Pain Management Services and Procedures

We offer a multitude of treatment options, from the minimally invasive injection therapy to the complex advanced disc technologies, such as electrothermal disc depression, implantable stimulators and drug administration systems, cognitive and quantitative somato-sensory testing, vertebroplasty, and kyphoplasty.

We specialize in the following procedures and pain management treatments:

Blood Patch

Used to treat severe headaches, nausea and/or vomiting caused by a leak in spinal fluid into the epidural space, the blood patch acts like a band-aid and seals the leak. In most instances, symptoms are resolved immediately.

BOTOX

BOTOX injections allow therapy to be targeted to specific problem muscles, not possible with existing medications. BOTOX can be used to reduce the muscle tension involved with chronic headaches, neck aches and back pain. It can also be used to reduce spasticity or excessive muscular contractions to relieve pain; assist in posturing and walking; and allow better range of motion.

Percutaneous Neuromodulation Therapy, or PNT

Using innovative technology, PNT delivers electrical stimulation directly to the deep tissues near the spine in order to reach the nerve pathways that can affect the pain. It is believed that this type of stimulation modulates-that is, alters-the "hypersensitivity" of the nerve cells that give rise to persistent pain.

The PNT System includes ten filament electrodes (3-cm for the lumbar application, 2-cm for the cervical application) that are inserted percutaneously to deliver electrical stimulation to the deep tissues near the spine in order to reach the nerve pathways that can affect pain. This procedure is performed by a physician in a series of outpatient sessions that last approximately 30 minutes each.

Subutex/ Suboxone

In October 2002, the Food and Drug Administration (FDA) approved Subutex® (buprenorphine hydrochloride) and Suboxone® tablets (buprenorphine hydrochloride and naloxone hydrochloride) for the treatment of opiate dependence. These are the only buprenorphine based products approved to treat opioid dependence (addiction). Buprenorphine (BYOO-pre-NOR-feen) is an opioid medication used to treat opioid addiction in the privacy of a physician's office. Buprenorphine can be dispensed for take home use, by prescription. This in addition to buprenorphine's pharmacological and safety profile makes it an attractive treatment for patients addicted to opioids.

Synivsc

One possible method for treating arthritis of the knee without performing surgery has been with an injectable medication called Synvisc (the generic name is Hylan, and sold under the trade name "Synvisc"). Hyaluronan, the name of the substance in Synvisc, is secreted by cells in the cartilage of joints. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid, also called synovial fluid, its viscous, slippery quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion. By injecting Synvisc in a knee, some people consider this a socalled joint lubrication.

Ketamine

Ketamine can be used for perioperative pain management as well as a dissociative anesthetic agent in emergency situations. However, ketamine can induce both cardiovascular and respiratory depression, especially in pediatric patients. Although ketamine has usually been regarded as sympathoexcitatory, recent work has demonstrated that ketamine has important actions on parasympathetic cardiac vagal efferent activity. The current study tests the hypothesis that ketamine, at clinical relevant concentrations, alters central cardiorespiratory interactions in the brainstem and, in particular, the inspiration-evoked increase in gamma-aminobutyric acidmediated and glycinergic neurotransmission to parasympathetic cardiac efferent neurons.

Discogram: Lumbar/Cervical

A discogram is an x-ray procedure that deliberately provokes the patient's pain symptoms in order to pinpoint its source in the intervertebral discs. The procedure is designed to create a pain “road-map,” making the discogram an excellent fusion surgery-planning tool.

Discography is reserved for patients who have not responded to medications and conservative treatments, such as bed rest, traction, or physical therapy, and for whom the possibility of lumbar (lower back) surgery is being considered. Besides studying abnormal discs, discograms can detect problems within intervertebral discs that appeared normal on the CT or MRI scan.

Dorsal Root Ganglion Block

Facet Block: Lumbar/Cervical/Thoracic

Also known as a zygapophysial joint block, the facet joint block is performed to determine whether a facet joint is a source of pain. Facet joints are located on the back of the spine, where one vertebra slightly overlaps another. These joints guide and restrict the spines movement.

Radiofrequency Lumbar/Cervical/Thoracic

Radiofrequency (RF) rhizotomy or neurotomy is a therapeutic procedure designed to decrease and/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves destroying the nerves that innervate the facet joints with highly localized heat generated with radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken.

Epidural Steroid Injection Lumbar/Cervical/Thoracic/Caudal

Epidural steroid injections provide diagnostic data and pain relief by delivering local anesthetic (numbing medication) and anti-inflammatory steroid medications into the spinal area on the surface of the spinal column. This procedure may reduce inflammation, resulting in long-term pain relief, and can provide valuable information on the source of your pain.

Selective Nerve Root Block Lumbar/Cervical

Lumbar Sympathetic Block

Lumbar Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back. The injection blocks the Sympathetic Nerves which may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility.

