Medical Services –Pain Management
At Southeast Neurological Specialists, we treat many conditions such as Chronic Pain, Fibromyalgia, RSD, CRPS, neuropathy, spinal stenosis/degeneration/herniation, chronic migraine, and neurological injuries. Our practice has the distinct advantage of an on-site surgical suite which maximizes a warm, patient-focused environment. The following procedures are performed under fluoroscopic guidance to ensure the safest, most effective outcome possible. We also offer patients the choice of undergoing their procedures with Moderate Conscious Sedation.
Procedures
Botox Injection:
Botox is in a class of medications called neurotoxins. Botox is injected at the site of the pain and works by blocking the nerve signals that cause the tightening of muscles. Botox injections are typically used in the treatment of:
- Myofascial pain
- Migraine headaches
- Muscle pain due to chronic muscle spasm
- Neck pain in cervical dystonia
- Nerve disorders resulting in blepharospaThere have been very few reported side effects resulting from Botox injections. The most common include discoloration, redness, or discomfort at the injection site. Although Botox injections are not a cure for these conditions, the symptoms can decrease within a few days, and the effects can last for several months.
Caudal Epidural:
This procedure is designed for people experiencing chronic lower back and extremity pain. It involves injecting a steroid combined with an anesthetic into the epidural space. The steroid works to reduce inflammation and irritation, and the anesthetic interrupts the pain-spasm cycle.
- Caudal Epidurals are commonly used for:
- Herniated/Bulging Discs
- Degenerative Lumbar Spinal Stenosis
- Sciatica/Lubar Radiculitis
The medication takes about 2-3 days to take effect and can last for several months.
Celiac Plexus Block:
This procedure is performed on patients suffering from severe abdominal pain caused by several conditions, including cancer or chronic pancreatitis. The celiac plexus is a group of nerves surrounding the aorta; this is the main artery into the abdomen. The celiac plexus block works to prevent the nerves from carrying pain information into the abdomen. This is done by injecting a local anesthetic into or around these nerves. The injection takes between 10-30 minutes and is done under local anesthesia. Some sedative is commonly administered as well. Side effects are rare, the most common being temporary pain or soreness at the injection site.
The effects of the medication can last from days to weeks. Often people need a series of injections to treat the problem. These can range from a couple to more than ten. This varies from patient to patient.
Cervical Epidural
Cervical epidurals are performed to treat pain in the neck, head, and arms. This is usually done after other approaches such as ice, medications, and physical therapy fail.
A local anesthetic is used to numb the area. This is followed by an injection of a steroid such as Dexamethasone or Betamethasone. After the procedure, rest is advised. Return to normal activities is possible after 24 hours.
After the epidural, relief from pain usually lasts from a few weeks up to a few months.
Discogram
This diagnostic procedure is performed to determine if the cause of back pain is due to a degenerated or damaged disc(s), and if so, which ones. Treatment is then determined based on the findings.
During this procedure, x-ray dye or contrast material combined with antibiotics is injected into various spinal discs based on symptoms, and an examination including an MRI.
It is conducted under local anesthesia so the patient can tell the doctor what they are feeling. Then, when each disc is injected, the patient is asked if there is any pain, where it is, and if it’s in the same area as the usual pain.
The patient needs to be driven home, and the recommendation is to rest for the rest of that day, and normal activity can resume the day after the procedure.
Disc Decompression
Back pain caused by pressure on the nerve root can be treated by disc decompression. It is accomplished by removing the disc nucleus while preserving the disc strength.
The X-Ray guided procedure takes between 30-45 minutes to perform. First, the patient is given local anesthesia and the choice of sedation to relax. After 1-3 hours of recovery, the patient can go home. People can usually resume daily activities in about a week.
Intercostal Nerve Block
People who suffer from pain in the chest area caused by shingles or a surgical incision are often given an intercostal nerve block. The intercostal nerves are situated under each rib. If one of these nerves or the surrounding tissue gets irritated or inflamed, it can cause pain.
The intercostal nerve block contains a steroid medication and local anesthetic, reducing inflammation, thus alleviating the pain. These blocks also can help determine the exact source of the pain.
This treatment can be effective for up to several months, although there may be intermittent pain for 2 or 3 days after the injection until the steroid takes effect.
Side effects are low but may include bruising, tenderness, or soreness at the injection site. Rest is recommended for the first 24 hours after the treatment with resumption of normal activity after that
Lumbar Epidural Steroid Injection
This is a treatment for various forms of lower back and leg pain used when other non-surgical approaches have been unsuccessful in reducing pain.
After the exact location of where the nerve roots are being squeezed is determined (by imaging tests or computed tomography), an injection containing a corticosteroid is administered. This serves to reduce the swelling and inflammation, which then relieves the pain.
The average time for pain relief is about 2-4 weeks. However, some people have gotten enough relief that they could delay or no longer need surgery.
These injections may be given more than once; however, most experts recommend a maximum number of injections be 3 in 12 months.
Occipital Nerve Block
This procedure is indicated for patients who suffer from pain that occurs primarily at the back of the head, but there is some success with patients who get migraines and cluster headaches.
A steroid or other medication is injected around the greater and lesser occipital nerves that are just above the neck area. This reduces swelling and inflammation, which reduces the pain and other associated symptoms.
