PAIN MANAGEMENT & PROCEDURES

HOMEPain management & procedures

PAIN MANAGEMENT

More than one-third of the adult population in USA suffers from some kind of chronic pain – pain that lasts longer than 3 months. Majority of these people are women and elderly. Untreated back and neck pain, arthritis, neuralgic pain, fibromyalgia, migraine and cancer related pain accounts for majority of these cases.

Why relieve Pain?

Unrelieved pain has major negative effects on one’s life and is associated with many physical, psychological and social changes which become a major health problem. Chronic pain can be excruciating and totally incapacitating. Chronic Pain is now recognized as a disease in itself and not just a symptom (as per WHO).

What is Pain Management?

Pain Management (also called Pain Medicine) is a branch of medicine employing a comprehensive approach for easing the suffering and improving the quality of life of those living with long standing pain. This involves a spectrum of treatment protocols starting from simple medications to varied interventional procedures supported by counselling and rehabilitative measures.

What is Interventional pain management?

Interventional pain management deals with treating pain using precision-guided injection techniques to deliver pain-relieving medicine to specific areas of your body. The injections are performed with X-ray or CT scan control. These are also done in the joints and the discs between the spine bones. These injections can help us in avoiding spine surgeries in a vast majority of the patients.

What is a pain clinic?

A pain clinic is a specialized healthcare facility that focuses on the diagnosis and management of chronic pain. Pain clinics often use a multidisciplinary approach to help people take an active role in managing their pain and regaining control of their life. These programs are focused on the total person, not just the pain.
Pain clinics are ideal when a patient is looking at pain relief options which are minimally invasive and do not involve surgery. These treatment options are focused on relieving pain with minimal impact on life and with a short recovery time of a few hours (compared to recovery periods of 20+ days in case of surgeries).

What kinds of pain are treated?

Many different types of chronic pain problems are treated, but the most common are chronic lower back pain, sciatica, neck pain, joint pain, arthritis, headaches, neuralgic pain, post herpetic neuralgia, trigeminal neuralgia, fibromyalgia, migraine and cancer pain.

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    What types of procedures are done?

    The most common procedures are X-ray guided injections to relieve inflammation in spinal structures caused by herniated discs. These procedures include epidural injections, percutaneous discectomies, facet and sacroiliac joint injections. Certain advanced procedures such as inserting electrodes in the spinal cord (spinal cord stimulator) and pumps which deliver painkillers into the spinal fluid (intrathecal pumps/spinal pumps) are also performed.

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    What types of procedures are done?

    The most common procedures are X-ray guided injections to relieve inflammation in spinal structures caused by herniated discs. These procedures include epidural injections, percutaneous discectomies, facet and sacroiliac joint injections. Certain advanced procedures such as inserting electrodes in the spinal cord (spinal cord stimulator) and pumps which deliver painkillers into the spinal fluid (intrathecal pumps/spinal pumps) are also performed.

    Are these procedures safe?

    Some people are concerned about the safety and side effects of these procedures. When performed with precision by a skilled and experienced doctor, the procedures are safe and painless.

    Are these treatments successful?

    The treatments can be very effective when expertly performed using X-ray guidance. Following interventions, patient is put through a rehabilitation programme, which involves relaxation techniques, home-based exercises and lifestyle modifications. The long-term success rates in majority of cases are excellent.

    PAIN MANAGEMENT PROCEDURES

    All the procedures listed below are performed in office

    Epidural Steroid Injections

    These procedures are typically performed for leg and back pain or neck and arm pain caused by spinal nerve irritation/injury, disc pain, or joint pain. It involves injecting a solution containing steroid into the space of the spine outside the spinal cord protective lining. This does multiple things:

    • washes away the inflammatory mediators (chemicals that cause inflammation to continue),
    • coats the structures with potent anti-inflammatory steroid which decreases inflammation and irritation,
    • softens and degrades scar tissue.

    It is a short outpatient procedure that usually does not require sedation. The risks are very low.

    Trigger Point Injection

    Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, an injection is given at the trigger point. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.
    Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment. BOTOX® injections can be used to alleviate chronic migraine headaches. The procedure involves injections around the head and neck.back pain spinal injection

    Lumbar epidural steroid injection

    Also known as an LESI, this epidural steroid injection involves injecting steroid into the lumbar epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

    Lumbar transforaminal epidural steroid injection

    Also known as an TFESI, this epidural steroid injection involves injecting steroid into the epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

    Caudal epidural steroid injection

    This type of spinal injection is given at the bottom of the back, given near the coccyx (tailbone). Like the other types of epidural steroid injections, the target is the spinal nerves. In this case, the needle is used to access an area known as the sacral hiatus that is above the coccyx, and the steroid is injected directly into the pinched nerves near the very lowest part of the spinal canal.

    Thoracic epidural steroid injection

    Also known as an TESI, this epidural steroid injection involves injecting steroid into the thoracic (chest) epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

    Cervical epidural steroid injection

    Also known as an TESI, this epidural steroid injection involves injecting steroid into the thoracic (chest) epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

    Facet joint injection

    This is also known as a Median Branch Block It is a technique to diagnose pain associated with arthritis of the joints in the posterior aspect of the spine. Between each pair of vertebrae, there are two joints on the back side of the spine that become arthritic, just like knees and fingers. By specifically blocking the individual small nerves that go to the joints, one can assume the pain is coming from the joints if the pain is largely better after the block. Once two successful facet blocks have been performed, we can destroy the tips of the nerves and provide pain relief for 6 months, by a procedure that can be repeated when necessary. It can be performed in the neck, mid back and low back.

    Facet/Median Branch Radiofrequency Ablation

    This is the goal of performing facet blocks. Once two successful blocks have been performed, the tips of the nerves can be burned using electrically generated heat produced at the tip of a needle, in an outpatient procedure much like the blocks. Once the tips of the needles are appropriately located, heat is generated to a temperature of 80 degrees Celsius. This destroys the tips of the nerves for about 6 months. After the nerves grow back, the procedure can be repeated as needed for continued pain relief. It can be performed in the neck, mid back and low back.

    Sacroiliac Joint Injection

    The sacroiliac joint injection is a fairly common type of injection that is used to treat low back and hip pain. As the name would suggest, this injection is given in the joint that connects the sacrum to the hip. These joins lie close to the spine and represent an ideal area for this type of injection. Though it has quite a bit in common with several other types of injections, this method does have fairly specific uses. 

    This type of injection has three different uses for back pain. One of the most common is for the treatment of lower back pain, but the injection itself can also be used as a tool to diagnose the cause of such pain. Sacroiliac joint injections are fairly common procedures for those who receive treatment for chronic lower back pain, especially when they reach the point where their pain begins to interfere in their daily lives. 

    The sacroiliac joint injection tends to be effective in two different ways. The first, and the most immediate, is due to the local anesthetic used in the procedure. This provides an immediate, albeit temporary, form of relief to the patient. While this does wear off quickly, the second element of the injection tends to provide much more lasting relief. Like many other injections, the use of a steroid here helps to reduce inflammation and allows for a great deal of pain relief after a few days. As such, it is considered to be a solid alternative for some individuals who experience both chronic and acute back pain.

    L & D MEDICAL CENTER

    5041  Dallas Hwy
    Ste 1G
    Powder Springs, GA 30127

    (770) 693-1863  Office
    (770) 693-1857 Fax

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