Cervical Epidural Injections
Cervical or Neck epidural steroid injections are frequently used treatment for chronic neck and arm pain syndromes. When given in the cervical spine, they are frequently used to treat pain that is located in the neck or “radicular” pain that is going down to the shoulders or arms. Radicular pain refers to pain that comes from nerve root irritation. Nerve roots is the part of the neck anatomy where the nerves exit the spinal column and start their travel down to the arms.
Lumbar Epidural Injections
Epidural steroid injections are a frequently used treatment for chronic pain syndromes. When given in the lumbar spine they are frequently used to treat pain that is located in the back or pain that is characterized as “radicular”. Radicular pain refers to pain from and irritated nerve root that is exiting the spinal canal and typically travels down the leg.
Lumbar Transforaminal Epidural Steroid Injection
Much like interlaminar epidural steroid injection, this procedure will deliver a medication formulation put together by the Pain & Healing institute to more specifically address pain in the back and down the leg. For pain that can be ascribed to a single or multiple nerve roots, the transforaminal approach can be more selective and deliver more medication to the exact place that it is needed. This is perhaps the most commonly done procedure preformed by board certified physicians, as they are effective and safe. Please view the video for more information on how these procedures are preformed.
DiscographyDiscography is a procedure that is used to test to see if various intervertebral discs are the generators of pain. Most commonly the test is ordered by a spinal surgeon in anticipation of disc replacement. During the procedure a very small needle is placed into the disc and material is injected while the patient is awake to see if it can reproduce the pain that the pain typically has.
Sacroiliac Joint Injections
A sacroiliac (SI) joint injection – also called a sacroiliac joint block – is used to treat and or diagnose pain that may be coming from the sacroiliac joint. The sacroiliac joints lie next to the spine and connect the 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 that is felt in the low back and can cause referred pain to the groin.
A diagnostic 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.
Facet Joint Injections
The facet joint of the spine is a moveable connection that connects one vertebral body to another. This injection includes both a long-lasting steroid and an anesthetic such as lidocaine or bupivacaine. The steroid reduces the inflammation and irritation and the anesthetic works to numb the pain. The first time the injection is done, it is done for both diagnostic and therapeutic purposes.
If your pain disappears with the injection then it is clear that the pain is originating from the joint, and it has been shown that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin. Though, even if your pain does not get better, this is also useful information as the face joint can be ruled out as a pain generator.
The most important and greatest success achieved with the use of facet injections is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this they regain the ability to resume their normal daily activities that was not achieved with oral medications and physical therapy.
Cervical Facet Rhizotomy (Neurotomy)
Radiofrequency ablation is powerful and effective tool that is used to provide more long lasting relief to pain arising from the facet joints in the cervical spine. For patients who have pain typically in the neck and respond positively to cervical facet joint injections for, a radiofrequency ablation can provide more long acting relief. During the procedure, a small nerve that carries only pain sensation that surrounds the joints in the neck are selectively ablated using high heat in a small pinpoint area.
Lumbar Facet Rhizotomy (Neurotomy)
Radiofrequency ablation is powerful and effective tool that is used to provide more long lasting relief to pain arising from the facet joints in the lumbar spine. For patients who have pain typically in the neck and respond positively to cervical facet joint injections for, a radiofrequency ablation can provide more long acting relief. During the procedure, a small nerve that carries only pain sensation that surrounds the joints in the neck are selectively ablated using high heat in a small pinpoint area.
Shoulder Joint Injections
Shoulder pain can come from many different places in the shoulder and the various articulations in the shoulder. For patients who have tried physical therapy, or want to try surgical alternatives, shoulder injections can prove to be a powerful solution. The Pain & Healing institute has multiple medications that can be injected and tailored specifically to your condition. Shoulder injections can be done with ultrasound guidance or with fluoroscopic guidance to make sure the medications are going to the right place.
Knee Injection with ultrasound
Pain in the knee can come from many different places, including tears in the tendons and loss, loss of synovial fluid, and loss or cartilage. For patients who have tried physical therapy, or want to try surgical alternatives, knee injections can prove to be a powerful solution. The Pain & Healing institute has multiple medications that can be injected and tailed specifically to your condition. Knee injections can be done with ultrasound or with fluoroscopic guidance to make sure the medications are going to the right place.
Intrathecal Pump Implantation and management
Intrathecal pumps are typically used to treat patients who have failed many other therapies or not candidates for spinal surgery. It is a powerful tool at the hands of a trained physician that delivers medication in the fluid that bathes the spinal cord. A small reservoir to hold the medications is implanted into the abdomen and a small tube is connected to the spinal canal for a continuous delivery of medication. It can be done as an outpatient procedure or an inpatient. Please talk to your doctors at the Pain and Healing institute for more information about intrathecal pumps.
