Treatments

We thoroughly assess the pain problems you are experiencing and provide the least invasive, most effective treatment for acute or chronic pain. Some of the treatments that we use include:

  • Discography
    • Discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative, nonsurgical treatments such as medication and physical therapy. Discography can be used to determine if your back pain could be caused by an abnormal disk in your spine. It is also commonly used for surgical planning prior to a lumbar fusion. Lumbar discography is considered for patients who, despite extensive conservative treatment, have disabling lower back pain, groin pain, hip pain, and/or leg pain.

      During a discogram, dye is injected into the soft center of the disk. If the dye stays in the center of the disk, the disk is normal. If the dye spreads outside the center of the disk, it means that the disk is damaged. If the disk is the source of the back pain, pain during the injection will be similar to the back pain that the patient is experiencing day to day. The procedure takes between 30 and 60 minutes.

      Both the images taken during the discogram and the information about any pain experienced during the procedure will be taken into account to direct treatment. Typically results of a discogram are combined with the results of other tests to determine a treatment plan for back pain.

  • Lumbar & Cervical Facet Joint/Medial Branch Block Injections
    • Facet joints are small joints located between each set of vertebrae in the spine from the neck to the tailbone. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back. There are basically two reasons for having a facet joint injection:

      1. Diagnosis - to determine the source of pain
      2. Therapy - to treat an abnormality that has been detected

      Facet injections are used to reduce the inflammation and swelling of tissue in and around the facet joint space. A cervical facet joint injection is into one of the facet joints at the top of the spine or neck. A lumbar facet joint injection is into a facet joint in the lower back or lumbar region of the spine. To determine if the facet joint is truly the source of pain, an injection (sometimes called “block”) may be performed. If the pain is reduced after an anesthetic or numbing medication is injected into the facet joint, than it may be concluded that the facet joint is the source of pain. In addition, a facet joint injection of a corticosteroid or steroid may be injected to provide longer term relief of the pain.

      Facet injections may be medial branch blocks, where the medication is injected onto the nerve rather than the joint. A medial branch block injection is a procedure in which an anesthetic is injected near small medial nerves connected to a specific facet joint. This procedure is primarily diagnostic in that if a patient has an appropriate duration of pain relief from this procedure, then they may be a candidate for a subsequent procedure called medial branch radiofrequency neurotomy for longer term pain relief.

      These procedures are performed while you are awake using a local anesthetic. Multiple injections may be performed depending upon how many joints are involved. The actual injections take only about 10-20 minutes.

  • Lumbar Sympathetic Block
    • A lumbar sympathetic block typically involves a series of injections to relieve low back pain or leg pain (sciatica) caused by complex regional pain syndromes, usually after injury to a joint or limb. It involves an injection of local anesthetic into or around the sympathetic nerves, which are a series of nerves that spread out from the spine to help control involuntary body functions. The nerves are located on either side of the spine, in the low back. A lumbar sympathetic block is used to reduce pain, swelling, color, sweating and other unusual changes in the leg, and improve mobility. It is used to treat Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, Herpes Zoster (shingles) involving the leg, cancer pain and certain patients with neuropathy or peripheral vascular disease.

      The injection takes from ten to thirty minutes and consists of a local anesthetic. On occasion, epinephrine, clonidine or a steroid medication may be added to prolong the effects of the lumbar sympathetic block.

      Sympathetic blocks don’t work for everyone and the pain relief that they provide may lessen over time. For some, a sympathetic block may provide weeks or months of pain relief, and permanent relief is possible.

  • MILD Procedure for Spinal Stenosis
    • Spinal stenosis (SS) is an abnormal narrowing of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness, and loss of motor control. When spinal stenosis occurs in the lower back it may cause pain, numbness, or tingling in your lower back, legs or buttocks, limiting the ability to stand or walk. Usually, spinal stenosis is found in people over 50 years of age, and the likelihood of developing SS increases with age.

      MILD is a procedure that can help patients diagnosed with lumbar spinal stenosis stand longer and walk farther with less pain. It is a short, outpatient procedure, performed through a very small incision. No general anesthesia is required. Through the tiny incision in the back, small pieces of bone and excess ligament tissue is removed. Removing these elements restores space in the spinal canal and decreases the compression of the nerves, thereby reducing pain and restoring mobility.

