If you or one of your loved ones suffers from acute or chronic pain,
please do not hesitate to call us. We can help!
Epidural steroid injection is an injection performed in the back or neck in an attempt to place anti-inflammatory steroids with or without a local anesthetic into the epidural space close to the inflamed area that is causing the pain. These injections are generally done for pain involving the back and leg or the neck and arm/hand. They are usually done under x-ray guidance. There are two methods to encounter the epidural space, interlaminer and transforaminal. The interlaminar technique refers to injection into the space between the openings of adjacent vertebrae.
Transforaminal epidural refers to injection into the area where the nerve roots exit. While the interlaminar technique can be performed through paramedian or midline approaches, the transforaminal technique is performed through an oblique approach. Your physician will recommend which technique is best for you. Common side effects include soreness of the back or neck at the point where the needle enters the skin, there may be some temporary numbness in the involved extremity but persistent numbness or weakness (lasting over 8 hours) should be reported to your doctor. Epidural steroid injections may be placed in the lumbar (low back), thoracic (mid back), or cervical (neck) regions.
There are many joints and bursa in the body that may cause chronic, musculoskeletal pain secondary to inflammation or degenerative changes from arthritis. These include but are not limited to: shoulder, elbow, wrist, hip, knee, trochanteric bursa, and muscular trigger points. These injections are usually done in the office and consists of a combination of anti-inflammatory steroids and local anesthetic.
The facet joints assist with movement of the spine both in the neck and back. Injection into these joints can provide relief of neck and back pain. Median branch blocks are injections used to “block” the nerves which supply the facet joints. Both facet joint injections and median branch blocks are always performed under x-ray guidance. Common side effects include soreness in the neck or back when the needle was inserted. A needle is placed in the neck or back and advanced to the level of the joint under x-ray visualization. This block is often a diagnostic block and a more long lasting injection may be indicated if you have significant pain relief from this injection.
A sacroiliac joint injection (SI) is used to either diagnose or treat low back / upper buttock pain. The SI joint in the lower spine connects the sacrum with the hips on both sides. Degenerative changes in this joint can lead to inflammation which causes pain in the lower back. SI joints injections are usually done with the aid of x-ray or ultrasound. The patient is laid on his/her stomach and the skin is numbed with anesthetic. A small needle is then guided into the joint. A small mixture of numbing medication (anesthetic) and anti-inflammatory medication (usually steroid) are then injected. The goal of this procedure is to reduce inflammation of the joint and provide substantial to complete pain relief for an extended period of time.
Celiac Plexus/Hypogastric Plexus Blocks
These blocks are generally performed to relieve pain in patients with cancer of the pancreas, intestine, stomach or other chronic abdominal pains. A needle is placed via your back that deposits numbing medicine to the area of a group of nerves called the either the celiac or hypogastric plexus. This injection is often performed as a diagnostic injection to see whether a more permanent injection may help with the pain. If it provides significant pain relief then the more long lasting injection may be done. This injection is usually performed under x-ray guidance. You will be lying on your stomach for this injection. The needle is place via the mid back and placed just in front of the spine. Contrast dye is injected to confirm that the needle is in the right spot; followed by numbing medicine.
A lumbar sympathetic nerve block is performed for pain in the leg that is thought to be caused by complex regional pain syndrome (CRPS) or other neuropathic pain syndromes. These injections are performed under fluoroscopic (x-ray) guidance. Local anesthetic is placed near to the lumbar sympathetic chain in order to relieve the pain. Your leg will likely become warm immediately following the injection: this is an expected effect and not a complication. Back soreness is one of the more common side effects. If you feel any sharp pains down your leg or to your groin during the injection, you should let the physician know immediately.
There may be some temporary numbness following the injection but if there is persistent numbness or weakness (> 8 hours) the doctor should be notified. The injection is done from the back, in the lower aspect of the back. A needle is placed, often under x-ray guidance, to a spot just to the side and approaching the front part of the spine where the ganglion is located. A small amount of dye is injected to make sure the needle is in the right spot. After the doctor is satisfied that the contrast dye is in the right place, he/she will inject numbing medicine then remove the needle.
Radiofrequency ablation (RFA) or rhizotomy is a procedure used to reduce pain where an electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic low-back and neck pain and pain related to the degeneration of joints from arthritis. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years. More than 70% of patients treated with RFA experience pain relief. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. Your doctor can advise you about your particular risk. The main side effect of RFA is some discomfort, including swelling and bruising, at the site of the treatment, but this generally goes away after a few days.
A stellate ganglion block is an injection that can be performed for the diagnosis of complex regional pain syndrome (CRPS) or other neuropathic pain syndromes of the arm or hand. It can also be used to help to improve blood flow to the hand or arm in certain conditions that result in poor circulation of the hand. Side effects may include soreness in the neck where the needle was placed. In some instances the side effects may include droopiness of your eyelid on the side that is injected, along with a temporarily stuffy nose and sometimes temporary difficulty in swallowing. This injection can be performed with x-ray or ultrasound guidance. You will be lying on your back for this injection with your mouth slightly open. It is very helpful to the doctor if you try not to swallow during the injection. If this injection is performed under x-ray the doctor will first inject a small amount of contrast to confirm the placement of the needle then inject some numbing medicine.
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