Interventional Pain Management

Interventional Pain Management Phoenix AZ

pain-procedure 

Overview

Our Phoenix Interventional Pain Management physicians offer a range of procedures designed to help chronic or acute pain patients cope with their pain levels. Our procedures are performed by Board Certified, expert pain doctors in a minimally invasive fashion.

 

We offer a number of procedures, all of which work in different ways and may be used as part of a multidisciplinary approach alongside other pain management techniques such as physical therapy, acupuncture, chiropractic and spinal decompression therapy.

 Lumbar Transforaminal Epidural

Common conditions that might benefit from interventional pain management are neck pain, back pain, chronic headaches and severe muscle aches that cannot be helped with medication alone. You can find out more about how these techniques might benefit your individual circumstances by reading the treatment options below.

What Are Interventional Pain Management Options?

EPIDURAL STEROID INJECTIONS

 

An Epidural Steroid Injection is a procedure administered for pain caused by the narrowing of the nerve passage. A nerve that has experienced pressure may trigger an inflammatory response which causes a sharp shooting pain to travel up the affected area. If this occurs in the neck it’s called radiculopathy. In the low back it’s called sciatica.

 

Narrowing of the nerve passage can be a symptom of many conditions, including disc herniations, joint cysts, bone spurs or unusual alignment of the vertebrae. An epidural steroid injection works by delivering pain relief and anti-inflammatory medication to the affected area, providing immediate improvement.

 

What Is It For?

 

Epidural Steroid Injections can be an effective treatment for the following conditions:

 

  • Spinal Stenosis
  • Sciatica or Radiculopathy
  • Cervical or Lumbar Disc Herniation
  • Degenerative Disc Disease
  • Arm / Shoulder pain
  • Neck pain

 

What Does The Procedure Involve?

 

During the procedure, you will be asked to lay down on your front with a cushion placed underneath your abdomen to increase flexion in the lumbar spine. This will allow more room for the needle to be inserted.

First, a local anaesthetic is applied to numb the skin. X-rays are then used to direct the needle into the area, and contrast dye is injected for clarity. The exact placement of the epidural steroid injection is dependent on the condition it is treating.

 

The medication is then injected, with the steroids taking an active role in reducing inflammation at the root of the nerve.

 

The procedure does not take long, and when the needle is removed, a small bandage is fixed to the site to prevent infection. You will be monitored for a short time after the procedure has finished to ensure you’re feeling well, and then you can go home.

The effects of the procedure are not immediate, and can take several days to be felt.

 

What Are The Benefits?

 

At least 70% of pain patients who receive an epidural steroid injection report noticeable pain relief. An intervention like this significantly improves a person’s mental health, especially when living with a long standing chronic pain condition that is not easy to manage.

 

Although steroids do not alter or heal the underlying condition, they can disrupt the cycle of pain and inflammation. This then gives the body the freedom to compensate for the condition. Breaking this cycle can lead to long term benefits for chronic pain patients.

 

 

OCCIPITAL NERVE BLOCK

 Occipital blocks

An occipital nerve block is an interventional pain management treatment primarily for headache sufferers. It is a steroid based injection that is administered to treat the cranial nerves located at the back if the head and at the top of the neck.

 

The occipital nerve block works by diminishing the amplification of pain and sensory messages in the trigemonal nucleus. This in turn reduces the symptoms of migraines and headaches.

 

What Is It For?

 

Occipital Nerve Blocks can be used to treat the following conditions:

 

  • Cluster headaches
  • Chronic Migraines
  • Tension headaches
  • Cervicogenic headaches
  • Occipital nerve inflammation
  • Occipital neuralgia

 

What Does The Procedure Involve?

 

This is a very quick and painless procedure which can be performed without the need for hospital admission or sedation. Following a consultation with one of our practitioners, a local anaesthetic is injected into the site so that the area is numb. Then, a needle containing steroids and anaesthetic is injected into the occipital nerves. The site is then covered with a small bandage and you will be monitored for about 20-30 minutes before going home.

 

You may feel that the back of your head is somewhat tender after the procedure. Any immediate pain relief will be down to the anaesthetic, where as the longer lasting pain relief will be noticeable within 5 days. Depending on how you respond to the treatment, you may benefit from additional appointments in the future.

 

What Are The Benefits?

 

Headaches can interfere with day to day life, preventing a sufferer from socialising, working or functioning normally.

 

Clinical trials have shown that around 75% of headache sufferers have reported positive results following an occipital nerve block. Results can vary from patient to patient but typically last 2-3 months, and sometimes repeat appointments are necessary for chronic headache cases.

