Interventional Pain Management

The purpose of interventional pain management is to provide relief of painful symptoms originating from irreversible conditions of the spine without ingesting medications that could have adverse side effects. Interventional pain management uses a series of therapeutic injections to very specific areas of the spine to alleviate pain that would otherwise interfere with daily life.

Using the most advanced technologies and corticosteroid solutions, our pain management doctor is able to care for the spine alone, alleviating pain for long periods of time without altering any other area of the body. There are various types of minimally invasive injections useful in treating a range of specifically diagnosed medical conditions.

DIAGNOSIS

Diagnosing the exact origin of pain is essential in successful interventional pain management treatment. In most cases, the first injection serves as a diagnostic test to ensure that the area the physician determined as problematic is indeed the source of pain.

A physician will first ask a series of background questions that will include where the pain is, when it started, lifestyle activities, and past medical conditions. Imaging, either an x-ray or MRI, is frequently used to determine if there is any structural damage to the spine, such as herniated discs, arthritis of facet or sacroiliac joints, or areas where nerve roots may be compressed.

Since pain often radiates to other areas of the body when nerve roots are injured, it may sometimes be difficult to determine the exact spot or nerve in which the injection would be most effective. The first injection acts as a trial. If pain is alleviated a significant amount soon after the procedure, then it can be safely determined that the nerve or joint is the source of pain. Further treatment can then be planned on a more regular basis depending on how much relief the patient feels.

CONDITIONS TYPICALLY TREATED WITH INTERVENTIONAL PAIN MANAGEMENT

MOST COMMON INJECTIONS

Patients most often benefit from four particular interventional pain management injections. They are the most commonly used treatments because they can prevent pain from a range of different conditions originating in the spine.

EPIDURAL STEROID INJECTION

Epidural Steroid Injections target a wide area of the spine, alleviating most pain in the back, neck, and limbs. The needle is inserted into the back and the medicine reaches the epidural space, or the space between the covering of the spinal canal and the spinal cord. This is a frequent location for pinched or compressed nerve roots.

A number of different medical conditions, including herniated discs or spinal stenosis, can cause inflammation that narrows the spinal canal. Pressure is then placed on the nerve roots that run through the canal, causing them and the nerves that branch from them to malfunction.

Epidural steroid injections contain a local anesthetic, which numbs the immediate region of the body to the ache of the actual needle insertion. Corticosteroids are then released into the epidural space, which serve as a powerful anti-inflammatory. The corticosteroid will remain in patient’s systems for varying amounts of time, but most often provides pain relief for a period of months for those with chronic, underlying conditions.

It may take 2-7 days for the corticosteroid to become active. Epidural steroid injections may be repeated, though not more than twice in a six-month time period to avoid any adverse side effects the corticosteroid may have on soft tissues.

SACROILIAC JOINT INJECTION

Though the sacroiliac joints are a part of our hips, they greatly affect the lower back, making them an integral part of proper spine care. Sacroiliac joints are highly susceptible to pain for numerous reasons, whether the condition be chronic, like degenerative disc disease, or temporary, like pregnancy.

A local anesthetic injection to the SI joints will first be done to make certain they are the cause of lower back pain. If the anesthetic provides immediate relief, it proves that there are abnormalities within the joint.

Under x-ray guidance, a needle is inserted directly into the joints, injecting corticosteroid medication. The decrease in inflammation will ease pain for a longer period of time. SI joint injections may also be repeated as a therapy would.

FACET JOINT INJECTION

Facet joints are located on either side of each vertebra, holding them together and allowing the spine to bend and twist. Multiple conditions or injuries can cause damage to the facet joints, which will grind together, causing inflammation and pain.

The objective of facet joint injections is to provide enough pain relief to allow a patient to complete physical therapy sessions that will alleviate the facet joint condition on a long-term scale. The first injection serves as a diagnostic test to make sure the facet joint is the main source of pain. If it provides significant pain relief, it can then be used more regularly to treat inflammation. The needle is inserted directly into the damaged facet joint, injecting it with corticosteroids.

SELECTIVE NERVE ROOT BLOCK

A selective nerve root block pinpoints a single nerve root in the spine that may be compressed and sending pain signals to the brain. A single injection is often done to determine the exact nerve root causing the problem, since it is not always obvious through imaging. A dye is inserted into the region prior to insertion of the needle to direct the tip into the space surrounding the single nerve root.

If the local anesthetic of the injection provides significant pain relief, then the injections may be administered as a more regular therapy. A corticosteroid is also used in this type of injection to decrease inflammation around the nerve root, releasing compression and stopping pain signals.

OTHER INTERVENTIONAL PAIN MANAGEMENT INJECTIONS

  • Medial Branch Radiofrequency Ablation – A needle is inserted into the space directly around a targeted nerve branch. Radiofrequency waves are then passed through the needle to interrupt the pain signals the nerve sends to the brain for a long period of time.
  • Lumbar Sympathetic Block – A corticosteroid is injected directly into the sympathetic nerves located on either side of the lumbar region of the spine. This provides lower back pain relief.
  • Discogram – A dye is injected directly into the cushioning discs between the vertebrae, which will leak into cracks or deformities that could be causing back pain. Multiple discs may be injected to diagnose exactly which ones require treatment.

Endoscopic Facet Rhizotomy – The medial branch, which transmits pain of facet joints to the brain, is targeted by a needle. The needle is heated until the medial branch is ablated, or unable to send pain signals for a long period of time.

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