Treatments

General interventions

• Botox injections
• Infusions
• Medication management

Spinal and axial pain

• Discography 
• Epidural steroid injections
• Epidural scar lysis of adhesions
• Intra-articular facet injections
• Medial branch nerve blocks
• Transforaminal epidural steroid injections
• Trigger points injections

Abdominal and pelvic pain

• Celiac plexus blocks
• Ganglion impar blocks
• Ilio-inguinal and iliohypogastric nerve block pain
• Rectus abdominal block
• Superior hypogastric plexus blocks
• Transverse abdominal plane block

Thoracic pain

• Costocondral ligaments injections for Tietze syndrome 
• Intercostal nerve block
• Paravertebtral nerve blocks
• Pectus blocks 

Arthritic pain

• Genicular nerve blocks
• Genicular nerve radiofrequency ablation
• Hip intra-articular branches blocks 
• Hips intra-articular branches radiofrequency ablations
• Knee, hips and shoulder injections
• Sacroiliac joint injection
• Sacroiliac radiofrequency ablation
• Suprascapular nerve block
• Suprascapular radiofrequency ablation

Limb pain

• Brachial plexus block
• Femeral nerve block
• Lumbar sympathetic block
• Pyriformis block
• Sciatic nerve block
• Stellate ganglion block

Head and neck pain

• Botox injections
• Mandibular, maxillary nerve blocks
• Occipital nerve block
• Sphenopalatine nerve block
• Supraorbital, infraorbital nerve block
• Trigeminal ganglion block
• Trigeminal ganglion radiofrequency ablation

Cancer pain

• Neurolytic celiac plexus block
• Neurolytic ganglion impar
• Neurolytic superior hypogastric plexus block

Surgical interventions

• Intrathecal pump medications
• Kyphoplasty and vertebroplasty
• MILD procedures
• Peripheral nerve stimulators
• Spinal cord stimulators

Known for its ability to smooth wrinkles, injections of Botox (a brand name drug that contains botulinum toxin) may also reduce muscle pain. The medication works by blocking nerve impulses to the muscles in the injected area. As a result, the muscles relax and spasms decrease, reducing pain and increasing range of motion. In addition, Botox has been proven more effective in treating refractory migraines than conventional treatments.

Spinal discography is performed to diagnose conditions of the spinal discs. During the procedure, the physician injects contrast dye into healthy and diseased discs to pinpoint pain and determine if any discs have tears or other disruptions. Spinal discography can aid physicians in diagnosing herniated, bulging or torn discs and degenerative disc disease. It can also help determine an appropriate course of treatment.

When scar tissue restricts the normal movement of nerves, an individual can experience persistent pain. Epidural scar tissue lysis is a procedure designed to remove excess scar tissue in the epidural space (the area between the inside of the spine and the protective layer around the spinal cord). Using a fluoroscope to visualize the affected area, the physician injects a medication that disperses the scar tissue and applies steroids to decrease inflammation and boost pain relief.

An epidural steroid injection (ESI) may be performed to relieve neck, back, arm and leg pain caused by spinal stenosis (a narrowing of the spinal column), spondylolysis (stress fractures), disc herniation or other conditions. During this minimally invasive procedure, medication is injected into the spinal nerve through the area between the protective covering of the spinal cord and vertebrae. While the effects of an epidural steroid injection are temporary — lasting anywhere from several days to several years — the goal is to help patients resume their daily routine and begin a physical therapy program, if recommended.

Facet joints are small joints, located at each segment of the spine, which provide stability and enable the vertebrae to bend and twist. Degeneration of these lubricated connections can occur from everyday wear and tear, arthritis of the spine, a back injury or other stress to the back, and can cause pain in the spinal cord. Injection of a steroid medication into the cervical (neck), thoracic (upper back) or lumbar (lower back) region anesthetizes the facet joints and blocks the pain. Pain relief from this procedure is intended to help a patient better tolerate physical therapy during rehabilitation for a back condition or injury.