 

Call us now to find out more about occipital nerve block treatment for your headaches or migraine.

 

JOINT INJECTIONS

 Knee Injection

Joint injections are a treatment designed to target problems that arise in the joints of the body, such as the knee, elbow, ankle or hip. Frequently, joint pain is experienced by people with arthritis, but can also occur following an accident or injury.

 

According to the Centre of Disease Control and Prevention, 1 in 2 people develop osteoarthritis symptoms in the knee by the time they’re 85, and approximately 23% of Americans live with some form of arthritis condition.

Pain in the joints can be debilitating, and can have a significant impact on day to day life.

 

The type of joint injection you receive wholly depends on the joint that is inflamed. Options can include platelet rich plasma therapy, a corticosteroid injection or a hyaluronic acid injection. Joint injections are a good option for patients who find no relief from medications or physical therapy.

 

What Is It For?

 

Joint injections can be used to treat the following conditions:

 

  • Osteoarthritis
  • Rheumatoid arthritis
  • Gout
  • Arthritis
  • Arthrosis
  • Epicondylitis
  • Trigger Finger
  • Wrist Ganglion Cysts
  • Tarsal Tunnel Syndrome

 

What Does The Procedure Involve?

 

This simple outpatient procedure is very quick and simple. It does not require sedation or hospital admission. Your Phoenix pain management doctor will apply a local anaesthetic to the area before inserting a needle into the joint and delivering the medication.

 

Often, an X-Ray device will be used to assist the practitioner in locating the exact spot that requires treatment. Following the procedure, a bandage is attached to the site and you will be able to go home. Your doctor may wish for you to be monitored after the procedure for half an hour to ensure you’re feeling well.

 

It’s recommended you rest for the remainder of the day at home and avoid driving. Depending on your condition, there may be a need for additional injections in the future.

 

What Are The Benefits?

 

The majority of patients who have a joint injection benefit from significant pain relief and improved mobility. The success rate of hyaluronic acid injections to treat osteoarthritis of the knee is 75%, and PRP injections are also showing successful results in many pain patients. The treatments are low risk and can be performed quickly and efficiently, making this a popular choice among people with common joint problems.

 

If you’d like to hear more about how joint injections can work for you, call us now.

 

 

RADIOFREQUENCY ABLATION

 Lumbar_Radiofrequency_Ablation

An effective interventional pain management procedure is radiofrequency ablation. This is the application of thermal electromagnetic energy to reduce pain in the body.

The nerve endings that are transmitting pain are specifically targeted and as they are warmed, the endings are impaired. As a result, a person’s overall pain levels significantly decreases.

 

This procedure has a relatively long term success rate and is suitable for people who have chronic, long standing pain problems that have not changed with medication or other forms of physical therapy.

 

The primary use of radiofrequency ablation is to treat pain that occurs in the lumbar facet joints. These joints (which can be found within the spine) contain a network of nerves that deliver signals to the brain whenever there is inflammation or damage within the area. In cases where pain patients experience persistent and constant pain, the disruption of this network can help to provide general pain relief. Research has indicated that 45% of persistent back pain is caused by the facet joints in the spine.

 

What Is It For?

 

Radiofrequency Ablation can be used to treat the following conditions:

 

  • Whiplash
  • Pelvic Pain
  • Abdominal Pain
  • Lumbar Facet Arthritis
  • Thoracic Facet Arthritis
  • Complex Regional Pain Syndrome
  • Cervical Facet Arthritis
  • Headaches
  • Back Pain

 

What Does The Procedure Involve?

 

Radiofrequency Ablation is performed in an outpatient setting and does not require hospital admission. You are advised not to eat for six hours before the appointment.

 

After a consultation with the practitioner, you may be given the option to either receive a local anaesthetic or a combination of anaesthetic and a mild sedative. Some people prefer some form of sedation during this procedure especially if they are claustrophobic. It is up to you and your practitioner as to which option you choose.

 

You will be asked to lay down on your front. After an anaesthetic is injected into the area, an X-Ray machine will assist the practitioner in ensuring the needle and micro-electrode is placed into the correct part of the body. Your practitioner will spend some time ascertaining that he or she has located the correct nerves before the procedure begins. A test is performed to ensure that the motor nerves are not being targeted. A numbing agent is first used to reduce any discomfort in advance.

 

Then, a high frequency current that produces heat is transmitted into the nerves. Sometimes corticosteroids are also injected if there’s any inflammation detected.

While this procedure is relatively pain free, you should communicate with your practitioner if you can feel any discomfort so that the needle placement can be altered.

