Services
Caudal Steroid Injection
Celiac Plexus Block
Cervical Facet Radiofrequency Neurotomy
Cervical Selective Nerve Root Block
Cervical Steroid Injection
Cervical Transforaminal Epidural Steroid Injection
Costovertebral Block
Discography
Epidural for Cancer
Facet Joint Injections
Intradiscal Electrothermal Therapy (IDET)
Intrathecal Pump Implant
Interscalene Brachial Plexus Block
Lumbar Epidural Steroid Injection
Lumbar Radiofrequency Neurotomy
Lumbar Sympathetic Block
Lumbar Transforaminal Epidural Steroid Injection
Medial Branch Block
Percutaneous Disc Nucleoplasty
Sacroiliac Joint Steroid Injection
Spinal Cord Stimulator Implant
Stellate Ganglion Block
Thoracic Epidural Steroid Injection
Thoracic Facet Radiofrequency Neurotomy
Trigger Point Injections
Where Back Pain Begins
Spine Anatomy
About Cervical Radiculopathy
About Degenerative Disc Disease
About Facet Joint Syndrome (Arthritis)
About Herniated Discs
About Lumbar Radiculopathy (Sciatica)
About Metastatic Cancer
About Pain Management
Peripheral Neuralgia
About Phantom Limb Pain
About Scoliosis
About Spinal Stenosis
About Spondylolisthesis
About Whiplash Headache
Interventional Pain Care
Selective Nerve Root Blocks
Sympathetic Nerve Blocks
Facet Blocks
Epidural Steroid Injections
Advanced Treatment
Discogram
Radiofrequency Rhizotomy
Spinal Cord Stimulation
Lysis of Adhesions
Injection of Anesthetics and Anti-Inflammatory Agents
Radiofrequency (RF) Nerve Ablation
Spinal Infusion Pumps
Cryotherapy
Discectomy
Physical Therapy
Psychological
Pharmacotherapy
Intramuscular Stimulation (IMS)
Interventional Pain Care
Selective Nerve Root Blocks
A SNRB is primarily used to diagnose the specific source of nerve root pain, and secondarily, for therapeutic relief of low back pain and/or leg pain, neck and or arm pain.
When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain. A MRI may not clearly show which nerve is causing the pain. A SNRB injection is performed to assist in isolating the source of pain. In addition to its diagnostic function, this type of injection can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).
In a SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebrates). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine or bupivicane (numbing agents). Fluoroscopy (live x-ray) is used to ensure the medication is delivered precisely where it is needed. If the patients pain diminishes completely after the injection, it can be inferred that the pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root.
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Sympathetic Nerve Blocks
Chronic pain conditions often involve malfunctions of the sympathetic nerves. These nerves regulate blood flow, sweating, and glandular function. Blocks of these sympathetic nerves can provide important diagnostic information, and can also lead to a reduction of the pain.
Following are four examples of sympathetic nerve blocks.
- The sympathetic nerves of the stellate ganglion lie just in front of the spine in the lower neck. Blocking these nerves can help with pain stemming from the face, arms and hands.
- The lumbar sympathetic nerves in front of the spine of the lower back can be blocked to help with pain originating from the legs and feet.
- Pelvic pain often involves the sympathetic nerves in front of the sacrum. These nerves can be blocked with injections just above or below the sacrum.
- The celiac plexus (the solar plexus) is a bundle of sympathetic and sensory nerves that transmit much of the sensation from the abdominal organs. Celiac plexus blocks can help control a variety of chronic abdominal pains.
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Facet Blocks
The facet joints allow the spine to twist and turn from the neck all the way down to the low back. The joints are also helpful in supporting the body’s weight. Aging, normal wear and tear, athletics, and arthritis all cause problems with the facet joints. Facet joint pain most commonly occurs near the spine and possibly in the shoulders or in the hips and buttocks in the low back region.
In cases where the facet joint itself is the pain generator, this type of injection temporarily shuts off the pain impulses from the facet joint. Similar to SNRBs, facet block injections are a diagnostic tool used to isolate and confirm the specific source of pain. Additionally, facet blocks may have the therapeutic effect of decreasing the inflammation within the joint.
