Interventional pain management consists of minimally invasive procedures to reduce pain. Pain management typically utilizes a multidisciplinary approach to managing joint and back pain. Procedures are performed by specially trained clinicians and can be done in the office or under fluoroscopy (x-ray) guidance. The interventionalist coordinates closely with other specialists such as chiropractors, physical therapists and surgeons to manage pain and improve function.
Transforaminal epidural steroid injection
An epidural steroid injection (ESI) can be both diagnostic as well as therapeutic. If the injection provides pain relief for the patient, an ESI can help identify the specific pain generator. Epidural steroid injections are utilized for discogenic pain; both for back and leg problems. Steroid and an anesthetic agent are injected into the epidural space surrounding the disc to reduce inflammation and pain. This is a safe procedure performed by a fully trained and qualified physician under fluoroscopic guidance.
Selective nerve root block
A selective nerve block (SNRB) is similar to an epidural steroid injection, except that it focuses on a specific nerve root. Medication (steroid and anesthetic) is injected into just one or two nerve roots. Nerve roots are attached to the spinal cord. When one of the lumbar nerve roots becomes compressed and irritated, it can produce back pain and/or numbness, tingling and sometimes weakness down a leg.
Facet joint injection
This injection can also be both therapeutic and diagnostic. There is a pair of facet joints at each vertebral level which allow movement of the spine and provide stability. When people have significant back pain with sitting, it is usually indicative of facet joint inflammation. Steroid and an anesthetic agent are injected into the facet joint space to reduce inflammation and decrease pain. These injections are typically done in combination with physical therapy for maximum benefit.
Medial branch blocks
Medial branch blocks help to diagnose and relieve back pain from degenerative and painful facet joints. The medial branch is a nerve that carries pain signals from the facet joint to the spinal cord. Each joint gives pain signals to the medial branch located above and below the joint. A local anesthetic medication is injected over two medial branches to block the pain signals from a facet joint.
Sacroiliac Joint injection
Sacroiliac joint (SI joint) dysfunction is a common diagnosis. The sacroiliac joints are located in the back where the lumbo sacral spine joins the pelvis. An inflamed SI joint will usually give patients the feeling that the hip is giving out. An SI joint injection is also both diagnostic and therapeutic. These injections eliminate pain temporarily by filling the SI joint with a combination of steroid and anesthetic medication that numbs the joint, the ligaments, and joint capsule around the SI joint.
The hip joint is a large joint where the leg joins the pelvis. If this joint experiences arthritis, injury or mechanical stress, one may experience hip, buttock, leg or low back pain. A hip joint injection can be beneficial for patients with these symptoms. Hip joint injections involve injecting medicine (steroid and an anesthetic agent) directly into the joint using x-ray guidance. The injection can help relieve pain and discomfort in the hip joint, as well as confirm a diagnosis.
Trigger Point Injections
A trigger point is a sensitive or irritable spot that can be a source of soft tissue pain. Trigger points are commonly found in muscle (myo) and its lining (fascia) and are called “myofascial” trigger points. The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point. Trigger points can result from strains, repetitive use injuries, stress, and muscle tension conditions. An anesthetic medication and sometimes an anti-inflammatory steroid is injected directly into the trigger point(s). These injections are done in the clinic. Trigger point injections have been found to be very effective in relieving pain. They are often used in combination with exercise, heat, cold and medication