Advanced Pain Medical Group runs the gamut when it comes to diagnosing our patients, identifying your pain’s point of origin with pinpoint accuracy. We then treat this pain with some of the following:
Spinal Cord Stimulator Implant
This procedure uses electrical impulses to prevent pain signals from reaching the brain. Patients suffering from neuropathic pain who have not had any success with conservative treatments would benefit most from spinal cord stimulation for relief of chronic pain in areas like the arm, legs, and back.
Lumbar Radiofrequency Neurotomy
Pain resulting from damaged facet joints can be eliminated with this minimally invasive procedure. A needle-sized tube called a cannula is inserted using a fluoroscope x-ray near the irritated medial branch. A surgeon will then insert a radiofrequency electrode using a weak electric jolt to test positioning. The electrode is used to heat the nerve to the point of cauterization, stopping the medial branch nerves from sending pain frequencies to the brain. Pain is likely to increase a week after the procedure but relief will come within a month and can have longer lasting effects than a steroid block injection.
Stellate Ganglion Block
This procedure is administered to clear away pain of sympathetic nerves affecting the face, head, neck, and arms caused by shingles and other regional pain syndromes. The patient will lie on a table face up while an IV is inserted using an x-ray fluoroscopic unit to administer relaxing medication and a numbing anesthetic to the areas of treatment near the ganglion nerves. Contrast dye is then injected to help the physician identify the areas of pain using the fluoroscope unit. Once the location is confirmed the physician will inject a mixture of saline and anti-inflammatory anesthetic. This medicine should stop the ganglion nerves from sending pain signals to the brain. Side effects of this procedure include bloodshot or droopy eyes on the side of injection along with a hoarse voice, nasal congestion, and a slight tingling sensation. These symptoms should go away after a few hours. If pain is alleviated after the initial injection, more injections will come over time. Each injection will administer longer pay relief.
Sacroiliac Joint Steroid Injection
When arthritis creates pain in the sacroiliac joint, a steroid injection is administered to relieve pain and reduce inflammation at the point of the spine and hipbone. The patient will lay face forward with a cushion under the stomach to arch the back while the physician locates the sacroiliac joint using a fluoroscope x-ray. After numbing the local skin and tissue with an anesthetic, the physician will then insert a needle into the sacroiliac joint, injecting a mixture of steroids and anesthetics to the area of pain.
Diagnostic Medial Branch Block
A facet joint is the point between vertebrae that allows the spine to twist and bend. This procedure is used to diagnose which facet joint is causing a patient pain. The procedure begins with the patient laying face down. The physician will administer a numbing anesthetic for the skin and tissue around the affected joint. A contrast dye is then injected to pinpoint the area of injection. Using live x-ray images from the fluoroscope, the physician will confirm the location and position of the needle. Once this is done the medication will be fed through an attached syringe and will bathe the small branch nerves that generally carry signals for the facet joint, numbing all feeling. If the patient feels relief from this injection, the physician will inject a longer lasting anesthetic. If pain is still felt by the patient, other facet joints will need to be tested to identify which is the cause of pain.
Lumbar Transforaminal Epidural Steroid Injection
This procedure is administered to relieve pain and inflammation from irritated spinal nerves. It only takes a few minutes to administer the steroid-anesthetic medication to clear away lower back and leg pain. The process begins with the patient laying face down with a cushion directly under the abdomen to bend the spine and open up the foramina. The physician will then inject a local anesthetic to numb the skin and tissue around the spine and will guide a needle to the space around the irritated nerve root. A contrast solution is used to determine the correct point for injection and the medication will be administered to the spinal nerves. Once the steroid anesthetic sooths the irritated nerve roots the patient should feel relief right away. Some patients may need more than one injection in order to receive the full relieving effects of the medication administered.
Lumbar Sympathetic Block
When a patient has had an injury to a joint or limb, leg pain can develop from these pain syndromes. To treat the pain a series of injections are administered. To prepare for the treatment the patient will lay on his or her side while an IV line begins running a numbing anesthetic to the skin and tissue of the sympathetic nerves as well as a medication that will calm the patient. The physician will then use a fluoroscopic x-ray unit to inject Contrast dye to identify the areas affected and to determine the location of the injection. A mixture of anti-inflammatory medication is then injected to block pain signals from arriving to the brain. Legs may feel frail once the procedure is completed but the pain is only temporary. The block procedure should be repeated every week and until the pain is fully relieved.
Lumbar Epidural Steroid Injection
his injection is administered to alleviate pain in the lower back and legs due to swelling caused by spinal conditions. To prepare for the procedure, the patient will lay face down with a pillow under the stomach to allow better access to the epidural space in the spine. Skin and tissue around the lumbar vertebra bone is anesthetized using a local anesthetic and a fluoroscope is used to insert a needle between vertebra in the epidural space. When the location of the needle tip is confirmed and a mix of steroids and anesthetics are injected to soothe the enflamed nerve. After the procedure many patients will feel a significant amount of pain relief, however some patients may need to repeat the injection to feel the medication’s full benefits.
Intraarticular Facet Joint Injections
When facet joints regularly found around the spine are inflamed, a facet joint injection is administered to relieve the irritation and diagnose where the patients pain is coming from. Once the skin and tissue above the facet joint is thoroughly numbed with local anesthetic, the physician will use a fluoroscope to insert a needle into the facet joint. The proper positioning of the needle is confirmed with the injection of contrast dye and a soothing and numbing combination of anesthetic and anti-inflammatory steroid is injected. If the pain in the facet joint is relieved upon administration of the medication,the physician will then infer that that particular facet joint is the cause of pain. The anesthetic will begin to wear off in time but the steroid will continue to relieve pain and inflammation for up to several months. Our physicians can treat continuing pain by administering up to three injections a year.
