Treatment for Pain

This information is organized into sections related to the area of the body where you are experiencing pain:  general body pain along with foot, ankle and knee; and pain in the head, neck and spine. While not fully inclusive, this information will provide an overview  of treatment options that you and your PCA physician may discuss together. Once your procedure is scheduled with PCA, our team will provide you with complete information on the procedure as well as what to do in advance and how to care for yourself afterwards. 

This procedure is an injection that numbs branches of nerves in your lower back which helps doctors find and treat a number of problems linked to these nerves. The sympathetic nerves travel along both sides of your spine and are associated with a wide range of functions that you don’t consciously control including circulation, digestion and sweat production. In preparation for the procedure, you lie on your stomach or your side and are given mild sedative to make you feel relaxed. After the skin and tissue at the injection site is numbed, the physician inserts a needle and carefully guides it to the sympathetic nerves. The physician typically uses a fluoroscope (a video x-ray) which shows the physician a video image of the needle’s position. Contrast dye may be injected to help confirm that the needle is placed correctly. The medicine that the physician injects numbs the nerves and reduces inflammation. If these nerves have been a source of pain, the medicine can relieve it. When the procedure is complete, the needle is removed and the injection site is covered with a bandage. You will be monitored for a brief time before you are allowed to go home. After a lumbar sympathetic block, many people experience leg numbness or weakness which is normal and usually lasts for only a few hours. Note that you may need to return for more injections in the future. Your PCA physician will work with you to create an individualized treatment plan.

Stellate ganglion nerve block is an injection that numbs branches of nerves in your neck which allows the physicians to find and treat a number of problems linked to the nerves.  The stellate ganglion nerves travel along both sides of your spine and are associated with a wide range of bodily functions that you don’t consciously control including blushing, heart rate, sweating and the dilation of your pupils. For this procedure, you lie on your back and are given a mild sedative to make you feel relaxed. After the skin and tissue at the injection site is numbed, the physician inserts a needle and carefully guides it to the nerves of the stellate ganglion. The physician typically uses a fluoroscope (a video x-ray) which shows a video image of the needle’s position. The physician injects medicine which numbs the nerves and reduces inflammation. If these nerves have been a source of pain, the medicine can relieve the pain. When the procedure is complete, the needle is removed and the injection site is covered with a bandage. You will be monitored for a brief time before you are allowed to go home. After a stellate ganglion block, many people experience some noticeable temporary effects. The arm on the side where you were given the injection may feel warm and tingly. Your voice may be hoarse, and nasal congestion, a flushed face and a droopy eye may occur. These side effects are normal and usually disappear after a few hours. Treatment may require you to return for a series of injections. Your PCA physician will work with you to create an individualized treatment plan.

Knee pain can often be treated with Genicular nerve ablation or RF Neurotomy. During this procedure, the physician uses a radiofrequency device to heat up and disrupt the genicular nerves which are the sensory nerves that transmit pain signals from the knee to the brain. Disrupting these pathways can provide long term relief from knee pain. In preparation for the procedure, you may be given a mild sedative to help relaxation. The skin of the knee is cleansed and sanitized and then numbed with a local anesthetic.  The physician typically uses a fluoroscope (a video x-ray) which shows a video image of the needle’s position as it travels through the skin to the target nerve. A thin electrode is passed through this needle, and when the electrode is activated it heats up the nerve. This heating process, called ablation, is not painful  and will eliminate the nerve’s ability to transmit pain signals. The ablation process is repeated at two more locations to treat three of the genicular nerves. When the procedure is complete, the knee is bandaged and you will be monitored for a short time before being released. Your leg may feel numb for a short time after the procedure until the anesthetic wears off. Pain relief should begin immediately and may last for several months. Your PCA physician will work with you to create an individualized treatment plan.

This procedure uses heat from radio waves to treat painful facet joints in your neck and eases pain that isn’t helped by medications or physical therapy. In preparation for the procedure, you lie on your stomach and are given mild sedative to make you feel relaxed. After the skin and tissue of your neck is numbed, the physician guidea a tube called a “cannula” to your spine. inserts a needle and carefully guides it to the sympathetic nerves. The physician uses an x-ray device called a “fluoroscope” to help guide the tube to the medial branch nerves, the tiny nerves that carry pain signals from your facet joints to your brain. Next the physician pushes an electrode through the cannula and down to these nerves. He tests its position with a weak jolt of energy. If this recreates your pain, the physician knows it is in the right place.. Then, he heats the nerves with radio waves. Heating them blocks their ability to carry pain signals. Several nerves may need to be treated. When the procedure is finished, you get a small bandage on your skin and will be watched in a recovery room for a brief time. Afterwards, you can return home. You may feel sore and you may still have neck pain, but you’ll gradually feel pain relief within a few days or several weeks. Your PCA physician will work with you to create an individualized treatment plan.

