Interventional Pain Management

An epidural steroid injection is one method of relieving pain and pressure on the spinal cord through an injection into the space surrounding the spinal cord and nerve roots. The injection involves both a local anesthetic for more immediate pain relief and a corticosteroid for strong anti-inflammatory effects. X-rays are used to locate the proper site for administration. Epidural steroid injections may be offered when other nonsurgical options have not proved beneficial.

• Cervical Epidural Steroid Injection (CESI)
• Thoracic Epidural Steroid Injection (TESI)
• Lumbar Epidural Steroid Injection (LESI)
• Transforaminal Epidural Steroid Injection (TFESI)
• Caudal Epidural Steroid Injection (Caudal ESI)

Medial branch nerve blocks are anesthetic injections delivered around the facet joints of the spine, where small nerve branches reside. They temporarily block pain signals at a specific facet joint. The facet joints are the connecting points between the bony prominences of the vertebrae. X-rays are used to locate the proper site for administration.

This procedure is both therapeutic and diagnostic. If the medial branch is identified as a target for more permanent pain relief, a neurotomy may be offered to provide longer-lasting relief.

• Cervical Medial Branch Nerve Blocks (Cervical MBNB)
• Thoracic Medial Branch Nerve Blocks (Thoracic MBNB)
• Lumbar Medial Branch Nerve Blocks (Lumbar MBNB)

Radiofrequency ablation uses radiofrequency energy to heat targeted regions of nervous tissue and provide pain relief. Guided by X-rays, a microelectrode is introduced to a specified region through a needle. The targeted tissue is heated to block pain signals from that region.

• Cervical Radiofrequency Ablation (Cervical RFA)
• Thoracic Radiofrequency Ablation (Thoracic RFA)
• Lumbar Radiofrequency Ablation (Lumbar RFA)

Botox® for Chronic Migraines

What it is:

Botox® is an FDA-approved treatment for chronic migraine, defined as:

• Headaches occurring 15 or more days per month.
• At least eight days having migraine features.

Although not fully understood, Botox® appears to:

• Reduce the release of pain-related neurotransmitters.
• Decrease activation of pain pathways involved in migraines.

Treatment protocol:

Multiple injections are given in specific locations around the:

• Forehead
• Temples
• Back of the head
• Neck
• Shoulders

Benefits:

• Fewer migraine days per month.
• Reduced headache severity.
• Decreased need for rescue medications.

Duration: Treatments are usually repeated every 12 weeks.

Botox® for Cervical Dystonia

What is cervical dystonia?

Cervical dystonia is a neurological movement disorder that causes involuntary contractions of the neck muscles, leading to:

• Abnormal head position.
• Neck pain.
• Muscle spasms.
• Tremors.

How Botox® works:

Botulinum toxin type A is injected into the affected neck muscles. It blocks the release of acetylcholine at the neuromuscular junction, temporarily weakening overactive muscles.

Expected effects:

• Reduced muscle spasms.
• Improved head posture.
• Less neck pain.

Duration: Effects typically last three to four months before repeat injections are needed.

Botox® for Hemifacial Spasms

What are hemifacial spasms?

Hemifacial spasm is a neurological condition that causes involuntary twitching, tightening or contractions of the muscles on one side of the face. Spasms often begin around the eye and may gradually spread to the cheek, mouth and neck muscles on the same side of the face. The condition is commonly caused by irritation or compression of the facial nerve.

How Botox® works:

Botox® is injected into the affected facial muscles. It temporarily blocks the nerve signals that trigger muscle contractions, helping the muscles relax and reducing the frequency and severity of spasms. Botox® is considered a highly effective, nonsurgical treatment option for managing hemifacial spasms.

Expected effects:

• Reduced frequency and intensity of facial twitching and spasms.
• Improved comfort and facial function.
• Better ability to keep the eye open if eyelid spasms are present.
• Improved quality of life and confidence in social interactions.
• Effects typically begin within three to seven days, with maximum benefit occurring within one to two weeks after treatment.