      MILD is an outpatient procedure performed in less than 1 hour. After the MILD procedure, most patients are able to return home the same day and are generally able to resume light tasks and everyday activities within just a few days.

  • Percutaneous Discectomy
    • A percutaneous discectomy is a procedure performed when someone has a herniated disc. Percutaneous literally means “through the skin” or using a very small cut. Discectomy is surgery to remove herniated disc material that is pressing on a nerve root or the spinal cord and thereby creating a lot of pain.

      A percutaneous discectomy may be performed when:

      1. Physical exam and diagnostic tests show a bulging disc but the material inside the disc has not ruptured into the spinal canal
      2. Pain has not improved after 4 or more weeks of nonsurgical treatment
      3. Pain and other symptoms are disrupting normal daily activities
      4. There are signs of serious nerve damage in the leg, such as severe weakness, loss of coordination or loss of feeling
  • Platelet Rich Plasma Therapy
    • Platelet Rich Plasma Therapy (PRP) is used for the treatment of chronic ligament, tendon injuries and chronic degenerative joints. Conditions treated include tennis elbow, knee, shoulder, hip and ankle arthritis, knee ligament tears, partial thickness rotator cuff tears of the shoulder, plantar fasciitis and achilles tendonitis.

      Platelet structures are fragments of cells that contain proteins necessary to help seal broken blood vessels. In an injury, it is the platelet mixture that responds first to help prevent bleeding. Their purpose is to implement tissue repair and prevent further injury to the body. Because the natural healing factors of platelets restore order within the body, concentrating these healing efforts towards the specific areas of injury by implementing PRP injections boosts the recovery process. With PRP, the concentrated platelets target the injured area of the body to immediately begin the strengthening and healing of the damage sustained.

      PRP therapy utilizes platelets from the patient’s own blood to rebuild a damaged tendon or cartilage. Platelet-Rich Plasma Therapy is done in an exam room and takes less than an hour. The patient's blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage with the guidance of an ultrasound machine.

  • Prolotherapy & Neural Prolotherapy
    • "Prolo" is short for proliferation, because Prolotherapy causes the proliferation, growth and formation of new ligament tissue in areas where it has become weak. Prolotherapy is non-surgical ligament construction and is a safe and effective treatment for various types of chronic pain.

      Common problems treated with prolotherapy include knee, shoulder and hip arthritis, knee ACL ligament tears, chronic neck and back pain, TMJ dysfunction, whiplash-type motor vehicle related injuries, fibromyalgia, shoulder injuries, carpal tunnel syndrome, etc.

      Prolotherapy targets the joint, ligaments and tendons that are weakened from injury or aging and promotes healing and repair. The procedure involves injecting a solution into the damaged joint, ligament or tendon. This stimulates the body to begin the healing process to restore length and function.

      Neural prolotheraphy is used to treat neuropathic pain in a variety of musculoskeletal injuries and various pain conditions. These include: rotator cuff injuries, knee pain, neck pain, back pain, sciatica, chronic regional pain syndrome, reflex sympathetic dystrophy, neuroma pain, arthritic pain (osteoarthritis, rheumatoid arthritis, and reactive arthritis), weak or unstable joints, and neuralgia.

      Neural prolotheraphy is the injection of a medical grade sugar just below the skin to promote healing of injured nerves and restoration of tissue function. Both traditional prolotherapy and neural prolotherapy promote healing and result in pain relief and function restoration, but each uses different concentrations of dextrose and different techniques for injections. Neural prolotherapy injections are applied at multiple points just below the surface of the skin to target subcutaneous nerves to reduce neurogenic inflammation.

  • Radiofrequency Neurotomy
    • Radiofrequency neurotomy is a type of procedure in which a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain in the facet joint (connecting the vertebrae) or sacroiliac joint (connecting the bones of the pelvis).

      A medial branch neurotomy affects the nerves carrying pain from the facet joints, and a lateral branch neurotomy affects nerves that carry pain from the sacroiliac joints.

      In radiofrequency neurotomy, radio waves are delivered to targeted nerves by needles inserted through the skin above the spine. Imaging scans, such as ultrasound, are used during radiofrequency neurotomy to help position the needles precisely.