This procedure, also called a “discogram,” helps your doctor find painful spinal discs. In order to show the source of pain in your back. For the procedure, you lie down and you are given a mild sedative to help you relax. Note that you are still awake so that you can tell your doctor what you feel during the procedure. Your lower back is numbed with local anesthetic. The doctor uses a video x-ray device called a “fluoroscope” to carefully guide a needle into the target disc. If more than one disc is being tested, a needle is placed into each one. Next, the doctor injects contrast dye into each disc, one at a time. The dye raises the pressure inside the discs and you may feel pressure or pain. If you feel pain, that may be a sign that the disc is diseased. The physician will take images with the fluoroscope so your discs can be studied carefully. When the procedure is finished, the needles are removed. Before you leave, your doctor may want to get a more detailed scan of your discs. Discography can cause your back to be slightly sore for a few days. Your PCA physician will work with you to create an individualized treatment plan.

An Epidural Steroid injection treats the pain of an inflamed nerve at the top of your spine, or the cervical spine.  If you have a herniated disc, spinal stenosis or another problem that is pressing on a nerve, an ESI may help as it relieves nerve swelling. As the procedure begins, you lie down and may be given a mild sedative to help you relax. You are numbed with an injection of local anesthetic. Next, the physician inserts a needle through this numbed tissue into the epidural space (the space around the inflamed nerve), using an x-ray called a fluoroscopy for guidance. The physician may inject contrast dye to make sure the needle is in the right place. Then the physician injects the medicine which surrounds the painful nerve to relieve pain and swelling. If you have other painful nerves, you may need more than one injection. After your injection, you’ll be watched for a short time, then you can go home. To get the full benefit, you may need to come back for more injections. Your PCA physician will work with you to create an individualized treatment plan.

The facet joints, which are found on both sides of the back of the spine, can become painfully irritated or inflamed. A facet joint injection may help diagnose the source of a patient’s pain but it also can relieve pain and inflammation. In preparation for the procedure, the physician numbs the skin and tissue above the facet joint with an injection of local anesthetic. With the aid of an x-ray device called a “fluoroscope”, the physician guides a needle through the numbed tissue and into the facet joint. Once the needle is positioned properly, the physician injects a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication. One or more facet joints may be treated. If this injection causes the pain to subside, the physician may determine that the facet joint (or joints) that was injected was the cause of pain. Back or neck pain may disappear immediately after a successful injection because of the anesthetic that was administered. As this anesthetic wears off, pain may return, but the steroid will begin to take effect in the days after the injection. The steroid will reduce inflammation and pain. The injection can provide relief for a span ranging from several days to several months. Up to three injections may be given per year. Your PCA physician will work with you to create an individualized treatment plan.

This injection procedure is performed to relieve neck, mid/lower back and radiating arm/leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions. During the procedure, the patient lies face down with a cushion under the stomach area to provide comfort and the ability to flex the back. In this position, the spine opens and allows for easier access to the epidural space. A local anesthetic is used to numb the skin. All the tissue down to the surface of the lamina portion of the lumbar vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized track. Using a fluoroscope (a video x-ray) for guidance, the physician slides the needle toward the epidural space. The physician uses the fluoroscope to confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication. When the needle is removed, a small bandage is applied to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. Many patients get significant relief from only one or two injections. Your PCA physician will work with you to create an individualized treatment plan.

This procedure is performed to relieve pain in the lower back that radiates to the legs. The injection of a steroid-anesthetic medication can reduce swelling and inflammation of irritated spinal nerves and only takes a few minutes to complete. For the procedure, you lie face down with a cushion placed under the abdomen, which causes the spine to bend in a way that opens the spaces on the sides of the spine. These spaces are called the foramina. The physician will swab an anesthetic on the skin to numb the skin and the tissue that covers the spine. When the area is numb, the physician carefully guides a needle into the foraminal space that surrounds the irritated nerve root. The physician uses a fluoroscope (a video x-ray) to confirm that the tip of the needle is positioned correctly. After the needle’s position has been confirmed, the physician injects a steroid-anesthetic medication. This medication bathes the irritated nerve roots to help alleviate the patient’s pain. When the procedure is complete, the physician removes the needle and bandages the insertion site. The patient may feel significant relief after one injection. Some patients may need multiple injections before they feel the full benefit of the medication. Your PCA physician will work with you to create an individualized treatment plan.