The injection takes just a few minutes, with the patient either seated or lying down. The patient can usually resume regular activities the next day. The steroid takes effect within 3 to 5 days and can last up to several months.
The amount of injections needed varies from individual to individual. Occipital nerve blocks are not recommended for individuals on blood-thinning medications, those with poorly controlled diabetes, or heart disease.
Stellate Ganglion Block
Patients suffering from pain in the head, neck, upper arm, or upper chest may be candidates for a stellate ganglion block. A stellate ganglion is a group of nerves on either side of the voice box in the neck.
The stellate ganglion block treats problems with circulation or nerve injuries so can be effective in relieving pain from
- Causalgia
- Shingles affecting the head, neck, arm, or upper chest
- Reflex sympathetic dystrophy
- Phantom limb pain
The block consists of two injections: an anesthetic and then a steroid pain medication. The procedure takes less than 30 minutes. The number of treatments needed varies from person to person. Each subsequent treatment tends to last longer.
Transforaminal Steroid Injection
This treatment is done to reduce inflammation and pain that an irritated spinal nerve root may cause. It may also reduce tingling and numbness. A long-acting steroid is injected into the neural foramen and targets the nerve root in question. The neural foramen is an opening at the side of the spine where nerve roots exist.
The procedure is done with local anesthesia and takes about 15 minutes. Afterward, the patient will be observed for about 30 minutes and then allowed to go home. Most people can go back to work the next day.
The steroid will start working in about 3-5 days and can be effective for several months. Side effects are few – the most common is pain at the injection site.
Ganglion Impar Block
The ganglion impar is a cluster of nerve cells located behind the coccyx (tail bone). The purpose of a ganglion impar block is to alleviate symptoms of chronic pelvic or rectal pain.
A local anesthetic is administered in the specified area. A needle is then placed into place using fluoroscopic guidance. A contrast dye is used to ensure the placement is correct, and then the block is performed. Patients may also opt for intravenous sedation. This procedure takes about 15 minutes to perform.
There are few side effects associated with this treatment. Relief from pain varies; however, it can last from weeks to years.
Greater Trochanteric Bursa Injection
Greater Trochanteric bursitis is a condition in which the sac that lies over the outside of the thing bone becomes inflamed and causes pain and stiffness in the hip area.
If conventional methods, including resting the affected area, applying ice, and taking anti-inflammatory drugs, don’t resolve the situation, a greater trochanteric bursa injection may help. This procedure is done by inserting a needle containing a local anesthetic and steroid medication into the affected area. The steroid takes 2 – 3 days to take effect and lasts for several weeks.
After the procedure, the patient rests for a few minutes and is then driven home by someone. Normal activities can be resumed the following day.
Intradiscal Electrothermal Therapy (IDET)
This minimally invasive treatment is designed to treat chronic low back pain resulting from various degenerative disc diseases or a herniated disc.
During Intradiscal Electrothermal Therapy (IDET), fluoroscopy (X-ray) imaging guides a hollow needle containing a catheter and heating element into the spinal disc. This is slowly heated to about 194 degrees Fahrenheit. The purpose of this is to destroy nerve fibers, toughen disc tissue and seal any small tears. In addition, antibiotics are injected into the disc or administered intravenously to prevent the disc from becoming infected.
After the procedure, there may be an increase in the pain; however, improvement is often noticed after about six weeks. Between 8-12 weeks, rehabilitation exercises should begin.
Intrathecal Catheter Placement
This procedure is usually performed only after other attempts to manage pain have failed. This approach is used with patients suffering from pain due to numerous conditions, including compression fractures, cancer, failed back or neck surgery.
A small incision is made in the back, and a catheter is placed near the spinal cord and stitched into place. The catheter is then run from the spine to the abdomen, where a pump containing medication will be positioned below the waistline. The incisions are then closed with stitches.
You may be under anesthesia for this procedure which takes 3-4 hours. Before leaving, you will be given a post-procedure care list. You will have a follow-up appointment to discuss your next steps.
The battery in the pump needs to be replaced every 5-7 years. In addition, you will need to carry an Implanted Device identification card because the pump is sensitive to metal detectors.
Medial Branch Blocks
This procedure blocks the sensory nerve supply to the facet joint. Facet joints are located between the vertebras and provide stability and flexibility to the spine. If one or more of these joints becomes inflamed or irritated, facet syndrome occurs, which results in pain.
A medial branch block is conducted to help reduce the inflammation. This procedure typically takes about 30 minutes. First, a local anesthetic is applied, followed by a fluoroscopy (x-ray) guided needle placement along the nerves that supply the joint. A local anesthetic will then be injected with possibly a steroid medication as well.
After the procedure, relief from the pain is usually experienced within minutes. However, patients are asked to record their pain level for the first few days following this procedure.
Facet Injection:
Facet joints are found between each set of vertebrae in the spine. These joints allow a vertebra to move against the surrounding vertebrae. When the tissue in and around the facet joint space becomes inflamed and swells, pain results; this inflammation can affect people with arthritis, those who have sustained injuries, and others.
A facet injection involves inserting a needle into the tissue containing an anesthetic mixture and a steroid medication. The injection is done using X-ray guidance.
Patients should rest following the procedure. In most cases, work can be resumed the following day. Facet injections offer relief from pain ranging from several days to several months.