Duration: The effects of Botox® are temporary and generally last approximately three to four months, or 12 to 15 weeks. Repeat treatments are usually recommended every three to four months to maintain symptom control.

Sacroiliac Joint Injection (SI Joint Injection): An anesthetic and/or corticosteroid is injected into the area where the pelvic bone, or ilium, joins the spine, or sacrum. These joints help transfer upper-body weight into the hips and legs. X-rays are used to locate the proper site for administration. This procedure is both therapeutic and diagnostic. Pain from sacroiliac joint dysfunction may be significantly reduced with this treatment option.

Intra-articular Hip Joint Injection (Int-Art Hip Injection): An injection directly into the hip joint to reduce pain and inflammation.

Intra-articular Knee Injection (Int-Art Knee Injection): An injection directly into the knee joint to reduce pain and inflammation.

Glenohumeral Joint Injection: An injection directly into the shoulder joint to reduce pain and inflammation.

Acromioclavicular (AC) Joint Injection: An injection into the joint at the top of the shoulder to reduce pain and inflammation.

Pubic Symphysis Joint Injection: An injection into the joint at the front of the pelvis to reduce pain and inflammation.

Trigger Point Injection (TPI): An injection into painful muscle knots, or trigger points, to reduce pain and improve movement.

Piriformis Injection: An injection into the piriformis muscle to relieve muscle spasms and sciatic nerve irritation.

Trochanteric Bursal Injection: An injection into the bursa on the outer side of the hip to treat bursitis pain.

Pericoccygeal Injection: An injection around the tailbone, or coccyx, to relieve tailbone pain.

Ischial Bursal Injection: An injection into the bursa near the sitting bone, or ischium, to reduce pain and inflammation.

Obturator Internus Injection: An injection into the obturator internus muscle to treat pelvic, hip or buttock pain.

Psoas Tendon Injection: An injection around the iliopsoas, or hip flexor, tendon to relieve tendon inflammation and groin or hip pain.

Iliolumbar Ligament Injection: An injection into the ligament connecting the lower spine to the pelvis to treat low back pain.

Occipital Nerve Block: A corticosteroid, with or without an anesthetic, is injected in the region of the occipital nerves. The injection site is just above the neck at the back of the head. This procedure offers temporary relief from neuralgia in this region.

Paravertebral Nerve Block: An injection near spinal nerves to relieve pain in the chest, abdomen or back.

Lumbar Sympathetic Block: An injection near nerves in the lower back to reduce chronic leg pain and improve blood flow.

Cluneal Block: An injection around nerves in the lower back and buttock area to relieve low back and buttock pain.

Ganglion of Impar Nerve Block: An injection near a nerve cluster in front of the tailbone to relieve pelvic, rectal or tailbone pain.

Pudendal Nerve Block: An injection around the pudendal nerve to reduce pelvic, genital or rectal pain.

Transversus Abdominis Plane (TAP) Block: An injection into the abdominal wall nerves to relieve abdominal pain, often after surgery.

Rectus Sheath Block: An injection into the abdominal wall to reduce pain from abdominal surgery or injury.

Anterior Abdominal Cutaneous Nerve (AACN) Block: An injection into the abdominal wall to relieve abdominal wall pain.

Celiac Sympathetic Block (Celiac Plexus Block): An injection around nerves near the abdomen to relieve severe upper-abdominal pain, often related to pancreatic or other abdominal conditions.

Ilioinguinal Block: An injection around the ilioinguinal nerve to relieve lower-abdominal and groin pain.

Lateral Femoral Cutaneous Nerve Block: An injection around a thigh nerve to treat burning, numbness or pain on the outer thigh.

Genicular Nerve Block with Steroid: An injection near the genicular nerves around the knee joint to relieve knee pain.

Parasternal Block: An injection near the sternum, or breastbone, to relieve chest wall pain.

Intercostal Block: An injection at the lower edge of a rib to relieve chest or upper-abdominal pain.

What it is:

Neurostimulation, also called spinal cord stimulation or SCS, is a therapeutic approach for managing chronic pain that is not effectively controlled with conventional treatments. This therapy uses an implantable medical device, similar to a pacemaker, to interrupt pain signals before they reach the brain. Some patients may be able to reduce or eliminate their use of pain medications.

