By listening to you and learning about your history with pain, we will have a conversation regarding which treatment options are most suited for your circumstances. Because your discomfort and situation are uniquely yours, we will work as teammates against the pain. Treatment options include various injections (usually with a steroid to reduce inflammation) and blocks (also injections but with a numbing agent), as well as other remedies, all focused on pain reduction and/or pain elimination. All of the injections described below are performed at PCA locations instead of in the hospital.
Being able to determine the source of arm or leg pain can begin with a procedure called a Selective Nerve Root Block. This procedure involves the injection of a long-lasting steroid to reduce inflammation with numbing medication around specific nerve roots exiting the spinal column. A selective nerve root block is a diagnostic tool to determine the type of back pain you are having accurately and while temporary pain relief may occur during the procedure, it is not considered to be a treatment for pain.
Facet joint syndrome can be diagnosed with the help of a medial branch block in which a physician will inject an anesthetic near small medial nerves connected to a specific facet joint. If you experience noticeable pain relief immediately after the injection, the physician may determine that the facet joint is the cause of your pain. If that noted pain relief occurs with a medial branch block, a treatment called medial branch radiofrequency neurotomy (or ablation) can be considered for long term pain relief.
Peripheral nerve blocks are most commonly used during surgery on the arms, hands, legs, feet, or face. A peripheral nerve block provides site-specific surgical anesthesia which reduces the need for general anesthesia and the common side effects of general anesthesia including nausea, vomiting, and tiredness. A peripheral nerve block can also reduce the need for oral narcotic medicines.
The stellate ganglion is a small group of nerves that carry nerve signals from the head, face, neck and arms. If pain is present in these areas a stellate ganglion block may be used to diagnose the cause of the pain so that a treatment plan can be formed. A stellate ganglion block is an injection with a local anesthetic in the front of the neck either on the right or left side. In some cases, this diagnostic tool may treat the pain itself and provide improved mobility in the upper portions of the body.
If you are experiencing pain or weakness in the lower back, legs or feet, a lumbar sympathetic block may be used to determine if the sympathetic nerves are causing that pain in the lower part of your spine. This type of injection is an important diagnostic tool to determine the exact issue and help develop a treatment plan. In some cases, however, the injections may also treat the inflammation and provide desired pain relief.
Persons being treated for advanced pancreatic cancer often experience severe abdominal pain due to the pancreatic tumor pressing on a nerve bundle called the celiac plexus located in the upper abdomen. The celiac nerves connect the stomach, liver, pancreas, gall bladder and intestines to the spinal cord and brain. Common treatment for this pain is through opioids which have strong side effects. A celiac plexus block is a procedure that targets the celiac nerves so they cannot send pain messages to the brain.
The symptoms of chronic pelvic, tailbone or rectal pain can often be treated by a ganglion of impar block which blocks nerve impulses. The ganglion of impar block is an injection of a medication with anesthesia to help reduce swelling, inflammation and pain.
Different types of headaches, such as migraines clustered with facial pain, may be related to a small collection of nerve cells and fibers called the sphenopalatine ganglion. A sphenopalatine ganglion block is a short, minimally invasive procedure that uses a local anesthetic to prevent the signals from going through those nerves.
Trigeminal neuralgia is a severely painful condition that causes sudden attacks of pain on one side of the face triggered by simple actions such as talking, eating, or even hair brushing. Trigeminal neuralgia can be caused by brain tumors, multiple sclerosis, or injury to the nerve from head, sinus or dental trauma. A trigeminal nerve block uses steroids with a local anesthetic to directly surround the trigeminal nerve root to reduce inflammation and provide pain relief.
Sciatica or other intense pain in the arm, neck, arms, mid and lower back, and down into the legs might be treated with an epidural steroid injection in conjunction with other treatments. This injection can often provide quick pain relief by reducing the swelling or inflammation of the nerve roots as they leave the spine.
Pain in large joints such as the shoulder, hip, or knee are often treated with a major joint steroid injection. If a joint injection is determined as the treatment option, PCA may use ultrasound or fluoroscopy for guidance while injecting the steroid directly into the joint.
