Chronic pain has traditionally been treated with medication. Opioid therapy may be indicated for certain patients who unfortunately have failed all other conservative and procedural measures. Depending on the nature and source of the pain, not all patients are candidates for chronic opioid therapy.
Facet Joint Injection
Two facet joints connect each vertebra in the spine, one on each side of the spine. Arthritic changes in the facet joints caused by irritation of the small nerve branches that communicate pain from the facet joints. Injecting a small amount of local anesthetic (numbing medicine) and steroid (antiinflammatory medicine) near the specific nerve being tested performs the Facet Injection. Blocking these nerves stops the transmission of pain signals from the joints to the brain. An x-ray is used to help place the needle into the facet joint, then to verify correct placement of the needle contrast dye is injected into the joint.
Radio Frequency Ablation (or RFA)
Is a procedure used to reduce pain that is caused by arthritic joints in the neck, mid-back or low back (known as facet joints). Once the joint has been confirmed to be the source of the pain through a diagnostic block the RFA procedure can be done.
An electrical current produced by a radio wave is used to heat up a small area of nerve tissue around the joint which then diminishes the pain.
Nearly everyone experiences an episode of low back pain at one time or another during his or her lifetime. Often low back pain results from nerve compression. Typically, the patient's complaint includes a low backache or sharp pain traveling down one or both legs. Common causes of pinched nerves include disc protrusions into the nerve space, arthritic facet joints with resultant narrowing of the spinal canal, and bone spurs. Less often, scar tissue that has formed from a previous surgery can cause nerve impingement and pain. Nerves exit the spinal cord through the epidural space. Often, this space is utilized to deliver medicine in close proximity to the spinal nerves. The most effective medications include local anesthetics (numbing/deadens pain) and anti-inflammatory steroids, which help reduce swelling and inflammation that can lead to pinched nerves.
Transforaminal Epidural Injections
Epidural glucocorticoid injections are commonly given to patients with leg and/or back pain to relieve such pain and improve mobility without surgery. These steroid injections buy time to allow healing to occur and/or as an attempt to avoid surgery after other conservative (non-surgical) treatment approaches have failed. This is an epidural injection to a specific site to a vertebra in the neck. It places steroid (anti-inflammatory) medicine and anesthetic (numbing) medicine close to the nerve endings and into the epidural space in the neck to decrease swelling (inflammation) of the nerve roots. Transforaminal injections are considered the most specific and effective route for epidurals and are administered laterally through the selected neuroforamen under fluoroscopy, thus explaining the descriptive label "selective transforaminal epidural injection." This technique allows for smaller volumes of injectate since the medicine is placed closer to the site of pathology at the interface of the nerve root, the disc, and the ventral dura. Injectate tends to flow more ventrally or
preferentially to the symptomatic side and along the involved nerve root. The injection can provide additional physiologic information not uncovered from spinal imaging, electrodiagnostics, or from the physical examination of a patient.
Transforaminal thoracic epidural injection is a epidural injection to a specific site of a vertebra in the mid-back that places anti-inflammatory medicine close to the nerve endings and into the epidural space to decrease inflammation of the nerve roots, reducing pain in your back or around the rib cage. Transforaminal lumbar epidural injection is a epidural injection to a specific site of a vertebra in the lower back that places anti-inflammatory medicine and anesthetic medicine close to the nerve endings and into the epidural space to decrease inflammation of the nerve roots, reducing pain in your back and legs.
At the Orthopaedic & Spine Center we treat and manage chronic pain using various methods such as:
Smpathetic Nerve Block
Sympathetic pain is usually described as a constant burning or electrical pain. A sympathetic nerve block involves injecting medicine around the sympathetic nerves in a lumbar or cervical area. By doing this, the system is temporarily blocked in hopes of reducing or eliminating pain. If the initial block is successful, then additional blocks are generally repeated in 7-10 days and repeated again until the pain diminishes.
Discography confirms or denies the disc(s) as the source of pain. Utilizing x-ray guidance, this procedure involves the placement of a needle into the discs along with a contrast dye. CTs and MRI scans only demonstrate anatomy and cannot absolutely prove a patient's pain source. In many instances, the discs may be abnormal on MRI or CT scans but not a source of pain. Only discography can tell if the disc(s) themselves are a source of pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Discography is usually done only if a patient's pain is significant enough for them to consider surgery.
Sacroiliac (SIJ) Joint Injections to Manage Back Pain
Sacroiliac joints are small joints in the region of the low back and buttocks where the pelvis actually joins with the spine. Irritation of the joint may cause pain in the low back, buttock, abdomen, groin or legs. Numbing medicine will provide temporary relief and can allow better manipulation of your body. The time release steroid will help reduce any inflammation in the joint. Although not usually a primary pain generator, the sacroiliac joint is a common area of referred pain and can persist as the primary focus of pain. The typical pain referral pattern is to an area around and just caudal to the posterior superior iliac spine. The SI joint should therefore be treated within the context of the entire spine and kinetic chain, including the pelvis, hips, and lower extremities. In patients who have failed four to six weeks of a comprehensive exercise program, local icing, mobilization/manipulation and anti-inflammatories, a sacroiliac joint injection can be helpful for both diagnostic and therapeutic purposes. In some patients, SI joint injections can provide significant pain relief. When sacroiliac joint injections are employed, they should be performed with fluoroscopic guidance using contrast medium to ensure proper needle and medication placement. If helpful, they may be repeated; however, the frequency of these injections should be limited with attention placed on the comprehensive exercise program.
An intrathecal pain pump implant is an implanted medical device that delivers opioid medication to the patient. Often, the intrathecal pump implantation is in the upper buttock region or the abdominal area. The intrathecal pain pump implant is programmed to deliver medication directly to the spinal cord, which is the major pathway for pain signals. Applying medication directly to the spine via the pain pump implant provides powerful pain management and relief with very small doses by blocking pain impulses at the spinal level.
Kyphoplasty is a surgical procedure are designed to stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.
Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.