Pain Management Procedures
Discography, or a discogram, is an injection that helps doctors locate a painful disc before performing lumbar fusion surgery in patients whose pain has not responded to conservative treatments. A discogram may be ordered when other diagnostic injections have failed to pinpoint the source of the pain, which may affect the back, legs, groin or hips.
Epidural Blood Patch
An epidural blood patch is an injection of your own blood into the epidural space, which surrounds the spinal cord. It is done for patients experiencing severe headaches after receiving a spinal injection. These headaches occur as a result of spinal fluid leaking into the epidural space. An epidural blood patch stops the leak, making the headache go away.
An epidural blood patch only requires local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. The skin on your back, as well as the skin surrounding one of your veins, is cleaned with an antiseptic solution. Then, a small intravenous catheter is inserted into your vein. Once the needle has been properly positioned over the epidural space, your doctor will draw about 20-25cc of blood from your vein and inject it into the epidural space. While an epidural blood patch only takes a few minutes to perform, you will remain at our office for about an hour and a half; this includes consulting with your doctor before the procedure and recovery room observation afterwards.
Facet Joint Injection
A facet injection is a minimally invasive treatment option for pain caused by inflamed facet joints. Facet joint pain is often related to spinal stenosis, sciatica or arthritis and is characterized by neck, arm, low back or leg pain. Each vertebra has four facet joints that connect it to the vertebra above and below. The injection may also be used as a diagnostic test to determine if facet joint inflammation is the source of a patient’s pain.
A facet injection is a combination of a long-lasting steroid and a local anesthetic that are injected either into the joint capsule or its surrounding tissue. The steroid reduces inflammation and can relieve pain for a few days to a few years. This procedure can be repeated up to three times a year for those who experienced successful but short-term pain relief.
Interlaminar Epidural Steroid Injections
Epidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.
Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself. Intralaminar ESIs require inserting the needle between the lamina, a small section of bone that covers the spinal cord, of two vertebrae. The medication enters the epidural space in the midline and from there is able to reach the nerve roots on either side of the spine.
Medial Branch Blocks
A medial branch block is a minimally-invasive procedure to diagnose and treat neck or back pain. This procedure can determine whether a facet joint-which connects the bones of your spine, providing support as you move-is the source of your pain. Next to the facet joints are the medial branch nerves, which transmit pain signals from these joints to your brain.
Before undergoing a medial branch block, you will be given intravenous medication to help you relax. With the assistance of imaging technologies, a small needle will be inserted near your medial branch nerve. Once it is situated properly, an anesthetic will be injected through it.
The effectiveness of a medial branch block varies depending on your individual condition. Patients whose pain returns after a short period of time may require a different form of treatment if it is confirmed that the facet joint is not the source of the pain.
Peripheral Nerve Blocks
A nerve block is a procedure used to treat or diagnose severe pain. The block is placed by injecting an anesthetic into the affected nerve to either numb the pain or determine if the pain is coming from the nerve. If the pain is relieved when the block is injected, it can be assumed that the pain is caused by the nerve. After a diagnostic nerve block, the procedure may be repeated as a more long-term treatment method.
Nerve blocks are placed with the help of ultrasound imaging, and injected directly into the affected nerve. Pain outside the spinal area is diagnosed with a peripheral nerve block, which may be inserted in the occipital nerves in the cervical area, the ilioinguinal nerve in the pelvic area or other motor nerves. Nerve blocks are not an option for all patients and can cause serious side effects.
The nervous system of the body is the network through which important messages are sent at extremely high speeds. These messages can be vital to the human’s survival, but in some cases can be too inflated or erroneous in nature. In these cases, the extra notes transferring through the system can be converted into disproportionate amounts of pain, especially when a nerve cord itself is disturbed. Radiofrequency nerve ablation is used to dull these messages superficially, so they either cease to exist or resemble the relevant amount of pain.
Spinal Cord Stimulator
A spinal cord stimulator is an electronic device that is implanted in the body to help relieve chronic pain. Also known as a dorsal column stimulator, the device sends low electrical currents through wires placed near the spinal cord, allowing patients to control when pain relief is offered.
The device does not cure chronic pain, but usually provides a 50% or greater decrease in pain and allows patients to be more active and require less pain medication. This procedure is usually considered when other solutions, such as surgery, injections and medications, have failed. Before implantation, patients will often be asked to go through a trial period with an external device. The trial will test patients’ pain levels and see if they improve with the help of the device.
During the implantation of the permanent device, wires are fed with a needle and positioned on the spinal cord. Placement of the device is dependent on the site of the pain. The device can be removed if necessary. The battery of the device must be replaced every 2 to 5 years. Proper care following the procedure is required and includes limiting movement and avoiding driving for the first few weeks.
Spinal Tap Diagnostic
Also known as a lumbar puncture, a spinal tap is a diagnostic procedure that involves removing a small amount of cerebrospinal fluid (CSF) from the spine to analyze it and help detect or rule out conditions such as meningitis, encephalitis, multiple sclerosis and certain cancers.
During the spinal tap procedure, you will lie on your side while a needle is inserted into the spinal canal to measure its internal pressure and carefully remove a small sample of fluid to be analyzed. A blood sample will also be removed from the arm and tested with the spinal fluid. This procedure usually takes about 45 minutes and is performed with a local anesthetic to minimize discomfort.
Once the CSF has been removed, it is examined for a number of different factors in order to accurately diagnose the patient’s condition. Lab technicians analyze the fluid for:
- General appearance
- White blood cell levels
- Protein levels
- Glucose levels
- Bacteria and fungi
After the spinal tap procedure, some patients may experience a spinal headache, bloody discharge or infection as a result of the needle injection. You may be instructed to lie flat for some time after the procedure, and avoid exercise and other strenuous activity for the first day after the spinal tap. The results of this test will be available within a few days. Your doctor will decide upon the best treatment option for you after evaluating the results of your procedure.
Selective Nerve Blocks
Selective nerve root blocks, or SNRBs, are steroid injections that help doctors diagnose the exact source of low back and leg pain arising from the compression and inflammation of one of the spine’s many nerve roots. Nerve root damage is often associated with a far lateral disc herniation. SNRBs can temporarily relieve nerve root pain if the injection is delivered directly to the damaged area.
Sympathetic Nerve Blocks—Stellate, Lumbar, Thoracic
A sympathetic nerve block involves the injection of a medication to numb a nerve and interrupt the pain signals it sends to the brain. It is used to both diagnose damage and treat pain caused by the sympathetic nerves, which run throughout the spine. The sympathetic nerves are responsible for essential bodily functions, including the regulation of blood vessels, heart rate, perspiration and more.
A therapeutic nerve block is used to treat pain and typically contains a local anesthetic that will relieve pain. Nerve blocks used to treat chronic pain can work for up to 6 to 12 months and can be repeated as needed. Diagnostic nerve blocks insert an anesthetic for a certain amount of time to determine the source of the pain.
Sympathetic nerve blocks can be performed along several areas of the spine. A stellate block focuses on the sympathetic nerves in the upper spine, including those that run to the chest, arms, neck and head. A lumbar sympathetic nerve block targets the sympathetic nerves of the lower spine that affect the legs and feet. A nerve block of the thoracic region involves the sympathetic nerves in the middle of the spine that reach the abdomen.
Transforaminal Epidural Steroid Injections
A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the injection often feels like just pinching and pressure.
Immediate pain relief is found because of the injection of anesthesia, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with pain that radiates through the arms or legs rather than just back or neck pain.
For more information, please call Northwest Spine & Pain Surgical Center at 503-694-8600.