Electrothermal Disc Decompression

ElectroThermal Disc Decompression is a minimally invasive non-surgical option to treat back and leg pain. It is designed to treat a bulging or contained herniated disc. A heating element is used to modify the protein wall of the disc and reduces the amount of disc material that causes nerve irritation. This is a minimally invasive procedure performed in an outpatient surgical center. The procedure involves a special wire (decompression heating element) which is guided into your disc through a spinal needle. An x-ray is used to confirm the catheter placement in the disc. The disc is heated for a short period of time determined by the physician. The catheter and needle are removed, and you will be discharged home with specific instructions.

Medial Branch Block

Facet Joints are innervated or supplied by nerves called medial branches. These nerves carry the pain signals to the spinal cord and the signals eventually reach the brain, where the pain is noticed. If the nerves are blocked or numbed, they will not be able to carry pain sensation to the spinal cord.

Stellate Ganglion Block

This is a type of sympathetic nerve block performed to determine if there is damage to the sympathetic nerve chain supplying the head, neck, chest or arms and if it is the source of pain in those areas. Although used mainly as a diagnostic block, the stellate ganglion block may provide pain relief in excess of the duration of the anesthetic.

Sacroiliac Joint Injection

A sacroiliac joint injection places local anesthetic (pain-relieving medication) in the sacroiliac joint, which is the region of your low back and buttocks where your pelvis joins the spine. Once the sacroiliac joints become painful, they may cause pain in the low back, buttocks, abdomen, groin, or legs. The amount of immediate relief experienced during the injection will help confirm or deny the joint as a source of pain. The cortisone (steroid) will help to reduce any inflammation that may exist within the joint(s).

Intraarticular Joint Injection Hip/Knee/Shoulder/Pubis Symphasis Intermediate

Intercostal Nerve Root Block

A nerve root block is an injection into the sheath surrounding a nerve root in the spine to decrease your pain temporarily and to define it more precisely. The exam uses therapeutic steroid and local anesthetic (numbing medication) to decrease pain and inflammation. Pain relief from the procedure varies from minimal to long-term, depending on the specific symptoms.

You must have symptoms present for this procedure to be effective. If you are not experiencing symptoms prior to your procedure, please cancel your appointment and reschedule the exam once your symptoms have returned.

Occipital Nerve Root Block

Sphenopalatine Injection/Radio Frequency

Trigger Point Injections

Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.

TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. TPI also is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments. However, the effectiveness of TPI for treating myofascial pain is still under study.

Spinal Cord Stimulator Trial/Implant

Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain.

Spinal cord stimulation is recommended when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed. However, the device is not for everyone; check with your doctor to see if the procedure is right for you

Intrathecal Pump Trial/Implant

Intrathecal drug delivery is designed to reduce pain by delivering pain medication to the intrathecal space surrounding the spinal cord. Because this therapy delivers pain medication directly to the receptors in the spinal cord, smaller doses of medication are required to gain relief. The system consists of a pump and catheter, both of which are surgically placed under the skin. The pump is implanted in the abdominal area, just above or below the belt line. A thin, flexible tube, called a catheter, connects to the pump and is tunneled under the skin to the site where medication is to be delivered. The pump releases the medication at a set rate, and the medication flows from the pump, through the catheter to the site of delivery in the intrathecal space.

Pain/Medication Management

There are many different types of medications used to treat pain, including those available over-the-counter (OTC) without a doctor's prescription and those obtained only by a doctor's prescription. OTC pain relievers include: Acetaminophen, Nonsteroidal anti-inflammatory drugs and Topical Corticosteroids. Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the "pain messages." NSAIDs are also available in a prescription strength that can be prescribed by your physician.

Peripheral Nerve Block

Intravenous Regional

For local anesthesia and many types of regional anesthesia, induction occurs when a local anesthetic is injected into the part of your body that needs to be anesthetized. Local and regional anesthesia often are given with other medications that make you relaxed or sleepy (sedatives) or relieve pain (analgesics). These medications are often given through a vein (intravenously, IV) before the local anesthetic is given.

Microcog/QST Testing

Quantitative sensory testing (QST) is a method used to assess damage to the small nerve endings, which detect changes in temperature, and the large nerve endings, which detect vibration. QST is used to diagnose and assess the severity of nerve damage, especially in the small nerve endings. It can also help determine if a neuropathy is responding to treatment. It is used to diagnose many different types of neuropathies, including peripheral neuropathies. It may also be used to identify where the nerves are damaged.

Hypogastric Plexus Block

The hypogastric plexus is a collection of nerves that is located near the lower part of your abdomen in the upper front of your pelvis. A hypogastric plexus block involves placing an anesthetic near the region of the plexus, usually involves a series of injections repeated at weekly intervals. This treatment has brought relief to many patients who suffer from pelvic pain including pain of the bladder and lower intestines. It also treats pain of the uterus, ovaries, and vagina in women, and pain of the prostate and testicles in men.