In a facet block procedure, our physician uses fluoroscopy (live x-ray) to guide the needle into the facet joint capsule to inject Lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patients pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected. If the facet block injection is effective in alleviating the patients low back pain, it is often considered reasonable for the procedure to be done three times per year. Facet block injections may lead to facet joint lesioning using radiofrequency energy to shut off the nerves permanently.
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Epidural Steroid Injections
Epidural steroid injections are typically used to alleviate low back and/or leg pain, neck and/or arm pain. While the effects of the injection are normally temporary (providing relief from pain for one week up to one year), an epidural steroid injection can be very beneficial for patients during an episode of severe pain. It can provide sufficient pain relief, allowing the patient to progress with their rehabilitation program (physical therapy, chiropractic manipulation, etc).
An epidural steroid injection is effective in significantly reducing pain for approximately 60-70 percent of patients. It works by delivering steroids directly to the painful area to help decrease inflammation that may be causing the pain. It is thought that there is also a flushing effect from the injection that helps remove or flush out inflammatory proteins from around the structures that may cause pain.
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The facet joints allow the spine to twist and turn from the neck all the way down to the low back. The joints are also helpful in supporting the body’s weight. Aging, normal wear and tear, athletics, and arthritis all cause problems with the facet joints. Facet joint pain most commonly occurs near the spine and possibly in the shoulders or in the hips and buttocks in the low back region.
In cases where the facet joint itself is the pain generator, this type of injection temporarily shuts off the pain impulses from the facet joint. Similar to SNRBs, facet block injections are a diagnostic tool used to isolate and confirm the specific source of pain. Additionally, facet blocks may have the therapeutic effect of decreasing the inflammation within the joint.
In a facet block procedure, our physician uses fluoroscopy (live x-ray) to guide the needle into the facet joint capsule to inject Lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patients pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected. If the facet block injection is effective in alleviating the patients low back pain, it is often considered reasonable for the procedure to be done three times per year. Facet block injections may lead to facet joint lesioning using radiofrequency energy to shut off the nerves permanently.
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Epidural Steroid Injections
Epidural steroid injections are typically used to alleviate low back and/or leg pain, neck and/or arm pain. While the effects of the injection are normally temporary (providing relief from pain for one week up to one year), an epidural steroid injection can be very beneficial for patients during an episode of severe pain. It can provide sufficient pain relief, allowing the patient to progress with their rehabilitation program (physical therapy, chiropractic manipulation, etc).
An epidural steroid injection is effective in significantly reducing pain for approximately 60-70 percent of patients. It works by delivering steroids directly to the painful area to help decrease inflammation that may be causing the pain. It is thought that there is also a flushing effect from the injection that helps remove or flush out inflammatory proteins from around the structures that may cause pain.
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Advanced Treatment
Discogram
A discogram is a diagnostic test performed to view and assess the internal structure of a disc and determine if it is a source of pain. A needle is inserted into the disc under fIuoroscopy (live x-ray). A saline solution and radiopaque dye are injected into the disc. A CT scan is usually performed on the painful disc after the dye is injected to obtain images of the dye distribution. This will reveal tears, scarring, disc bulges and changes in the nucleus of the disc. This procedure allows us to confirm a diagnosis and determine which disc or discs is the source of pain.
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Radiofrequency Rhizotomy
Radiofrequency rhizotomy, is a therapeutic procedure designed to decrease or eliminate pain symptoms within spinal facets.
The procedure involves using a needle to carefully place a small electrode adjacent to the facet under x-ray guidance. An electric current is then used to cauterize the sensory nerves that innervate the facet joint(s). If successful, the pain relief following this procedure can last considerably longer than relief following local anesthetic and steroid blocks. This process can be used on any area of the spine--cervical, thoracic, or lumbar.
Before patients can be scheduled for a radiofrequency rhizotomy procedure, they generally must undergo a series of facet injections, medial branch blocks and/or discography tests to verify the exact source of their symptoms. These tests may require several visits.
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Spinal Cord Stimulation
In spinal cord stimulation, a small wire (called a lead) is connected to a power source is surgically implanted under the skin. Low-level electrical signals are then transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain. Using a magnetic remote control, the patient can turn the current on and off, or adjust the intensity. The sensations derived from the stimulator are different for everyone; however, most patients describe it as a pleasant tingling feeling.
