Procedures

The following is a description of procedures commonly performed by our pain physicians for treatment of chronic pain conditions.

 One of the most common procedures that we perform is epidural steroid injections.  These can be performed in the cervical spine, thoracic spine or the lumbar spine for treatment of conditions related to nerve irritation or nerve damage at the nerve root level/spinal cord level.  Nerve root irritation, inflammation or damage often times occurs as a result of degenerative disc disease by chemical irritation or as a result of herniated disc material that can actually compress nerves and cause damage or irritation.  Nerve irritation at this level can also be caused by degenerative changes (spondylosis or arthropathy) of the bony part of the spine, particularly the joints of the vertebra known as facet joints.  Other conditions such as nerve root irritation or damage can be from traumatic, or stretch injuries, or mass effect from tumors.  Epidural injections are also recommended as a first line treatment for shingles.

 Epidural steroid blocks performed in the cervical, lumbar, or thoracic region are completed most commonly on an outpatient basis.  They are often performed under IV sedation and almost always performed with the use of fluoroscopy (x-ray).  The skin overlying the area to be injected is cleansed.  It is then anesthetized with local anesthetic.  A needle is then placed in between the vertebra and using special techniques, the epidural space is identified.  Medication consisting of local anesthetic with steroid is then placed into the epidural space.  The medication and treatment is used to reduce the irritation and inflammation of the nerve roots as they leave the spinal cord exiting through the epidural space in the spine.  The injection usually immediately relieves pain related to inflammation of the nerve roots.  The steroid medication over the course of 7-10 days reduces the inflammation and thereby reduces the severity and intensity of symptoms.  Often times the blocks are repeated two or three times in order to obtain optimal control of the irritated and inflammed nerve tissue.  These procedures are usually performed quite efficiently in an outpatient setting.  Activity usually can be resumed the following day but may be restricted in order to optimize the treatment effects.   

Another commonly performed injection is known as trigger point injections.  Trigger point injections are used to treat sprains, muscle strains, or conditions known as myofascial syndromes often times related secondarily to other causes.  Trigger points are hypersensitive areas of muscle and nerves in the muscle that cause pain to be referred to other areas when pressure is applied to them.  Treatment may often require injections with local anesthetic and sometimes a small amount of steroid in order to optimize control in conjunction with treatment such as physical therapy, stretch, and exercise.

 We often also perform various sympathetic nerve blocks for conditions known as reflex sympathetic dystrophy or complex regional pain syndromes.  This is also used to treat other types of chronic pain conditions, including peripheral vascular disease.  These blocks are performed by anesthetizing the sympathetic nerve centers which lie alongside the spine including the cervical, thoracic, and lumbosacral regions.  Again, these are performed in an outpatient setting and often times under IV sedation and with the use of fluoroscopy (x-ray).  The skin is cleansed and the areas overlying the sympathetic nerves are anesthetized.  Needles are placed using fluoroscopy (x-ray) and local anesthetic is injected onto the sympathetic nerve ganglion lying alongside the spine.  Temperatures are measured in the involved extremity being treated to help document good sympathetic blockade.  These blocks may be repeated at fairly frequent intervals in order to optimize control of sympathetic nerve dysfunction