A medial branch block injection of numbing medicine which helps to determine the source of your pain and may relieve your pain for a brief time.  The injection bathes the medial branch nerves, which attach to the facet joints of your spine. These nerves hurt when facet joints are injured or diseased. The physician begins the procedure by injecting a local anesthetic to numb the skin and  tissue.  Next, your doctor guides a thin needle through the numbed tissue using a fluoroscope (a video x-ray) to help find your medial branch nerves. Then the physician injects numbing medicine onto the nerve which temporarily numbs the nerves. If this area is the source of your pain, you’ll feel immediate pain relief. Note that more than one level of the spine may need to be injected. When the procedure is finished, you’ll be watched for a brief time and then you can go home. You may feel pain relief for the next few hours. You may be asked to keep track of your pain level as the medicine wears off. If the medial branch block is successful, your physician can recommend a different procedure to provide long lasting relief. Your PCA physician will work with you to create an individualized treatment plan.

This procedure uses heat from radio waves to treat painful facet joints in your lower back. It eases pain that isn’t helped by medications or physical therapy. In preparation for the procedure, you lie on your stomach and are given mild sedative to relax you. After the skin and tissue of your lower back is numbed, the physician guides a tube called a “cannula” to your spine. The physician then inserts a needle and carefully guides it to the medial branch nerves. A fluoroscope (a video x-ray) is used to help guide the tube to the medial branch nerves, the tiny nerves that carry pain signals from your facet joints to your brain. Next the physician pushes an electrode through the cannula and down to these nerves. He tests its position with a weak jolt of energy. If this recreates your pain, the physician knows it is in the right place.. Then, he heats the nerves with radio waves. Heating them blocks their ability to carry pain signals. Several nerves may need to be treated. When the procedure is finished, you get a small bandage on your skin and are watched in a recovery room for a brief time. Afterwards, you can return home. You may feel sore, and you may still have back pain. but you’ll gradually feel pain relief within a few days or several weeks. Your PCA physician will work with you to create an individualized treatment plan.

This steroid injection procedure is performed to relieve pain caused by arthritis where the spine and hip bone meet, known as the sacroiliac joint. The steroid medication can reduce swelling and inflammation in the joint. For the procedure, you like face down and a cushion is placed under your abdomen for comfort and to help arch the back. The physician uses touch and a fluoroscope (a video x-ray) to find the sacroiliac joint.  A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint. The physician advances a needle through the anesthetized track and into the sacroiliac joint. A steroid-anesthetics mix is injected into the sacroiliac joint, bathing the painful area in medication. When the needle is removed, a small bandage is used to cover the tiny surface wound. You may begin to notice an improvement in your pain two to five days after the injection. Your PCA physician will work with you to create an individualized treatment plan.

Spinal cord stimulation, or SCS, uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.  After the injection site is treated with an anesthetic to number the area, one or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space. Electrodes at the end of the lead produce electrical pulses that stimulate the nerves which block pain signals. You remain awake during the procedure in order to give feedback to help the physician determine where to place the stimulators to best block your pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help you.  If you and your physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed. Your PCA physician will work with you to create an individualized treatment plan.

A stellate ganglion nerve block is an injection that numbs branches of nerves in your neck. This block helps doctors find and treat a number of problems linked to the nerves. The stellate ganglion nerves travel along both sides of your spine and are associated with a wide range of bodily functions that you don’t consciously control. These functions include blushing, heart rate, sweating and the dilation of your pupils. For this procedure, you lie on your back and receive a mild sedative to help you relax. The skin and tissue of your neck are numbed before the physician begins. The physician inserts a needle and carefully guides it to the nerves of the stellate ganglion. The physician typically uses a fluoroscope (a video x-ray) to help guide the needle. The physician then injects medicine which bathes the nerves to numb the nerves and reduce inflammation. If these nerves have been a source of pain, the medicine can relieve it. When the procedure is complete, the needle is removed and the injection site is covered with a bandage. You will be monitored for a brief time before you are allowed to go home. After a stellate ganglion block, many people experience some noticeable temporary side effects. The arm on the side where you were given the injection may feel warm and tingly. Your voice may be hoarse. You may have nasal congestion, a flushed face and a droopy eye. These effects are normal and usually disappear after a few hours. You may need to return for more injections in the future. Your PCA physician will work with you to create an individualized treatment plan.

This procedure is an injection performed to relieve pain in the upper back. To begin this procedure, you either sit or lie down to expose your back. The back is cleaned and sterilized, and a local anesthetic is administered to numb the tissue of the injection site down to the spinal column. The physician uses a fluoroscope (a video x-ray) to guide a needle down to the vertebra that is causing the pain. The needle is carefully pushed into the epidural space, which is the area surrounding the spinal cord. A contrast solution is injected to confirm the needle’s position. Next, the physician injects a steroid-anesthetic mix into the epidural space to help reduce inflammation and reduce pain. After the needle is removed, the injection site may be covered with a small bandage. Extended pain relief usually begins within three to five days of the injection. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. However, many patients get significant relief from only one or two injections. Your PCA physician will work with you to create an individualized treatment plan.