Spinal Cord StimulationSpinal Cord Stimulator therapy is an exciting procedure that is becoming increasingly popular for the treatment of many causes of chronic back pain. This revolutionary treatment works by blocking pain perception from traveling up through the spinal cord to the brain. It involves a small device that is placed near the spinal cord in the epidural space. The spinal stimulator device delivers low-level electrical impulses that interfere with the perception of pain, especially chronic nerve pain.
The syndromes most commonly treated with SCS include:
- Nerve Root Compression
- Failed Back Surgery Syndrome
- Spinal Stenosis
- Degenerative Disk Disease
- Sciatica or Lumbar Radiculitis
- Complex Regional Pain Syndrome
- Peripheral Neuropathy
- Central Sensitization
Spinal Cord Stimulator uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain impulses. Under a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The spinal stimulator lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7days as the lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can undergo a permanent SCS if desired.
The implanted device near the area of pain produces a low voltage current, which creates a sensation that blocks the brain’s ability to sense the previously perceived pain. It interferes with the perception of pain received by the brain by creating a pleasant sensation that replaces the pain. The intensity of the stimulator can be changed, and the system can be turned on and off as necessary to provide optimal pain relief as experienced by the patient.
Spinal cord stimulator improves lumbar back pain in patients with many different conditions, and has proven to be extremely effective in patients with Failed Back Surgery Syndrome. It is shown to reduce the level of pain as well as the amount of pain medication taken by patients.
Platelet Rich plasmapheresis (PRP)
Plasma Rich Plasmapheresis is a Regenerative Injection Therapy utilizes your body’s own bioactive proteins, also know as growth factors, to replace, repair and regenerate tissue. Platelet Rich Plasma is used to deliver the growth factors directly to the pain-initiating site. This is accomplished at the Pain & Healing Institute by taking a small volume of the patient’s own blood which is then concentrated by proprietary methods to collect a smaller sample that caries all the regenerative factors and platelets.
Platelets are some of the first cells to typically go to an area that is damaged in the body to help with regeneration and clotting. These cells are rich in the nutrients and growth factors your body uses to heal it self. By injecting this in tissues that need powerful healing, we can dramatically enhance the body’s natural healing process.
PRP has been used for over 20 years in numerous surgical fields to enhance bone grafting, accelerate wound healing and reduce the risk of infection after surgery. In recent years physicians have begun injecting PRP to treat chronic pain. Tennis elbow, plantar fasciitis, Achilles tendonitis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are all being treated with the injection of PRP with the goal of regenerating degenerated connective tissue.
Stem Cell TherapiesStem cell therapy is a new and burgeoning field that is starting to produce real world results. We are beginning to bring these results to patients at the Pain & Healing institute. As science progresses, we are gaining further understanding of how the degeneration process occurs in the spine and joints at a cellular level. There is continual loss of healthy cells inside intervertebral discs and joints cause degeneration of the disc’s and various joints structure. Eventually, normal cells are replaced with fibrotic cells, and the walls of the discs and joint structure break down. This could lead to bulging discs, protrusions, and bone spurs from neighboring vertebrae begin to form in the spine and loss of normal anatomy in the bodies major joints. This process leads down its own pathway of natural degeneration, but what if there was a way to reverse this and return normal, healthy body?
Every person carries inside their bodies cells that have the ability to form new and healthy tissues. In fact, adult stem cells are found throughout the body and exist in order to replenish dying cells and regenerate healthy tissue. Muscles, bones, cartilage and tendons all come from a certain kind of adult stem cell called Mesenchymal stem cells. The main reservoirs of Mesenchymal stem cells are bone marrow and adipose (fat) tissue.
Scientists have known about these stem cells as early as 1993 and were deemed safe for therapeutic use in humans shortly thereafter. Since then, research has continued to show that they can aid in the repair of tendon ruptures, bone fractures, diseased muscles, and degenerated cartilage. Even more recent research has shown that adult Mesenchymal stem cells have the ability to produce new cells in lumbar discs, and major joints which are able to bring on new healthy tissue.
If the procedure is performed by a specialist in the field, adult stem cells can be transferred into a person’s degenerated disc safely and effectively in an outpatient setting, without resorting to surgery. Completed in the safe and sterile environment of an outpatient center, a small volume of stem cells can be easily harvested from a person’s bone marrow. It is then spun down in a centrifuge to concentrate the stem cells. These cells are then injected into a lumbar disc or major joints utilizing x-ray technology to guide the injection.