 

Following the procedure, a bandage is applied and you will be monitored for a short while to ensure you’re feeling well. It is recommended that you find someone else to drive you home, and that you avoid taking a bath or going swimming for at least 24 hours. The effects of the procedure should be felt quite quickly, but if the treatment hasn’t worked to its full potential it should be repeated after two or three weeks.

 

Nerves regenerate themselves after a period of time, usually between six and eighteen months following the damage inflicted by the treatment. However, this does not necessarily mean that the pain will reoccur in the same way as before.

 

What Are The Benefits?

 

The primary benefit for radiofrequency ablation is mid to long term pain relief for chronic pain problems. The relief lasts longer than steroid based therapies.

 

Approximately 70% of patients who use this therapy report an improved pain level although this is dependent on the particular condition that’s being treated. For neck pain specifically, the improvement rate is over 50% and if you have suffered whiplash, this treatment can prevent your pain from becoming chronic.

 

You will notice a greater range of motion in the days following the treatment as well as a better outlook on life due to minimal (or eliminated) pain.

As this is a minimally invasive procedure, you should be able to return to work the next day with vastly improved comfort levels.

 

To hear more about how radiofrequency ablation can help you, call us now.

 

 

SPINAL CORD STIMULATOR IMPLANTS

 Spinal Cord Stimulators

A spinal cord stimulator implant has two parts – the battery, which is attached to the subcutaneous soft tissues around the abdomen or buttock region, and the wire that is fed down the spinal canal. The wire is connected to the paddle lead that has diodes on it to deliver the electrical impulses. The battery is charged via a belt which can be worn to bed every couple of nights.

 

The device works by emitting pulses that change the way the brain receives pain signals. It is considered a last resort in cases where other pain management treatments have failed. It is also an option for people who have had failed surgeries in the past but continue to have chronic pain.

 

What Is It For?

 

Spinal Cord Stimulator Implants are for conditions that cannot be treated through other means of physical therapy, surgery or pain medication. Conditions can include:

 

  • Failed neck surgery syndrome
  • Peripheral neuropathy
  • Post laminectomy syndrome
  • Chronic pelvic pain
  • Diabetic neuropathy
  • Chronic abdominal pain
  • Chronic testicular pain
  • RSD
  • Coccydynia

 

What Does The Procedure Involve?

 

The first step to having a Spinal Cord Stimulator Implant fitted is to take part in a ‘trial run’. A trial implant is inserted during an outpatient visit. This will involve some level of sedation, but you will not be fully asleep as you may need to follow some minor instructions during the procedure.

 

A tiny incision is made and a catheter lead is inserted into the spinal canal. You will then be asked whether or not the electrical stimulation current is helping with any pain. The implant will be ‘programmed’ at this stage to ensure that all of your pain levels are being catered for. Then, the implant is left in place and a bandage will be placed over the area. Your physician will send you home, and after 5-7 days the implant will be taken out again.

 

At this stage, you’ll have a conversation with your practitioner where you can share your experiences wearing the implant.

If you both decide that the implant is worthwhile and has decreased your pain levels by more than 50%, you will be booked in for a more permanent implant.

 

The next procedure involves the need for general anaesthetic, so you will be unaware that it is happening. This is because the paddle lead used in the second procedure is slightly larger, and sometimes a small amount of bone is removed from your spine to create the perfect fit.

 

Once the implant is in place, the wire is pushed through soft tissue until it attaches to the battery that has been fitted into the abdomen or buttocks. The positioning of the battery is important to ensure that you do not sit on it or rub against it too frequently.

You will then be woken up and monitored for a short while before your care givers decide it’s ok to go home. In most cases you will go home the same day and will be able to function as normal the next day.

 

What Are The Benefits?

 

Spinal Cord Stimulator Implants are of great benefit to people who have tried everything else and had no improvement in pain levels. Typically, 50%-60% of patients obtain meaningful pain relief (which is considered to be a pain reduction of 50% or more). There have been some results of Spinal Cord Stimulator Implants being as effective as 80% in pelvic pain cases, and with technology always improving, these results are expected to get better over time.

 

The ultimate goal of this therapy is to achieve a better quality of life, with a better ability to partake in day to day activities.

What makes this treatment different to many other forms of interventional pain management therapies is that you can have a trial run to see if it works or not. This gives you the freedom to decide whether it’s worth undergoing a surgical procedure to have a permanent implant fitted.

If you’d like to hear more about Spinal Cord Stimulater Implants, call us now.

