyes, arms, or legs swelling and elevated sugars for diabetic patients.

It is very important that the patient inform the physician about pregnancy or if he/she is taking blood thinning medication.
View video

Cervical Epidural Steroid Injection



Spinal Cord Stimulator Implant



PRP Therapy



Trigger Point Injections



Radiofrequency Neurotomy of the Lumbar Facets



Medial Branch Block



Sacroiliac Joint Steroid Injection



Viscosupplementation for Arthritis of the Knee



 

Conditions:

BACK AND SPINE CONDITIONS

ELBOW, HAND & WRIST CONDITIONS

HIP, FOOT & ANKLE CONDITIONS

KNEE CONDITIONS

  • Meniscus Tears
  • ACL & PCL Tear / Sprain
  • MCL & LCL Tear / Sprain
  • Patellofemoral Pain Syndrome
  • Patellar Tendonitis
  • Knee Bursitis
  • Tendonitis
  • Iliotibial Band Syndrome
  • Chondromalacia Patella
  • Arthritis
  • Achilles Tendonitis
  • Shin Splints

NECK CONDITIONS

Shoulder Conditions

  • Rotator Cuff Injuries
  • Shoulder Arthritis
  • Shoulder Pain
  • Shoulder Instability
  • Shoulder Tendonitis/Bursitis
  • Biceps Tendonitis
  • Shoulder Impingement
  • Rotator Cuff Tear
  • Frozen Shoulder (Adhesive Capsulitis)
  • Shoulder Sprain/Strain

Chronic Pain Conditions