This is a continually changing field with new data coming forward all the time. Please speak to your doctor at the Pain & Healing Institute for the newest and latest information.
Ketamine InfusionsKetamine is one of the oldest used pain medications, however, its true power has only recently been uncovered. Unlike many other medications that work on pain, ketamine works on various receptors. The most important is thought to be the NMDA receptor. Ketamine has been used for many different conditions. For people with chronic myofasical, chronic burning neuropathic pain, and complex regional pain syndrome (also known as reflex sympathetic dystrophy), ketamine infusion can provide life changing pain relief. We are excited to offer ketamine infusions at the Pain and Healing institute, please talk to your doctor at if this is a proper treatment for you and your condition.
Occipital Nerve Block
The occipital nerves are nerves that exit the skull at the bases on both sides. Inflammation and irritation of these nerves can cause a myriad of problems and pain in the head. Nerve blocks of the occipital nerve are done in the office and it only takes minutes to perform. These nerves often can be a contributing factor in chronic headaches and pain in the upper neck.
Lumbar Sympathetic Nerve Block
Lumbar sympathetic nerve blocks are a tool used to treat neuropathic pain in the legs. For patients who have chronic peripheral nerve pain, complex regional pain syndrome, or phantom limb pain, a lumbar sympathetic nerve block can provide a diagnosis and provide treatment For people dealing with complex regional pain syndrome, a series of lumbar sympathetic nerve blocks can help to provide long relief to the burning pain that can occur in the legs or feet.
Stellate Ganglion Block
The stellate ganglion is a collection of sympathetic nerves located in front of the cervical vertebrae. A stellate ganglion block is done for both diagnostic and therapeutic reasons. As a diagnostic procedure, it is used to test for neuropathic pain in the arm and head and to test for complex regional pain syndrome. As a repeated procedure that is done in a series, it can be used to effectively provide relief of neuropathic pain in both the arms and face.
Kyphoplasty is an advanced technique used to treat fractures of the vertebral spine. The procedure can be done as an outpatient or in an inpatient setting. New onset deep and terrible pain that is localized to the back can be caused by a vertebral fracture. This is especially true in the elderly or in people with osteoporosis. The diagnosis of vertebral fracture can be made with a CT scan or MRI.
Trigger Point Injection
Some pain can be a simple as continually spasmed muscles or knots in muscles that do not go away. These areas can be located anywhere in the body that there is a collection of muscles and tendons are pinpointed by pressing on the tissue and identifying the problem areas. Trigger points can be caused by traumatic injury, overexertion, muscle tension, muscle spasms, pinched spinal nerves and hormonal deficiencies. A simple injection of a solution of local anesthetic and other medications tailored for your body by the doctors of the Pain & Healing institute can help to relieve this pain. It is a fast and easy procedure that can be completed in minutes.
Botox injections maybe most famous for its cosmetic use, however, it also can play a key role in the treatment of pain. Botox is a toxin that is isolated from bacteria that essentially relaxes muscles where it is injected. Muscle spasms are the cause of pain in a various number of painful conditions that can contribute to headaches, neck pain, myofascial pain (pain from muscles) and low back pain. Please talk to your doctor at the Pain & Healing institute to see if botox can help you.
Splanchnic Nerve Block
Chronic abdominal pain can be a debilitating and frustrating condition. For patients who have had all pathology ruled out with test generally run by gastrointestinal doctors, we can do splanchnic nerve blocks to try and alleviate the pain. The splanchnic nerves are a collection of sympathetic nerves in front of the lumbar and thoracic vertebrae. It is a similar procedure to a celiac plexus block without having to contact the aorta. The procedure is quick and easy to do and works best when done as part of a holistic approach to treat a troubling affliction.
Intercostal Nerve Blocks
Intercostal nerve block is a procedure used to treat pain in the chest and upper abdomen area. The intercostal nerve is found between ribs throughout the thoracic region. Injecting anesthetics, steroids or other medications, inhibits the transmission of pain signals and reduces inflammation of these nerves. This procedure may also be used to diagnose pain and identify the route of the pain signal. Conditions treated with the intercostal nerve block include:
- Neuropathic pain in the chest associated with herpes zoster or shingles.
- Postoperative pain of chest or upper abdominal surgery
- Chronic pain after mastectomy
- Rib fracture pain
- Pain related to the formation of scar tissue after surgery
- Somatic pain secondary to metastatic cancer to the ribs
The intercostal nerve communicates pain messages from the muscles, bones and skin to the brain, and a block can be effective in relieving pain without the side effects of opioid pain medications. The nerve is easy for the physician to access and the procedure low risk. A single block may result in permanent pain relief.