 

BOTOX INJECTIONS FOR MIGRAINES

 

While Botox is usually associated with cosmetic dermatology to smooth out wrinkles, it is also an effective treatment for people who suffer with chronic migraines.

 

It was first discovered in the 1990s that Botox happened to be reducing headache symptoms when patients were using it for other medical reasons. Following this discovery, the drug became licensed to use in chronic headache or migraine cases.

 

It works by releasing the chemical ‘botulinum toxin’ into the face or forehead muscles. This then ‘freezes’ the muscles, inhibiting pain by reducing the expression of certain pathways that contain nerves in the trigeminovascular system.

Chronic headaches are considered to be headaches that occur more than 15 times in a month. If this sounds like something you suffer with, this simple outpatient procedure could be for you.

 

What Is It For?

 

Botox can be used for a wide range of medical and cosmetic procedures, but in this instance it is suitable for chronic headache or migraine sufferers.

 

What Does The Procedure Involve?

 

A Botox session takes about thirty minutes. It does not require sedation or pain relief and is relatively pain free. It involves a small needle being injected into the skin until it reaches the muscle, which then pushes the toxin into the area. It’s likely that your practitioner will work on multiple parts of your head and face, including your forehead, temples, bridge of your nose and the back of your head.

 

You will be able to go home straight away and can continue your day as usual.

As Botox is impermanent, you may be asked to attend follow up sessions every few months to ensure your headaches stay away.

 

What Are The Benefits?

 

Headaches can be crippling and can cause conditions such as depression when left untreated. Having a persistent, regular headache interferes with everyday life, work attendance and socializing.

 

Botox is a simple, quick procedure that can provide relief for a number of months at a time.

Typically, after 12 months of treatments, 70% of patients report a 50% or more decrease in the regularity of headaches.

 

Furthermore, Botox is very well tolerated with the vast majority of patients reporting no (or very few) side effects.

If you think you might benefit from Botox injections to treat your persistent headaches, contact us now for more information.

 

 

KYPHOPLASTY AND VERTEBROPLASTY

 Kyphoplasty

Kyphoplasty and Vertebroplasty are similar procedures that treat vertebral compression fractures. This is a fracture of the spine and can occur when there’s a significant bone-calcium deficiency caused by osteoporosis. The procedure involves the injection of bone cement into the fractured area with an aim to stabalize the bones while minimizing pain.

 

A small balloon is also inserted to keep the bones in place as the operation is performed. While this procedure is conducted under general anaesthetic, it can still be performed in an outpatient setting. For best results, the procedure should be performed within 8 weeks of the fracture.

 

What Is It For?

 

Kyphoplasty and Vertebroplasty are treatments for the following conditions:

 

  • Vertebral compression fracture caused by osteoporosis
  • Vertebral compression fracture caused by bone malignancy
  • Vertebral compression fracture caused by trauma

 

What’s Does The Procedure Involve?

 

Due to the fact that this procedure is performed under general anaesthetic, there are a number of ways you can prepare in advance. It’s important you do not eat or drink after midnight before the treatment, and speak to your physician about any medications you are taking. A full medical history will also be discussed, as conditions like bleeding disorders can impact on the procedure. It’s also advisable that you arrange for someone to collect you and take you home after the procedure.

 

When you arrive at the clinic, you will sign a consent form and change into a gown. A nurse will fit you with an IV line. You will be given a general anaesthetic so that you fall asleep.

During the procedure you will be placed onto your front.

 

An incision will be made over the damaged vertebra and a needle equipped with a small balloon will be inserted into the bone. The balloon is then inflated and with the help of an X-Ray, the needle finds the exact spot where the fracture has occurred. The balloon assists in returning the bone to its correct placement before a cement is injected into the bone and left to harden.

 

After the treatment is finished, a bandage will be applied to the area and you will be taken to recovery and woken. A nurse will ensure that you’re well enough to be discharged, and once you get home you’re advised to rest for 24 hours. There may be some pain following the procedure so an ice pack can be used to relieve this symptom.

 

What Are The Benefits?

 

When the soreness from the procedure subsides, a reduction in pain is the primary benefit of the treatment. Both vertebroplasty and kyphoplasty are successful approximately 90% of the time in providing pain relief. The sooner the treatment is performed following the fracture, the better the expected outcome is. The reduction in pain will also assist in providing better overall mobility and quality of life.

 

 

FACET INJECTION

 

A facet injection is a minimally invasive procedure that can be performed as an outpatient appointment. It is used to treat back and neck pain. The injection delivers two drugs (corticosteroid and a numbing agent such as lidocaine) to the affected facet joint located at the spine. The corticosteroid acts as an anti-inflammatory which in turn relieves pain caused by the facet joint. This is a quick procedure with minimal downtime.

