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Comprehensive Pain Center

Epidural Steroid Injection

An epidural injection is a procedure performed to reduce swelling, inflammation or irritation of the spinal nerve roots involved in causing your pain. An epidural injection can be performed in the cervical, thoracic, lumbar or caudal (tailbone) area of the spine. This procedure can be done with or without the use of fluoroscopy (x-ray). The procedure takes approximately 10 minutes, and you will be kept for observation between 20 and 30 minutes after the procedure. You should use icepacks to the injection site for the rest of the day. It is suggested that you eat prior to your visit and take any routine medications, unless otherwise instructed by your pain physician. You may ask a family member or friend to drive you home after the procedure.

Facet Injections

The facet joints are located on each side of the spine. These joints often have arthritis, which causes back pain. A facet injection can be performed in the cervical, thoracic, or lumbar area of the spine. This procedure must be done with fluoroscopy (x-ray). The procedure takes approximately 10  15 minutes depending on the number of vertebral levels that require injection. You will be kept for observation between 20 and 30 minutes after the procedure. You should use icepacks to the injection site for the rest of the day. It is suggested that you eat prior to your visit and take any routine medications, unless otherwise instructed by your pain physician. You may ask a family member or friend to drive you home after the procedure. For more information regarding this procedure, please speak to your pain physician at your next scheduled visit.

Indwelling Catheter Placement Cervical, Thoracic, Lumbar

Patients requiring long-term pain management may benefit from permanent indwelling catheters for delivering a constant infusion of local anesthetic or other medication. Possible candidates for this procedure include patients with malignant disease, degenerative illness, vascular disease, systemic reflex-dystrophies and neuropathies. The local anesthetic also reduces the need for narcotic medication in treating postoperative pain. There is a low risk of complications and adverse side effects with this method of pain management. The procedure is performed under general anesthesia with the patient asleep. A small incision is made on the right or left side of the chest or neck by the surgeon. The catheter is inserted into the vein and tunneled under the skin to an exit site on the chest. Small stitches may be placed around the catheter at the exit site for keeping the tubing from coming out. The stitches usually break loose from the skin by themselves in about two to four weeks. Sometimes, instead of a tunneled catheter, an injection port is placed completely under the skin. There is an incision located just above or below the injection port. Patients may leave the operating room with a needle inserted in the port and taped in place for immediate use. External catheter removal is usually performed under general anesthesia on an outpatient basis. Patients should consult their physician for a complete explanation of the procedure and its associated risks and complications.

Intrathecal Pump

Intrathecal pumps are used to treat painful conditions that have not responded to other treatments, including interventional therapy. An implanted device is permanently placed into the intrathecal space of the spine and is connected to an internal pump reservoir. Medication such as morphine, fentanyl or baclofen is placed in the pump by the nurse or doctor in the office at regular intervals. This pump can not be accessed by the patient nor can the rate of the medication be adjusted by the patient. The computer chip inside the reservoir can be programmed by the physician to deliver the medication at varying rates during the day, depending on the patients pain report. For more information regarding this procedure, please speak to your pain physician at your next scheduled visit.

Nerve Blocks

Nerve blocks are injections of local anesthesia around the sympathetic nerves in the neck or lower back. The sympathetic nerves are present on the front side of the spinal column. This chain of nerves is part of the autonomic nervous system and controls such bodily functions as sweating, heart rate, digestion, and blood pressure. In some cases following an injury, the sympathetic nervous system becomes activated. This can result in the condition known as Complex Regional Pain Syndrome (CRPS), formerly called Reflex Sympathetic Dystrophy (RSD). Symptoms of CRPS include severe burning pain, swelling, and skin color changes in an upper or lower extremity following an injury. The nerve block procedure blocks can be used at the Stellate Ganglion, a grouping of sympathetic nerves in the neck. This type of block is helpful for pain in the arm, shoulder, or facial area. A Lumbar Sympathetic Block is helpful for back, leg, or foot pain. These nerve blocks not only help to ease the painful symptoms of CRPS, they also confirm the diagnosis. A series of nerve block injections may be required depending upon the severity of the condition.

The nerve block procedure is performed under local anesthesia with IV sedation. The physician uses fluoroscopy or x-rays to determine the correct placement of a needle placed near the sympathetic nerves. A small amount of x-ray dye is injected to confirm proper spread of medication. A local anesthetic (numbing) medication is then injected through the needle. Following the block, the patient may be asked to move into a position that normally produces his or her pain. It is not uncommon for patients to have some weakness and numbness of their arms, chest wall, or legs for a short while after the procedure. This is more common after a selective nerve block. Patients may be asked to keep a record of their pain relief during the next several days or longer. Patients should consult their physician for a complete explanation of the procedure and its associated risks and complications.

Radiofrequency Ablation (Denervation)

Radio frequency ablation is a procedure used to treat chronic painful conditions of the spine and nervous system. An electrode delivers a low voltage, high frequency current to heat up a small area of nerve tissue, which decreases painful signals from that area.. This procedure must be done with fluoroscopy (x-ray). The procedure takes approximately 30 minutes depending on the number of levels that require injection. You will be kept for observation for 30 minutes after the procedure. You should use icepacks to the injection site for the rest of the day. It is suggested that you eat prior to your visit and take any routine medications, unless otherwise instructed by your pain physician. You may ask a family member or friend to drive you home after the procedure, though this is not mandatory. For more information regarding this procedure, please speak to your pain physician at your next scheduled visit.

Spinal Cord Stimulation (Dorsal Column Stimulation)

Spinal cord stimulators are used to treat painful conditions that have not responded to other treatments, including interventional therapy. An implanted lead is permanently placed in the epidural space of the spine and is connected to a battery operated generator that is also permanently placed in the patient. The stimulator can be programmed by the company representative and adjusted by the patient to deliver stimulation at varying intensity depending on the pain pattern. The patient will meet with the physician to have further adjustments made to the stimulator. For more information regarding this procedure, please speak to your pain physician at your next scheduled visit.

Trigger Point Injections

A trigger point is an area of tissue that is tender when compressed and may give rise to a referred pain and tenderness. Trigger points are often found along the spine and in the neck and shoulder area. Trigger point injections are done in the office, and take approximately 5 minutes. You will be kept for observation between 10 and 30 minutes after the procedure. You should use icepacks to the injection site for the rest of the day. It is suggested that you eat prior to your visit and take any routine medications, unless otherwise instructed by your pain physician. You may ask a family member or friend to drive you home after the procedure, though this is not mandatory. For more information regarding this procedure, please speak to your pain physician at your next scheduled visit.