Pain Management

Non-Surgical Procedures

Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord.

• Cervical Epidural Steroid Injection: Injections that deliver strong anti-inflammatory medicine into the epidural space of the spinal cord in the neck region.      
  Discography:  Performed under X-ray guidance, a needle is advanced to the suspected painful discs and a dye is injected.  This procedure is done to confirm or deny discogenic pain.      
• Lumbar Epidural Steroid Injection: Injections that deliver strong anti-inflammatory medicine into the epidural space of the spinal cord in the lower back.
  Sacroiliac Joint Steroid Injection:  Injections for pain and inflammation that originate from the sacroiliac facet joints in the lower back where the pelvis joins the spine.      
• Facet Joint Injection:  Injections for pain and inflammation that originate from one or more facet joints.       
• Lumbar Sympathetic Blocks:  Injections for pain and inflammation that are delivered to the sympathetic nerves in the lumbar region.       
• Medial Branch Blocks:  Injections for pain and inflammation delivered to the medial branch nerves.  These injections may be indicated for facet joint pain that is unrelieved from facet joint injections.
• Multiple joint injections:  Used in the management of musculoskeletal and joint injuries and pain, multiple joint injections involve administering a corticosteroid (anti-inflammatory medication) through a needle directly into the affected joint spaces.
• Trigger points:  Trigger points are localized, painful areas of soft tissue related to muscle spasms.  The area may feel tight or knotted when touched.  These areas “trigger” a painful response when pressed and the pain may radiate to other areas of the body.  Trigger points are often the result of overuse of the muscle area, stress, and poor posture.  Trigger point injections of anesthetic and/or steroid (anti-inflammatory) may be recommended when conservative treatment measures such as exercise, stress reduction, and improved posture do not help.  
• Tendon sheath injection:  A tendon sheath is a lubricating membrane surrounding a tendon allowing it smooth movement.  When disease or injury affects the tendon sheath and its ability to lubricate the tendon, movement is limited and painful.  Tendon sheath injections involve the administration of anesthetics and steroids to treat the pain and inflammation directly at the source.
• Cervical sympathetic block:  Also called a stellate ganglion block, this is a diagnostic procedure to assess if sympathetic nerves in the neck are the cause of your neck or shoulder pain.  The procedure involves inserting a needle into the sympathetic nerves in the neck area near the spine followed by the injection of x-ray contrast dye.  X-rays are then taken to ensure the needle is in the correct position.  Then local anesthetic mixed with a corticosteroid is injected through the needle to provide relief of pain and inflammation. If effective, your doctor can confirm the source of the pain and tailor the treatment plan accordingly.  
• Electromyography and nerve conduction studies: These are tests to assess if a nerve is pinched, as well as the severity and location of the pinched nerve.  Electromyography or EMG is a test involving the placement of small needles into the muscles to monitor electrical activity.  This test is used to detect the level of nerve root damage related to chronic pain.  Nerve Conduction Tests are non-invasive tests to assess the speed of conduction along a nerve.  Electrodes are placed on various parts of the skin along the course of the nerve.  The nerve is then stimulated with a weak electrical impulse and the speed the impulse travels along the nerve is measured.  A slower weaker impulse indicates a problem with the nerve enabling the physician to customize your treatment plan based on the test results.
• EMG guided nerve and motor blocks:  Performed to diagnose nerve and muscle disease as well as to provide a therapeutic benefit of pain relief and relief from muscle spasms. These procedures involve the administration of medicines on and around a nerve to “block” pain.  EMG or electromyography is used to localize the muscle and guide the needle into the correct position.