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Physicians' Pain and Spine Specialists, PLLC

Pain Management

Interventional pain management is a discipline of medicine devoted to the diagnosis and treatment of pain related disorders through a multidisciplinary approach. The goals of interventional pain management are to reduce pain and improve a patient’s quality of life through minimally invasive techniques. Interventional pain management also strives to help patients return to their everyday activities quickly and without reliance on medications. Some of the pain management services we provide are:

  • Electrodiagnostic & Nerve Conduction Study
  • Epidural Injections (Cervical Epidural Steroid Injection,Cervical Tranforaminal Epidural Steroid Injection,Lumbar Epidural Steroid Injection,Lumbar Transforaminal Epidural Steroid Injection,Thoracic Epidural Steroid Injection,Thoracic Transforaminal Epidural Steroid Injection)
  • Facet Joint Injections
  • Radiofrequency Neurotomy(Cervical Facet Radiofrequency Neurotomy,Lumbar Radiofrequency Neurotomy,Thoracic Facet Radiofrequency Neurotomy)
  • Selective Nerve Root Block
  • Spinal Cord Stimulator Implant
  • Sacroiliac Joint Injections

Electrodiagnostic and Nerve Conduction Study

Electrodiagnostic studies are a commonly used technique to test the function of muscles and nerves. These studies help narrow down the possible causes of back or neck pain, numbness/tingling and strength loss. There are usually two parts: one testing nerves (NCS or “nerve conduction studies”) and the other testing muscles (EMG or “electromyography”).

NCS is performed by placing small electrodes on the skin. A stimulator delivers a very small electrical current to your skin near nerves being tested, causing your nerves to fire. The electrical signals produced by nerves and muscles are picked up by the computer, and the information is interpreted by a physician specially trained in electrodiagnostic medicine able to see how fast or slow nerves are functioning. Comparisons are made to averages to see if see the nerves are working properly.

EMG is performed by placing small needles in the muscles of the arm, leg or back to directly evaluate the electrical activity caused by a muscle contraction. Using a specialized computer, the examiner actually sees and hears how your muscles and nerves are working. In addition, the EMG study can help determine if muscles are receiving the proper signal from nerves.

Some commonly diagnosed conditions include:

  • pinched nerves (radiculopathies)
  • peripheral nerve injuries
  • muscle disease.

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Epidural Injections

Epidural Steroid Injections (ESIs) are a common method of treating inflammation associated with low back related leg pain, or neck related arm pain. In both of these conditions, the spinal nerves become inflamed due to compression from the narrowing of the passages surrounding the nerves that exit the spine. Narrowing of the spinal passages may be due to variety of causes, including disc herniations, bone spurs, thickening of the spine ligaments, joint cysts, or even abnormal alignment of the vertebrae (slipped vertebrae).

The epidural space is a fat filled ‘sleeve’ that surrounds the spinal sac and provides cushioning for the nerves and spinal cord. Steroids placed into the epidural space have a very potent anti-inflammatory action that can decrease pain and allow patients to improve function. Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation and allow the body to compensate for the condition. In this way, the injections can provide benefits that outlast the effects of the steroid itself.

There are three common methods for delivering steroid into the epidural space: the interlaminar (medicine injected through the back part of spine), caudal (medicine injected at the base of the tailbone), and transforaminal (medicine injected near the disc and nerve root). All three methods entail placing a thin needle into position using fluoroscopic (x-ray) guidance. Prior to the injection of steroid, contrast dye is used to confirm that the medication is traveling into the desired area. Often, local anesthetic is added along with the steroid to provide temporary pain relief.

All three procedures are performed on an outpatient basis, and you can usually return to your pre-injection level of activities the following day. Some patients request mild sedation for the procedure, but many patients undergo the injection using only local anesthetic at the skin.

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Facet Injections

Facet joints are located between each set of vertebrae in the spine from the neck to the tailbone, providing stability and allowing the spine to bend and twist. The joint contains cartilage between bones and is surrounded by a sac-like capsule that is filled with synovial fluid which provides lubrication to reduce friction between bony surfaces. A facet injection involves injecting medication into the actual facet joint – and has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from your facet joints. Second, it can be used as a treatment to relieve inflammation and pain caused by various spine conditions.

Facet injections may be intraarticular (into the joint) or medial branch blocks (where the medication is injected onto the nerve). The procedure is performed with the use of fluoroscopic (x-ray) guidance, while the patient is conscious using local anesthetic.

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Selective Nerve Root Block

Selective Nerve Root Block

A selective nerve root block (SNRB) is an injection that delivers medication into the space around spinal nerve roots – and has two purposes. First, it can be used as a diagnostic test to locate the specific spinal nerve root that is the suspected cause of the pain. Second, it can be used as treatment to relieve back, leg or other pain caused by the irritated spinal nerves.

Compared to an epidural steroid injection—which targets a relatively large area surrounding the length of your spinal cord, called the epidural space—a selective nerve root block can provide much more detailed information when diagnosing potential sources of back-related symptoms. Selective nerve root blocks may also reduce the area in your body affected by medication.

Under fluoroscopic guidance, the physician will target specific compressed or irritated nerves in your neck (cervical spine), upper back (thoracic spine) or lower back (lumbar spine) and inject an anesthetic, anti-inflammatory corticosteroid or a mixture of these two medications into the space immediately surrounding them.

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Spinal Cord Stimulator Implant

A spinal cord stimulator (SCS), also known as a dorsal column stimulator, is a device surgically placed under your skin to send a mild electric current to your spinal cord. A small wire carries the current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. Your pain is reduced because the electrical current interrupts the pain signal from reaching your brain.

Stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain, and so the amount of pain relief varies for each person. Some patients may find the tingling sensation unpleasant. For these reasons trial stimulation is performed before the device is permanently implanted. The goal for spinal cord stimulation is a 50-70% reduction in pain. However, even a small amount of pain reduction can be significant if it helps you to perform your daily activities with less pain and reduces the amount of pain medication you take.

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This procedure is used to treat patients suffering from pain in their sacroiliac joint (SI joint). It is also used as a diagnostic tool in that it helps locate the source of pain that may or may not be emanating from the SI joint.

Sacroiliac Joint Injections
The SI joints, which are in your lower back, connect your spine to the pelvis, and thus, the entire lower half of the skeleton. When these joints become inflamed or irritated, they may cause pain in the lower back, buttocks, abdomen, groin or legs. A SI joint injection involves placing numbing and steroidal medicine into the irritated joint or joints, guided by fluoroscopy. The amount of immediate pain relief experienced will help confirm or rule out the joint as the source of pain.

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