Pain Treatment

Cervical Neck

Overview
This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

Patient Sedated
The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

Needle Inserted
Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel.

Contrast Dye Injected
Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

Steroid Injected
A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication. It is absorbed by the inflamed nerves to decrease swelling and relieve pressure. The needle is removed and a small bandage is applied.

End of Procedure
The patient goes to a recovery room and is given food and drink and discharged with post treatment instructions. Some patients may need only one injection, but it may take two or three injections (administered weeks apart) to provide significant pain relief.

Overview
This is an injection of numbing medicine. It bathes the medial branch nerves, which attach to the facet joints of your spine. These nerves hurt when facet joints are injured or diseased. The injection helps find the source of your pain. And it may relieve your pain for a brief time.

Preparation
To begin, your doctor injects local anesthetic. This numbs your skin and tissue around the areas to be injected.

Inserting the needle
Next, your doctor guides a thin needle through the numbed tissue. A video x-ray device called a "fluoroscope" helps find your medial branch nerves. Contrast dye is injected to make sure the needle is in the right place.

Injection
Then, the doctor injects numbing medicine onto the nerves. The medicine temporarily numbs the nerves. If this area is the source of your pain, you'll feel immediate pain relief. More than one level of the spine may need to be injected.

End of procedure
When the procedure is finished, you'll be watched for a brief time. Then you can go home. You may feel pain relief for the next few hours. You may be asked to keep track of your pain level as the medicine wears off. If the block was successful, your doctor can recommend a procedure to provide long-lasting relief.

Overview
During this minimally-invasive procedure, the physician uses heat from radio waves to treat painful facet joints in your neck. This procedure is also called radiofrequency rhizotomy. It can treat pain that doesn't respond to medications or to physical therapy.

Preparation
In preparation for the procedure, you lie on your stomach. You are given medicine to make you feel relaxed. The skin and tissue of your neck is numbed.

Inserting the Cannula
The physician inserts a tube called a "cannula." A video x-ray device called a "fluoroscope" helps guide the cannula to the medial branch nerves in your spine. These tiny nerves carry pain signals from your facet joints to your brain.

Treating the Nerves
The physician inserts an electrode through the cannula. A weak electric jolt is used to test its position. If the jolt recreates the pain but does not cause any other muscular effects, it is positioned correctly. Then the physician uses the electrode to heat the nerve. This disrupts its ability to transmit pain signals. Several nerves may be treated if necessary.

End of Procedure
When the procedure is complete, the electrode and cannula are removed. A small bandage is placed on your skin. You will be monitored for a brief time before you are allowed to go home. Your injection site may feel sore after the procedure, and you may still have neck pain. If the correct nerves were treated, you will gradually experience pain relief as you heal. This may take several weeks.

An occipital nerve block is an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.

This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a common treatment for shingles and complex regional pain syndromes affecting the head, face, neck, or arms. Usually a series of these injections is needed to treat the problem.

Lumbar / Low Back

This outpatient procedure is an injection performed to relieve pain in the upper back.

This diagnostic procedure is performed to identify a painful facet joint. The facet joints are the joints between the vertebrae in the spine. They allow the spine to bend, flex and twist.

RFA uses radiofrequency energy to disrupt nerve function. When this is done to a thoracic medial branch nerve, the nerve can no longer transmit pain from an injured facet join.

An intercostal nerve block is an injection of a steroid or other medication around the intercostal nerves that are located under each rib. This block may reduce pain, and other symptoms caused by conditions such as herpes zoster, rib fractures or a scar after chest surgery.

Overview
This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

Patient Sedated
The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

Needle Inserted
Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel.

Contrast Dye Injected
Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

Steroid Injected
A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication. It is absorbed by the inflamed nerves to decrease swelling and relieve pressure. The needle is removed and a small bandage is applied.

End of Procedure
The patient goes to a recovery room and is given food and drink and discharged with post treatment instructions. Some patients may need only one injection, but it may take two or three injections (administered weeks apart) to provide significant pain relief.

This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. The injection takes only a few minutes to complete.

