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A multi-disciplinary approach to pain management

An illustration of a needle

Spinal cord stimulation

Spinal cord stimulation is a very effective therapy for controlling pain related to nerve damage. Stimulating electrodes are placed next to the spinal cord and are attached to a pacemaker like device which can be implanted under the skin. The spinal cord is then stimulated with small electrical impulses which substitute a pleasant sensation for the pain the patient usually experiences. Spinal cord stimulation can be effective for failed low back syndrome, complex regional pain syndromes, peripheral neuropathy, and a variety of other pain states related to nerve damage. Trials of spinal cord stimulation can be done in the office.

Epidural steroid

An epidural steroid injection is an injection of local anesthetic and steroid deposited into the epidural space. The epidural space is a space located in the spine just outside of the sac containing spinal fluid. The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. An epidural steroid injection will not correct the preexisting medical problem but may improve the level of pain. It is not unusual for someone to need more than one injection to get long term benefit. The injections are done routinely in a series of three injections about 2 weeks apart if needed. If the pain is improved significantly no further injection is needed.

Transforaminal epidural injections

The Transforaminal Epidural Steroid Injection is a similar but more advanced technique than the Epidural Steroid Injection with the physician utilizing a transforaminal approach and catheter to inject the epidural space with a local anesthetic and steroid. This technique has proven to be quite successful with pain relief and minimal complications. Again, these injections are typically performed in a series of three injections approximately two weeks apart to achieve best results.

Selective nerve root blocks

A selective nerve root block is an injection of local anesthetic and steroid into the area where the nerve root exits the spinal column. A nerve root block usually is performed for pain in the arm or leg that follows the path of a single nerve (i.e. sciatica). A selective nerve root block may be diagnostic and/or therapeutic. Therapeutic injections are intended to provide long-term pain relief. Most patients require more than one injection. If you receive sufficient relief from the injection, the nerve root block can be repeated if your pain returns.

Stellate ganglion block

The stellate ganglion is a nerve complex in the neck that controls autonomic function in parts of the face and arms. These autonomic functions include whether the skin is warm or cool to the touch, as well as responses like sweating and goose bumps. In certain conditions, the nerves from the stellate ganglion as well as some nearby nerves can become involved in the transmission of pain signals from the face and arms to the brain. Blocking these nerve signals can produce dramatic and sometimes long-term relief of pain. This block is usually performed under X-ray guidance to minimize the risks to the patient. After receiving this block, the patients will often notice several common side effects. These include an enlarged pupil and drooping eyelid on the side that was blocked, a hoarse voice, and the sensation of having a lump in the throat. These are normal responses to stellate ganglion block and will resolve in 8-12 hours. Patients usually return to work the day after this procedure.


Therapeutic treatment of nerve roots using a spinal endoscope is a minimally invasive, outpatient procedure indicated for patients suffering from radicular back pain who have failed other therapies or treatments. These patients often have nerve roots that are encased in adhesions from injury or previous surgical procedures. This entrapment causes chronic inflammatory reactions and intractable pain without relief. Diagnosis and treatment of this type of low back pathology is extremely difficult. Epidural diagnostic and therapeutic procedures using a spinal endoscope requires light anesthesia. Patients typically are discharged to home in a few hours following completion of the procedure.

Caudal epidural steroid

Steroid injections into the sacral epidural space through an opening at the base of the spine, just above the tailbone or coccyx are useful in patients with certain types of low back and leg pain. This technique is particularly useful in patients who have had previous back surgery. Medications injected through the caudal approach distribute through the epidural space and bathe the inflamed nerve structures in a mixture of local anesthetic, anti-inflammatory medication, and steroid solution to attempt to decrease inflammation and pain.

Occipital nerve injection

Injury and compression of the occipital nerve within the muscles of the neck can cause headache and neck pain (occipital neuralgia). Occipital nerve injections can be used treat neck pain and headache.

Trigger point injections

Trigger point injections are done primarily to treat pain related to muscle spasm. Local anesthetic and in some cases cortisone is injected into the painful muscle to relax it. These injections can provide long lasting pain relief in many types of myofascial pain.

Radiofrequency therapy

Radiofrequency current is used to heat up a small volume of nerve tissue, thereby interrupting pain signals from that specific area. Radiofrequency techniques can be used to help manage: chronic neck pain, chronic facial pain, chronic mechanical low back pain, chronic headaches, and chronic malignant pain involving the nervous system.

Medial branch block

Each vertebra in the spine is connected by two facet joints- one on each side of the spine. For back or neck pain believed to originate in these joints, a facet joint block can be both diagnostic and therapeutic. This injection can confirm whether the facet joints are indeed the source of pain and can help relieve the pain and inflammation.
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