Interventional pain management consists of minimally invasive procedures to reduce pain. Pain management typically utilizes a multidisciplinary approach to managing joint and back pain. Therapeutic injection procedures are performed by specially trained clinicians and can be done in our office 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.

Epidural steroid injection

An epidural steroid injection (ESI) involves injecting medications (steroid and anesthetic) along the nerve roots, which are attached to the spinal column. When one of the spinal cord nerve roots becomes compressed and irritated, it can produce neck and/or back pain along with numbness, tingling and occasionally extremity weakness. If the injection provides pain relief for the patient, it can help identify the specific source of pain. This is a safe procedure performed by a fully trained and qualified physician utilizing fluoroscopic guidance.  The procedure can be both diagnostic and therapeutic, helping surgeons identify the source of pain while at the same time affording relief.

Fluoroscopy

When you have a therapeutic injection performed at ISS, we use a real time X-ray machine called a fluoroscope. It can be adjusted in several different directions and angles, during the procedure, in order to see the same location from a different perspective. We take a series of images as we insert and guide the needle to the exact right place. Having our own fluoroscope allows us to perform almost all our interventional procedures right in our office. This can save you thousands of dollars versus going to a surgery center.

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Facet joint injection

This injection can also be both therapeutic and diagnostic. There are 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.

Radiofrequency Ablation

After a Facet Joint Injection or a Medial Branch Block has been performed to diagnose the exact source of pain, a radiofrequency ablation (RFA) may be performed on the same nerve roots. Radiofrequency waves treat the nerve that is causing the pain using heat, minimizing the transmission of pain signals to the brain. It can provide longer lasting relief for people with chronic pain, especially in the back and neck. This is a safe procedure performed by a fully-trained and qualified clinician in our office, and requires the use of flouroscopy. The procedure takes less than 20 minutes. The results after receiving an RFA vary with each individual. Overall healing time is typically 4 to 6 weeks after the procedure, due to the residual effects of the nerve ablation or muscle spasm. The duration of pain relief from this procedure varies from person to person, but typically lasts between 6 and 12 months.

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, ligaments, and joint capsule around the SI joint.

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Minor Injections

All of the injections we do at ISS are out patient procedures but these injections often don’t even require the use of our Fluoroscope. These minor injections can usually be done using ultrasound to guide the needle.

Hip, Shoulder, & Knee Injections

Any joint can experience arthritis, injury, or mechanical stress, which may cause pain in the joint as well as the surrounding areas. A hip joint injection can be beneficial for patients with pain in the hip, buttock, leg, or low back; shoulder pain can radiate out through the arm and up into the neck; knee pain can radiate up and down the legs. These large joint injections involve injecting medications (steroid and an anesthetic agent) directly into the joint using ultrasound or flouroscopic guidance. The injection can help relieve pain and discomfort in the 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.

Ultrasound

An ultrasound is a device that is used to see the muscles, joints and bones inside your body. It uses a handheld “wand” that is pressed against the skin to create an image of the area below the surface. Then, the image is transmitted to a computer that displays it on screen. Like the fluoroscope, this helps the providers at Integrated Sports & Spine guide a needle into your joint to inject steroid and anesthetic. 

Unlike the Fluoroscope, which uses radiation to create images, the ultrasound uses high frequency sound. This sound is too high pitch for humans to hear. Properly performed ultrasound poses no known risks to the patient. 

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More Interventional Procedures

Kyphoplasty

Balloon kyphoplasty is a minimally invasive procedure that can stabilize pathological fractures of the vertebral body due to osteoporosis, cancer, or benign lesions. The procedure can reduce back pain, as well as restore vertebral body height. Orthopedic balloons are used to gently elevate the fractured vertebrae in an attempt to return it to the correct position. The cavity is then filled with bone cement, creating an internal cast to support the surrounding bone. Balloon kyphoplasty can safely and effectively be performed in the surgical suite under moderate sedation. Studies have shown this procedure can provide rapid and sustained pain relief, enhanced quality of life, improved mobility, and lessened use of narcotic analgesics when compared to non-surgical management.

Spinal Cord Stimulator

Spinal cord stimulation is a treatment for patients who suffer from chronic neuropathic (nerve) pain in the trunk and extremities. First, a temporary evaluation is performed where two leads with electrodes are inserted through a needle into the epidural space above the spinal cord. An electrical block is programmed and the patient tries the temporary system for a week to evaluate their pain relief and daily activities to assess their percentage of pain relief.  The patient has a programmer that allows them to make changes to their programming during the week of their trial. A temporary generator is placed in a bandage on the outside of their body to power the leads during the trial.  Leads are removed after one week and pain relief is assessed.

A permanent implant is performed once a trial is complete and successful. This procedure is done in an ambulatory surgery center in the operating room as an outpatient. New leads are placed and connected to a generator that is implanted under the skin. The leads are programmed with a mild electrical block, and the patient receives a controller that allows them to make changes to their programming. Periodic reprogramming of the device in the office keeps the patient’s pain relief controlled.