During an infusion, anesthetic medication is delivered intravenously through the arm or hand through a needle or catheter. The infusion can take up to several hours. There are a variety of medications that can be used for infusions. Physicians might use several in combination to achieve the best result. Infusion offers an alternative treatment option to oral medication and is often used for patients with chronic pain, including neuropathic pain, cancer pain, arthritis, gastrointestinal disorders and more.

During a joint injection, the physician injects a steroid medication into the affected area to reduce swelling and inflammation of joint tissues. The goal is to reduce irritation and alleviate joint pain. Our physicians use ultrasound or X-ray to perform the injections for maximal benefit of our patients.

When patients suffer from vertebra compression fractures or compression of the vertebra, physicians can perform kyphoplasty. During this procedure, our physicians insert a needle into the vertebra and places an inflatable balloon-like device. As the balloon inflates, it creates space in the vertebra that can then be filled with bone cement. This releases compression and stabilizes vertebra. The pain relief after this procedure is very effective. Our physicians perform this procedure for osteoporosis and cancer related vertebral (spine) fractures.

Minimally invasive lumbar decompression (MILD) is performed to treat lumbar spinal stenosis (LSS). LSS is a condition in which the spinal canal narrows and compresses the spinal cord nerves in the lower back. This narrowing may be caused by thickened ligament tissue, formation of excess bone or bulging of the discs. Symptoms can include pain or numbness in the buttocks, leg and lower back. During the MILD procedure, the small pieces of bone and excess tissue that cause the narrowing of the spinal cord are removed. The procedure is done in an outpatient setting using minimal sedation.

A peripheral nerve block is used for the diagnosis and treatment of nerve pain, which is sometimes the result of nerve damage. The procedure involves injecting a local anesthetic and sometimes an anti-inflammatory steroid to target the area around a specific nerve. Disrupting painful nerve impulses can result in various degrees of symptom relief. If a patient attains limited relief after the first block, then the physician may recommend a series of blocks, which may result in sustained relief.

During a radiofrequency neurotomy, radio waves are sent to interrupt pain signals between the brain and the affected nerve. A physician delivers heat-generated waves, using image-guided technology to directly target and block the nerve. More than 75 percent of patients with facet or joint pain (such as knee, shoulder or hip pain) experience relief — lasting up to 18 months — after the treatment.

If a nerve root becomes compressed, it may cause inflammation and pain. When an imaging study does not clearly show which nerve is responsible for the pain, the selective nerve root block (SNRB) procedure may be used to identify the source. In addition to this diagnostic function, a selective nerve root block can provide therapeutic relief of low back pain and/or leg pain. It can also treat far lateral disc herniation (a disc that ruptures outside the spinal canal).

If a patient has chronic leg or arm pain and has not found relief through conventional therapies, then spinal cord stimulation may be an option. The procedure involves sending low voltage electrical signals from an implanted battery-powered generator to nerves in the spinal cord in order to interrupt pain signals. After spinal cord stimulation, patients usually experience a comfortable, tingling sensation instead of pain.

The spinal infusion pump (also known as a morphine pump or an intrathecal infusion pump), delivers concentrated amounts of medication into the spinal fluid space through a small catheter. The purpose of this procedure is to continuously saturate pain receptors with medication, which adequately alleviates the pain.

The sympathetic nerve block procedure is used to establish if there is damage to the sympathetic nerve chain, a set of nerves that extends the length of the spinal cord. Using image guidance, the physician inserts a needle into the lumbar (lower) or thoracic (upper) area of the back and injects an anesthetic medication into the targeted area. While it is primarily done for diagnostic purposes, the procedure may bring long-term pain relief to the damaged area.

Trigger points — also known muscle knots — are distinct spots located in a taut bundle of fibers within the skeletal muscles. These points can cause localized pain and often are associated with musculoskeletal conditions. A trigger point injection (TPI) aims to alleviate pain through a shot of a corticosteroid that inactivates the trigger point. The physician may inject multiple sites in one office visit. One treatment session usually brings sustained relief.