The facet joints are part of your spine and provide stability and allow you to bend and twist. Facet joints can become painful often due to injury or arthritis. A steroid injection directly into the facet joint can reduce the associated pain and inflammation.
The joints where your lower spine connects to your pelvis can become inflamed, causing pain in your buttocks, lower back, and extending down one or both legs. A sacroiliac joint injection may reduce the associated pain and inflammation.
When pain is not in a joint but rather in a muscle that has “knotted up” and will not relax, a trigger point injection may be used as a treatment option. Trigger point injections direct small amounts of medication directly into the trigger point to help ease the pain. This treatment can be used in muscles in the neck, arms, lower back, and legs, and may also be considered for fibromyalgia and tension headaches.
Pain in the hip or buttock region may be due to the tightness in the piriformis muscle, located behind the hip joint and over the buttocks. The piriformis muscle is responsible for turning the leg and foot outward by rotating the hip joint. Tightness in this muscle can affect the sciatic nerve, which causes pain to extend down the leg. A piriformis injection of a steroid directly into the muscle helps to relieve the pain and can be used in conjunction with physical therapy.
Radiofrequency ablation (RFA) is a treatment option for pain coming from the facet joints which can contribute to chronic pain in the neck or mid and lower back, or from the sacroiliac joints which can cause chronic low back pain. RFA is a minimally invasive, non surgical procedure which uses heat to reduce or stop the transmission of pain. Performed as an outpatient procedure, RFA waves ablate, or “burn” the nerve that is causing the pain, which then stops the pain signals from traveling to the brain. People experiencing severe joint pain (shoulder, hip, knee), or abdominal/pelvic pain from ovarian or pancreatic cancer may also be candidates for RFA.
Pain is most often treated with injections, oral medications or nerve blocks as non-surgical options based on the reason for the pain. However, if these treatments fail and the pain becomes chronic, peripheral nerve stimulation (PNS) may be considered in consultation with your PCA physician. PNS is a minimally invasive, surgical procedure which implants electrodes directly on the nerves or under the skin where the pain is occurring. PNS could be a treatment option if you are living with pain from cluster headaches or migraines, complex regional pain syndrome, post amputation or phantom limb pain among other conditions.
Spinal Cord Stimulator (SCS) is a therapy which masks pain signals before they reach the brain. It involves a small device, much like a pacemaker, that sends electrical pulses to the spinal cord in order to modify the pain signals. After the device is implanted, these pain signals are no longer perceived or they are replaced by a faint tingling feeling. SCS does not eliminate the source of pain as it simply changes the way the brain perceives the pain. SCS is used most commonly to treat CRPS (complex regional pain syndrome), neuropathic pain, and radicular pain in the arms or legs. This therapy can be used in those with a history of spine surgery or may be used to avoid spine surgery in the first place.
Back or leg pain can come from several different conditions, so accurately diagnosing the reason for the pain is critical for a proper treatment plan. A discogram is a diagnostic procedure which helps to determine if your back or leg pain is related to a degenerative vertebral disc. By injecting dye into specific vertebral discs to recreate the pain, the discogram allows the physician to view your disc and locate the pain source. If you feel pain when the dye is injected, it is likely that the disc is the source of your pain. If you don’t feel the same kind of pain, your physician will explore other possible causes of your pain in order to diagnose and develop an appropriate treatment plan accurately.
Genicular nerve radiofrequency ablation (GNRFA) is an outpatient procedure which provides a non surgical approach to treat chronic knee pain if other treatment options have not been successful. Radiofrequency ablation of the genicular nerves (the branch of nerves surrounding the knee) might be a successful alternative to surgery. With GNRFA there are no incisions and no need for steroid or cortisone injections. This procedure stuns the painful nerves to prevent the pain signals from reaching the brain, which allows for quality of life to improve and function to return.
Medications are often part of a treatment plan for people living with pain in order to improve quality of life by reducing or removing pain. Because each patient is different with a unique medical history and medication plan, responsible management of the various medications is critical for overall safety. Medication management by PCA is an outpatient service which reviews and evaluates the effectiveness of the prescriptions and notes any side effects you might be experiencing and how the medications are working together.