Pain Management

Oral steroids and pain medications provide general pain relief in a less-focused manner. Conversely, epidural injections deliver a steroid directly into the space surrounding the dural sac, which encloses the spinal cord, nerve roots, and cerebrospinal fluid. The injection stops the body’s natural inflammatory response as the result of a chemical or mechanical pain source. This is a common practice when treating cervical, thoracic, lower back and leg pain.

Prior to Epidural Injection

Before the injection, patients must cease use of Coumadin, Plavix, or any other medication as directed by their physician. They must also arrange for a ride back home after this 15–30-minute procedure, as it is strongly recommended to take it easy for the rest of the day following an epidural.

Day of Epidural Injection

1. Patient’s skin will be sterilized with betadine.
2. A local anesthetic will be used at both levels of injection.
3. A fluoroscopy will be used to provide live image access to the needle’s location as it is inserted into the epidural space.
4. Contrast dye will be injected to confirm the correct location and delivery of the medication.
5. After confirmation, the combination of steroid and anesthetic will be released into the joint – which should mostly result in the patient feeling a slight sting and pressure of the needle.

Over the next few days, it’s possible the patient may feel sore or a bit of pain, but it should resolve quickly and can be moved along with periodic use of an ice pack. An epidural is proven to be most effective when combined with therapeutic exercises or a series of injections.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

At every segment of your spine, there is a set of facets that guide movement, provide stability, and prevent the spine from twisting too far. As with any other joint, they are subject to wear and tear over time and can become painful due to stress, injury, and arthritic changes. There are three types: cervical (head, neck, shoulder, and arm pain), thoracic (upper back and chest pain), and lumbar (lower back, hip, butt, and leg pain). Facet joint injections are diagnostic and therapeutic – they both identify the cause of pain and relieve it by reducing inflammation.

Prior to Facet Joint Injection

This procedure typically takes between 30 and 45 minutes. Before the injection, patients must cease use of Coumadin, Plavix, or any other medication as directed by their physician. They must also arrange for a ride back home afterwards, as it is strongly recommended to take it easy for the rest of the day following the epidural.

Day of Facet Joint Injection

1. The skin on the patient’s neck or back will be sterilized with betadine.
2. A local anesthetic will be used at both levels of injection.
3. A fluoroscopy will be used to provide live image access to the needle’s location as it is inserted into the facet joint.
4. Contrast dye will be injected to confirm the correct location and delivery of the medication.
5. After confirmation, the combination of steroid and anesthetic will be released into the joint – which should mostly result in the patient feeling a slight sting and pressure of the needle.
6. The needle will be removed and the process will be repeated as needed at each joint location.

Over the next few days, it’s possible the patient may feel sore or in a bit of pain, but it should resolve quickly and can be moved along with periodic use of an ice pack. An epidural is proven to be most effective when combined with therapeutic exercises or a series of injections.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Radiofrequency ablation is a procedure used to treat facet and sacroiliac joint pain by blocking or reducing pain signals sent to the brain. This process uses radio waves to create heat around the nerve, destroying its ability to transmit pain signals to the brain.

If the ablation is effective, relief should last 9-14 months, or sometimes much longer. After this period of time, the ablated nerve will begin regenerating, opening up the possibility of pain returning.

Prior to Radiofrequency Ablation

To be considered, patients must have already received previous joint injections with relief lasting less than two weeks. This procedure typically takes between 30 and 60 minutes to complete.

Prior to treatment, patients must cease use of Coumadin, Plavix, or any other medication as directed by their physician. They must also arrange for a ride back home afterwards, as it is strongly recommended to take it easy for the rest of the day following the epidural.

Day of Radiofrequency Ablation

1. The skin on the patient’s neck or back will be sterilized with betadine.
2. A local anesthetic will be used at both levels of injection.
3. A fluoroscopy will be used to provide live image access to the needle’s location as it is inserted into the facet or sacroiliac joint.
4. A small electrical current will be sent through the needle to confirm that it’s next to the correct nerve.
5. After confirmation, the nerve will be numbed, and the nerve will begin to be ablated.
6. This process can be repeated for up to 5 nerves.