This procedure is administered to diagnose the amount of spinal discs causing back pain. A lumbar discography is used as an aid to assist the physician in planning future treatment. To prepare for this procedure the patient should lie on the side while medication is given to calm the patient and keep them awake. The patient needs to be awake to inform the physician about what is felt throughout the procedure. A local anesthetic is applied to numb the tissue and skin around the disc area. An x-ray is used to guide the needle through to the center of the disc and is repeated for each disc. After placing the needles, the physician will inject contrast dye and the patient will be asked to inform the physician about whether pain or pressure is felt. If the patient experiences pain, the disc may be diseased. After testing is done a fluoroscopic unit is used to take images of the discs. This procedure will not take more than an hour to perform. Soreness may be felt by the patient a few days after the procedure but can be relieved with acetaminophen and ice.
Cervical Epidural Steroid Injection
This procedure is used to decrease the swelling of pinched and compressed nerves in the cervical spine that can be caused by herniated discs and spinal stenosis. In preparation for the injection the patient will lay down and a a local anesthetic will be administered to the neck for numbing. Intravenous sedation is optional and can also be given by choice of the patient. A physician will then use x-ray guidance to insert a needle in the epidural. Contrast dye is injected to assure proper needle positioning near the irritated nerves. Once position is concurred the steroid is injected. The steroid used is made up of anesthetic and cortisone, an anti-inflammatory combination that will stop swelling and decrease pressure in the nerves. After the procedure the patient will be discharged to the recovery room to rest. Some patients can feel immediate relief after one shot but it can take up to three injections given weeks apart for significant relief to be felt by the patient.
Celiac Plexus Block
A celiac plexus block procedure is performed to diagnose pain in the abdominal region that is caused by cancer or pancreatitis. The first step of this procedure is numbing of the skin using a local anesthetic. Once the back is completely numbed, a physician will insert a needle to the celiac plexus nerves using an x-ray or CT scan for guidance. A dye is then injected to assure that the needle placement is correct. The physician will inject anesthetic medicine around the affected nerves to stop pain signals from affecting the brain. The first injection is sometimes administered as a test and if the patient feels relief a permanent injection will be given to provide the patient with immediate and lasting pain relief.
Caudal Epidural Steroid Injection
In this procedure a steroid-anesthetic medication is injected into a sacrum opening to alleviate the pain of inflamed nerves in the spine. To prepare for this procedure the patient will lay face down over a cushion placed on the abdomen to raise the sacrum. Once the preparation is completed an anesthetic injection will be administered to numb the affected area. Upon effectively numbing the Sacral hiatus, the physician will direct a needle to the location of the irritated nerve roots and inject a contrast solution. Using an x-ray device called a fluoroscope the physician will ensure that the placement is correct and will then inject the medication. It takes a few minutes to administer the injection and once completed the patients pain should be immediately relieved. In some cases, more than one injection will be needed for full benefit to be felt by the patient.
Spinal Cord Stimulation
For patients who haven’t yet found satisfactory relief from pain in the back, arms or legs, Spinal Cord Stimulation (SCS) may be a viable long-term treatment. Through the use of mild electrical pulses, SCS is found to prevent pain signals from reaching the brain.
Following the successful one-week trial use of a temporary SC stimulator inserted via a simple outpatient procedure, the patient returns for permanent implantation of a SCS device that he or she will control with an external wireless programmer. Although local anesthesia is utilized during implantation of the trial stimulator, for maximal comfort, sedation or general anesthesia is used when the permanent stimulator is implanted
A minimally invasive procedure, radiofrequency ablation can help eliminate pain caused by damaged facet joints along the spine. It involves the use of heat from a high-frequency alternating current, and is easily performed in an outpatient setting, utilizing local anesthesia.
In this treatment, a needle-like cannula tube in inserted near the irritated nerves. Once the doctor has determined the proper positioning of the tube via X-ray or fluoroscope, an electrode is used to cauterize the nerve or nerves, thus preventing pain signals from continuing to reach the brain. Multiple nerves may be treated, and in some cases, RFA has been found to last even longer steroid block injections.
Stem Cell Therapy
As with Platelet Rich Plasma (PRP), the use of stem cells is an extraordinary breakthrough in regenerative medicine. Stem cells begin as undifferentiated cells that can become specialized and divide to create more stem cells.
The introduction of this kind of natural element – in this case, one found within the human body – can dramatically stimulate the body’s ability to self-repair. As a treatment for various orthopedic situations, such as degenerative disc disease, the injection of stem cells has been found to slow the degenerative process and in fact to help regenerate the spine.
There are some instances when injections are the most effective procedure available to treat pain. Steroid injections, for example, can significantly reduce pain-causing inflammation, and may provide many months of relief following a single injection.
Injections may also aid in diagnoses. For example, a stellate ganglion block enables the doctor to locate the areas of pain through the injection of a colored solution. In this case, once located, the irritated or inflamed areas are bathed in a soothing anti-inflammatory, anesthetic saline solution. In this procedure, as with any procedure involving an injection of this nature, both a relaxing IV line and local anesthesia are applied so the patient remains comfortable throughout. Our patients’ comfort is our first and final priority.
Utilizing the body’s own natural ability to heal, PRP is a state-of-the-art, minimally invasive, non-surgical treatment. In this outpatient procedure, blood is drawn from the patient and placed in a centrifuge, which leads to the isolation of Platelet Rich Plasma cells. These cells, which contain highly concentrated growth factors, are then gently injected into the area of injury, or where chronic pain is present.
Besides the back, among the common areas where our patients report success of PRP therapy are the hips, shoulder, neck, elbow, wrist and hand, ankle, knee and foot. It is also being used to help stimulate bone formation in spinal fusion therapy.