      These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs so there is no danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.

      The goal of radiofrequency neurotomy is to temporarily reduce chronic pain in the back or neck that hasn't been adequately relieved by other means, such as medications or physical therapy.

  • Sacroiliac Joint Injections
    • A Sacroiliac (SI) Joint Injection is the injection of local anesthetic (like Novocain) and anti-inflammatory steroid (not muscle building) into and around the SI joint in the pelvis. The SI joint is actually not like any other joint. Other joints in the body are pivot points that allow movement. The SI joint is actually fused together by ligaments, and doesn’t move. An SI joint injection is performed if your doctor suspects that your pain may be originating from your SI joint and/or from the muscles, tendons, or ligaments around the joint. The local anesthetic numbs the joint and also numbs and relaxes the muscles around the joint, which can result in sustained pain relief. If you achieve partial sustained relief following the first SI joint injection, then a series of injections may give you even a greater degree of sustained relief.

      Fluoroscopy (X-ray) is used to help guide placement of the needle into the SI joint. The low back will be cleansed with an antiseptic and then numbed. The injection will then be performed using the local anesthetic and steroid. The procedure takes about 10-15 minutes.

      Pain may improve immediately after the injection from the local anesthetic. Once the numbing medicine wears off, the pain may return. The steroid medication takes 2-3 days to start having an effect in most people.

  • Spinal Cord Stimulation or Neuromodulation
    • Treatment of chronic pain using Spinal Cord Stimulation (SCS) is on the forefront of interventional pain management techniques. Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps to better manage pain and potentially decrease the amount of pain medication. It may be an option if you have long-term (chronic) leg or arm pain, and have not found relief through traditional methods. A spinal cord stimulator device is surgically placed under the skin to send a mild electrical current to your spinal cord. The result is a tingling sensation in the area where pain was felt. By interrupting pain signals, the procedure has shown success in returning some people to a more active lifestyle.

      Patients selected for this procedure usually have had a disability for more than 12 months and have pain in their lower back and leg (sciatica). They've typically had one or more failed spinal surgeries.

      You may be a candidate for SCS if you meet the following criteria:

      1. Conservative therapies have failed
      2. Your source of pain has been verified 
      3. You would not benefit from additional surgery 
      4. You are not seriously dependent on pain medication or other drugs
      5. You do not have depression or other psychiatric conditions that contribute to your pain
      6. You have no medical conditions that would keep you from undergoing implantation
      7. You have had a successful trial stimulation

      An SCS can help lessen chronic pain caused by:

      1. Chronic leg (sciatica) or arm pain: ongoing, persistent pain caused by degenerative conditions like arthritis or spinal stenosis, or from nerve damage.
      2. Failed back surgery syndrome: failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure. 
      3. Complex regional pain syndrome (CRPS): a progressive disease of the nervous system in which patients feel constant chronic burning pain, typically in the foot or the hand. Formerly called reflex sympathetic dystrophy (RSD). 
      4. Arachnoiditis: painful inflammation and scarring of the meninges (protective layers) of the spinal nerves. 
      5. Other: stump pain, angin, peripheral vascular disease, multiple sclerosis, spinal cord injury.

      If your pain is caused by a correctable condition, then this must be fixed first. Also, if you have a cardiac pacemaker, you cannot have a stimulator.

  • Stellate Ganglion Block
    • A stellate ganglion block is an injection of local anesthetic into the front of the neck to reduce pain located in the head, neck, chest or arm. The nerves that are injected are part of the sympathetic nerve tissue of the neck, and are located on either side of the voice box, in the neck.

      A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done in the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm, or the head and face.

      The actual injection takes only a few minutes. The injection consists of a local anesthetic. Epinephrine or steroid medication may be added to prolong the effects of the stellate ganglion block.

  • Ultrasound Guided Injections
    • Ultrasound can be used to guide injections into the affected area, minimizing pain and maximizing the effect of the injection. It has become a useful addition to may procedures performed in pain management and rehabilitation medicine. With ultrasound, needles can be guided accurately to the target site to increase the success of injection procedures. Ultrasound is used in sacroiliac joint injections, hip, shoulder and foot injections, and many other injections to relieve pain from medical conditions such as arthritis, tendinitis, etc.

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