How it works:

A small pulse generator is implanted under the skin and connected to thin electrodes placed near the spinal cord. The device delivers mild electrical impulses that modify or block pain signals before they reach the brain, reducing the sensation of pain. The stimulation can be adjusted to meet each patient's individual needs.

Indications:

• Chronic back, leg, neck or arm pain that has not responded to conservative treatment.
• Failed Back Surgery Syndrome (FBSS) or persistent spinal pain after surgery.
• Complex Regional Pain Syndrome (CRPS).
• Neuropathic, or nerve-related, pain, including diabetic peripheral neuropathy.
• Chronic pain associated with spinal cord injury or nerve damage.

Potential benefits:

• Significant reduction in chronic pain symptoms.
• Improved daily function, mobility and activity levels.
• Reduced reliance on opioid or other pain medications.
• Improved sleep and overall quality of life.
• Reversible and adjustable therapy tailored to individual pain patterns.

What it is:

ReActiv8® is an implantable neurostimulation device used to treat chronic mechanical low back pain in patients whose pain is related to dysfunction or weakness of the multifidus muscles, which are small muscles that stabilize the spine.

How it works:

Electrodes are surgically implanted near the nerves, typically the medial branch of the dorsal ramus, that control the multifidus muscles. The device delivers electrical stimulation to activate these muscles. The goal is to restore muscle control and spinal stability rather than simply mask pain.

Indications:

• Chronic low back pain lasting more than six months.
• Mechanical back pain not adequately relieved by conservative treatments.
• Patients who are not ideal candidates for major spine surgery.

Potential benefits:

• Reduced pain.
• Improved function and mobility.
• Improved spinal stability.

What it is:

The Nalu™ Peripheral Nerve Stimulation (PNS) System is a minimally invasive, drug-free therapy designed to treat chronic nerve-related pain. The system uses a small implant placed near the affected peripheral nerve to deliver gentle electrical stimulation that interrupts pain signals before they reach the brain. Unlike traditional neurostimulation systems, the Nalu™ system uses a miniature implanted pulse generator powered wirelessly by an external wearable Therapy Disc.

How it works:

Thin leads are placed near the peripheral nerve responsible for the pain. The implanted micro-generator delivers mild electrical impulses that modify or block pain signals traveling to the brain. The system is powered and controlled through an external wearable Therapy Disc and can be personalized to each patient's pain pattern and treatment needs. Most patients do not feel the stimulation, although some may experience a mild tingling sensation.

Indications:

• Chronic focal neuropathic, or nerve-related, pain.
• Complex Regional Pain Syndrome (CRPS).
• Persistent pain after surgery, including post-laminectomy and post-hernia repair pain syndromes.
• Peripheral neuralgia and other chronic nerve pain conditions affecting the shoulder, low back, knee, foot, ankle and other peripheral nerve distributions.
• Patients seeking a non-opioid, reversible treatment option when conservative therapies have not provided adequate relief.

Potential benefits:

• Significant and sustained reduction in chronic pain symptoms.
• Improved function, mobility and quality of life.
• Drug-free therapy that may reduce reliance on pain medications, including opioids.
• Minimally invasive implantation and rapid recovery.
• Personalized and adjustable therapy settings tailored to individual pain patterns.

What it is:

The mild® Procedure is a minimally invasive procedure used to treat lumbar spinal stenosis, a condition in which the spinal canal narrows and compresses the nerves.

How it works:

Through a very small incision, excess ligament tissue, usually from the ligamentum flavum, is removed. This increases space in the spinal canal and reduces nerve compression.

Symptoms treated:

• Leg pain when walking.
• Neurogenic claudication, including pain, heaviness or weakness in the legs while standing or walking.
• Lower back pain associated with spinal stenosis.

Benefits:

• No large incision.
• Minimal tissue disruption.
• Ability to stand longer with less pain.
• Ability to walk farther with less pain.
• Better posture.
• Decreased use of opioid pain medications.