Before a spinal cord stimulation system is permanently implanted, a trial period is recommended. During this time, a temporary stimulator lead or leads is inserted to allow the patient to try the therapy for a short period of time. This trial period is important to determine if the therapy provides satisfactory pain relief and is a good way to find out if the patient is comfortable with the sensations of spinal stimulation.
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Lysis of Adhesions
Lysis of Adhesions involves the placement of chemicals and enzymes that are placed within the spinal canal to help loosen nerves from scar or fibrotic tissue, usually in the case of leg pain that exists after back surgery
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Injection of Anesthetics and Anti-Inflammatory Agents
Injection of anesthetics and anti-inflammatory agents directly into the area surrounding the pain generating nerve can relieve pain symptoms and often times allow the nerve area to heal and repair itself. These injections, often referred to as "epidural or facet blocks", can effectively break the cycle of pain which becomes chronic if left untreated. Injections can be targeted to cervical, thoracic, and lumbar areas across the entire spine from neck to lower back depending on the nerve involved. Patients can experience relief that ranges from several months to several years depending on their condition. Procedures are quick and patients have little pain associated with the procedure.
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Radiofrequency (RF) Nerve Ablation
Radiofrequency (RF) Nerve Ablation can be used to temporarily deactivate minor nerves around the spine. The pain generating nerves for many patients are often small, unimportant fibers which can cause severe pain. These nerves can be temporarily shut down using radiofrequency energy to heat the surrounding tissue and deactivate the pain generating nerve fibers. The procedure is performed by accessing the affected nerve under x-ray guidance. Once properly positioned, a special probe is advanced allowing the delivery of radiofrequency energy to the targeted area. Results can last from months to years.
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Spinal Infusion Pumps
Spinal infusion pumps may be used in patients with chronic back pain, cancer pain, and other pain disorders that have not responded well to other treatments. This device allows localized pre-programmed infusion of pain medications directly to the fluid surrounding the spinal cord. This therapy offers relief to patients suffering with significant chronic back pain that has not responded well to traditional surgical and nonsurgical treatment options. This procedure does, however, involve a minor surgical procedure during which a small medication delivery device is implanted under the skin. A tiny computer allows precise delivery of medication to the spinal nerves thus modulating and greatly reducing the pain signals perceived by the patient.
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Cryotherapy
Cryotherapy is most often used to treat nerve pain generated by peripheral nerves (nerves located outside of the spinal column). A special probe is carefully placed adjacent to a specific nerve. This is most often done with the aid of x-ray guidance. Once in the appropriate area the probe is first used to stimulate the affected nerve helping to verify correct positioning. Once certain of proper placement, the tip is cooled to temperatures between -50 C and -70 C absorbing heat from the surrounding tissue and causing a cryo lesion. This results in reversible but very prolonged block of the pain signal.
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Discectomy
Discectomy of the intervertebral disc nucleus pulposus for relief of low back and radicular pain is the most commonly performed neurosurgical procedure achieving success rates in excess of 90%. Less invasive methods for discectomy and disc pressure reduction also play an important role in the treatment of patients suffering from smaller disc herniations.
Disc decompression using controlled ablation benefits patients through:
- an approximate 10% decrease in disc volume which reduces internal disc pressure and external pressure on an irritated nerve root
- a reduction in permanent structural alterations including those produced in open surgery by the invasion of the spinal canal, dissection of the ligamentum flavum, removal of lamina, disruption of the disc annulus
- a decrease in anesthesia procedure time recovery time
- a decrease in complication and morbidity rate
- a decrease in postoperative spinal instability
- a reduced likelihood of perineural scarring and postoperative fibrosis
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Physical Therapy
All types of PT are available at North Valley Hospital Pain Center, including dry land, deep tissue, spray and stretch, work hardening, warm pool therapy
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Psychological
Pain management psychologists are available for patients who need help with relaxation training, biofeedback, EMDR, and management of depression.
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Pharmacotherapy
Opioid and non-opioid adjuvant medications that are used in the treatment of pain are prescribed, managed, and monitored by board-certified pain physicians and physician assistant. Addiction management is not offered at the pain center.
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Intramuscular Stimulation (IMS)
This dry-needling technique serves to deactivate tight, painful muscle bands that are a frequent cause of pain.
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