Pain Management is a medical specialty more commonly known today, than say 15 years ago when people suffering from chronic pain had very few options and solutions. Now, there is tremendous hope for chronic pain sufferers. There is a treatment plan that is right for each and every chronic pain patient, but what is it? As we addressed in the first part of this series, medical management may be a viable solution for many people. But what about the millions of Americans that do not want to take medication, or for one reason or another it is not determined best for them, or perhaps they require an adjunct therapy to their medical management? Many people are caught in a place where medication isn’t the answer or isn’t enough, surgery is not an option, and conservative treatment measures have failed. Interventional pain management treatment is the perfect solution. Minimally invasive, yet highly effective, interventional pain management procedures, like an epidural steroid injection treat pain at its source. An injection goes directly to the root cause, no pun intended. Many people find relief for months, if not indefinitely and are able to return to their activities of daily life within a few short days.
The ultimate goal of any pain management specialist is to identify the source of a patient’s pain, to reduce that pain and to improve overall quality of life. At an initial consult, a medical professional will discuss a patient’s pain history, symptoms and past treatments. They will review diagnostic imaging (X-ray, CT scan, MRI, EMG, etc.) and perform a detailed assessment to help determine the source of pain. The next goal is to reduce the pain and greatly improve quality of life.
This part of the series, Part 2, will discuss the different types of interventional procedures available as a multi-modal approach to pain management.
The following is a list of the most common nerve blocks:
Facet Medical Branch Block: This nerve block is for “arthritis” pain in the facet joints of the cervical, thoracic and lumbar spine. During the procedure, the physician will inject numbing medication and steroids around the facet joints. If the joints are what is the cause of your pain then you will immediately experience short-term pain relief in this area. If you get positive results with the diagnostic procedure we then perform a radiofrequency on the nerve which “puts the nerve to sleep” and pain is alleviated for approximately 6-12 months.
Transforaminal Epidural: This nerve block is for “discogenic” pain caused by compression of a nerve root in the spine. The physician is able to target a specific nerve root that is likely the source of the pain. He will inject the area around the nerve with numbing medication and steroids and you will experience short-term relief of the pain caused by the nerve. If you get positive results with the diagnostic procedure we then perform a radiofrequency treatment on the nerve which “puts the nerve to sleep” and pain is alleviated for approximately 6-12 months.
Lumbar Sympathetic Block: This nerve block is used to treat pain caused by the sympathetic nerves that are part of the autonomic nervous system. This is pain in an arm or leg that is caused by a malfunction in the autonomic system after an injury. By injecting medicine around the sympathetic nerves in the lumbar spine the pain is relieved and the procedure can be repeated until the pain has been eliminated.
KESI: This is an injection of steroids at the bottom of the lumbar spine and is used to treat lumbar degenerative disc disease or lumbar radiculopathy. The pain relief typically lasts at least 3 months and is repeated when indicated.
SI Joint Injection: This injection of numbing medication and steroids is for “sacroilitis” which is inflammation of the sacroiliac joint. This causes pain in the low back, buttocks, groin or hip.
Trochanteric Bursal Injection: This injection of numbing medication and steroids is used to treat trochanteric bursitis which is inflammation of the “bursa sac” located in the hip.
*Nerve blocks can also be effective for carpal tunnel, chronic abdominal pain, shoulder pain, rectal pain, pelvic pain, knee pain, shingles pain, TMJ, and headaches.
In addition, there is one minimally invasive procedure that does not involve an injection. This procedure is called a Radiofrequency Ablation or “RFA.” In this procedure, an electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
Please stay tuned as our next series (Part 3) will cover cutting edge treatment and technology at the forefront of pain management. This includes therapies such as implantable spinal cord stimulators and stem cell therapy.
Missed the first blog of this series? Click here to view Somewhere Over the Rainbow (Part 1): The Full Spectrum of Pain Management.