This diagnostic procedure is performed to identify a painful facet joint. The facet joints are the joints between the vertebrae in the spine. They allow the spine to bend, flex and twist.

Other

Overview
This procedure is an injection that numbs branches of nerves in your lower back. It helps doctors find and treat a number of problems linked to these nerves. Usually, a series of injections is needed to treat a problem.

About the Sympathetic Nerves
The sympathetic nerves travel along both sides of your spine. They are associated with a wide range of functions that you don't consciously control. These include your circulation, digestion and sweat production.

Preparation
In preparation for the procedure, you lie on your stomach or your side. You are given medicine to make you feel relaxed. The skin and tissue at the injection site is numbed.

Inserting the Needle
The physician inserts a needle and carefully guides it to the sympathetic nerves. The physician typically uses an x-ray device called a "fluoroscope." This shows a video image of the needle's position. Contrast dye may be injected to help confirm that the needle is placed correctly.

Injecting the Medicine
Next, the physician injects medicine. It bathes the nerves. It can numb the nerves and reduce inflammation. If these nerves have been a source of pain, the medicine can relieve it. The injection may also provide other benefits, depending on your needs.

End of Procedure
When the procedure is complete, the needle is removed and the injection site is covered with a bandage. You will be monitored for a brief time before you are allowed to go home. After a lumbar sympathetic block, many people experience leg numbness or weakness. This is normal, and usually lasts for only a few hours. You may need to return for more injections in the future.

A superior hypogastric plexus block is a type of injection that is used to control pelvic pain that does not respond to oral medications. This block can also alleiviate pain from the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon.
This minimally-invasive procedure is performed through a small tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. The surgery is performed under local or epidural anesthesia, allowing the patient to leave the hospital the same day.

Overview
This injection procedure is performed to relieve pain caused by arthritis in the sacroiliac joint where the spine and hip bone meet. The steroid medication can reduce swelling and inflammation in the joint.

Sacroiliac Joint Located
The patient lies face down. A cushion is placed under the stomach for comfort and to arch the back. The physician uses touch and a fluoroscope to find the sacroiliac joint.

Anesthetic Injected
A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint.

Needle Inserted
The physician advances a needle through the anesthetized track and into the sacroiliac joint. Steroids Injected A steroid-anesthetics mix is injected into the sacroiliac joint, bathing the painful area in medication.

End of Procedure
The needle is removed, and a small bandage is used to cover the tiny surface wound.

Overview
Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

Trial Implantation
The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space.

Find the Right Location
Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals. The patient gives feedback to help the physician determine where to place the stimulators to best block the patient's pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient.

Determine Effectiveness
If the patient and the physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.

Permanent Implantation
The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle or a small incision into the predetermined location in the epidural space.

Generator Implantation
Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the abdomen. The leads are then connected to the IPG battery.

End of Procedure
The implant’s electrical pulses are programmed with an external wireless programmer. The patient can use the programmer to turn the system on or off, adjust the stimulation power level and switch between different programs.

After SCS Implantation
After surgery, patients may experience mild discomfort and swelling at the incision sites for several days.

An intrathecal pump relieves chronic pain. It uses small amounts of medicine applied directly to the intrathecal space (the area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. Pump candidates include people for whom conservative treatments have failed and surgery is not likely to help.
This procedure is performed to diagnose and reduce abdominal pain caused by conditions such as cancer or pancreatitis. An injection is used to block the nerves serving the abdomen. An intravenous (IV) line may be used to administer medication to relax the patient.
A ganglion impar block is a procedure used to reduce some of the symptoms of chronic pelvic or rectal pain by blocking nerve impulses. The ganglion impar is a structure located at the level of the coccyx. The nerve block can be diagnostic or therapeutic.
A local anesthetic (usually lidocaine or bupivacaine) is typically injected into the joint with the goal of determining immediate pain relief to confirm the sacroiliac joint as the source of the patient's pain. This solution is used for a diagnostic sacroiliac joint injection.
Bursa injection is used to treat pain around a joint or bone due to inflammation of the bursa (sac producing fluid to lubricate the joint). Medications used for the injection can include anti-inflammatories, local anesthetics, or platelet-rich plasma.