Over the next few days, it’s possible the patient may feel soreness, muscle spasms, or nerve irritability due to the nature of the procedure, but this should subside, and regular activity can be resumed within a few days.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Spinal cord stimulation (SCS) is a chronic pain management technique that uses a Medtronic device to send small electrical currents through the spinal cord to interrupt signals to the brain and thus, relieve pain.

The intensity of the electricity is adjusted to individual pain tolerance.

Spinal Cord Stimulation Treatment Method

SCS is a non-opioid, FDA approved option when treating chronic pain. This is how it works:

1. A small pacemaker-like generator will be placed inserted under the abdomen.
2. Thin wires will connect from the generator to the area around the spinal cord.
3. Adjustable electrical impulses will be remotely sent through the spine to overcome pain once it is felt.
4. This may be repeated a few times a day for up to two hours each time, depending on the pain severity.

Before the implant surgery, a temporary device may be tried out to ensure the success of the permanent generator. Successful delivery of this treatment allows patients to manage their own pain according to how their body naturally feels through its recovery process.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Trigger points are painful knots in the muscles or bundles or fibers that form when the muscle is unable to relax. This irritates the nerves in surrounding areas, which can cause pain in other parts of the body – known as referred pain.

Trigger point injections involve the insertion of a needle directly into the trigger point to deliver a combination of lidocaine and an anti-inflammatory steroid. Multiple areas can be injected in one procedure and the process is very quick.

Joint injections also help relieve pain through the same mixture of medication, only with the needle being inserted into the affected joint. It may take a while to feel relief, up to ten days.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Nerve conduction studies (NCS) highlight the location of a blockage in the nerve pathway to the muscle by stimulating specific nerves and recording their ability to send signals. These studies help evaluate exactly how damaged the nerves are leading from the brain and spinal cord. It helps accurately locate abnormal sensations and diagnose the presence of nerve disorders, such as carpal tunnel syndrome.

Nerve Conduction Study Process

The length of this process varies from person to person, but can typically take between 30 minutes and an hour. This is how it works:

1. Electrodes will be placed on the skin over the area intended to be stimulated.
2. Another electrode will be placed on top of the muscle corresponding to the nerve.
3. Small, electrical currents lasting less than a millisecond will be sent to the nerve, followed by a brief tingling sensation or muscle spasm.
4. The time it takes for the muscle to contract in response to the current will be automatically recorded.
5. Nerves on the other side of the body will be simultaneously evaluated for comparison.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Discograms are diagnostic tests used to determine whether there is structural damage to intervertebral discs, if there are tears present or signs of rupture, or if a disc is the source of pain. It can also be used to locate a problem disc before surgery.

Day of Discogram

1. The patient will be given a medication one hour before the procedure to induce relaxation.
2. They will then change into a gown and the area on the neck or back will be sterilized with betadine.
3. A local anesthetic will be used at both levels of injection.
4. A fluoroscopy will be used to provide live image access to the needle’s location as it is inserted into the disc space.
5. Fluid will be injected to increase pressure in the disc space.
6. If the pain elicited mimics the back or leg pain the patient has previously been experiencing, the disc causing the problem will have been accurately identified.
7. The needle will be removed, and the process can be repeated at each joint as necessary.

After the procedure, there may be a bit of soreness due to the nature of the process, but it should resolve in a few days. It is recommended to take it easy for the remainder of the day and resume normal activities the following day.

This information is not to be a substitute for medical advice. For more information or questions, give us a call at (239) 591-2803.

Magnetic resonance imaging (MRI) can be helpful in diagnosing neurological conditions connected to back pain. This provides insight through detailed live imaging of the spine and surrounding soft tissue. It does not provide pain relief or likely change the plan of treatment your doctor has for you, but it can detect very small problems and changes that may have been missed in the initial diagnosis.