 

What Is It For?

 

Facet Injections can be used to treat the following conditions:

 

  • Spondylolysis
  • Herniated disc
  • Sciatica
  • Spinal stenosis
  • Trauma
  • Lower back pain
  • Neck pain

 

What Does The Procedure Involve?

 

When you arrive at the clinic for your procedure, you will be asked a number of medical questions to ensure your history is fully disclosed. Any blood thinners you’re taking may need to be ceased several days before the treatment.

 

Sedation is not necessary but in special cases it can be used to lessen anxiety. You will lay face down on a bed and a local anaesthetic will be administered to the area.

With the help of X-Ray equipment, a needle will be inserted into the facet joint. You are unlikely to feel any pain but may experience a pressure sensation.

 

The needle will then inject the two medications into the facet joint before being removed. A small bandage will be attached to the area and you will be permitted to go home as soon as you feel well enough to do so.

It is strongly advised that someone else drives you home following the procedure. Within 7 days you will be asked to discuss your pain levels with your doctor to ensure that the medication has worked. A second injection may need to be scheduled if the desired pain relief has not been achieved.

 

What Are The Benefits?

 

More than 50% of patients experience a varying degree of pain relief following a facet injection. For those who react well to the treatment, repeat procedures can be scheduled up to 3 times a year to maintain the effects. Some patients feel the benefits within a few days, where as others may take several weeks to notice any improvement.

This is a minimally invasive outpatient procedure that is quick to administer, making it convenient and effective.

 

 

MEDIAL BRANCH BLOCK

 

A medial branch block is a pain relief treatment specifically designed to help with arthritic pain. It focuses on treating the facet joints located in the spine. Approximately 350 million Americans suffer with arthritis and for many of these, pain management can be a challenge.

Each joint in the spine is supplied by nerves. The small nerve endings that come off the spinal nerve root are called medial branches. By blocking these nerves using an injectable numbing medication, the arthritic pain will also be blocked or significantly reduced.

 

What Is It For?

 

Medial branch blocks can benefit the following conditions:

 

  • Lower back pain caused by arthritis
  • Mid or upper back pain caused by arthritis
  • Referred pain originating at the facets but presenting in the neck or buttocks

 

What Does The Procedure Involve?

 

A medial branch block can be administered at a doctor’s office or any other outpatient setting. There is no need for sedation or general anaesthetic.

When you arrive at your appointment, a medical history will be taken. You will then lay down on your front and a numbing anaesthetic will be applied to the area due to be injected.

 

Contrast dye is injected into the joint to ensure accuracy and an X-Ray may also be used to ensure that the needle is inserted into the correct position. Then, both a numbing medication and a steroid will be injected so that it covers the medial nerves. The procedure only takes a few minutes and you should not feel any discomfort. After your practitioner has finished, you will be monitored for a few minutes and then be able to go home.

 

What Are The Benefits?

 

This quick and simple procedure is effective at reducing arthritic related facet pain.

The results of a medial branch block vary from patient to patient. It is beneficial to keep a pain diary following the procedure to measure your comfort levels. Typically, pain relief will be felt within 4-8 hours and you will also be able to continue with your medications after the procedure. It is reported that the average patient receives 4 months of distinctive pain relief following a medial branch block.

 

 

TRIGGER POINT INJECTION

 

A trigger point is a tight knot of muscle that is produced when a muscle is unable to relax. It can be very painful and uncomfortable, and often causes a deformity which interferes with day-to-day life and sleep quality. Causes of a trigger point can be poor posture, whiplash, emotional stress, poor back support, a sports injury or repetitive movements like clicking a mouse or playing an instrument. Due to the nerves in the area becoming trapped, trigger points can also cause referred pain in other areas of the body.

 

Trigger points are categorized as being ‘active’ or ‘latent’. An active trigger point produces pain even when resting. There tends to also be a referred pain. A latent trigger point does not cause persistent pain but does weaken and damage the muscles, restricting movement within that area.

 

A trigger point injection is a treatment that administers various medication such as local anaesthetic and corticosteroids into the trigger point to relieve the pain. Sometimes Botox is used. It is a minimally invasive procedure and is performed in an outpatient setting.

 

What Is It For?

 

Trigger point injections can be used to help treat the following conditions:

 

  • Migraines
  • Herniated discs
  • Whiplash
  • Fibromyalgia
  • Osteoarthritis
  • Scoliosis

 

What Does The Procedure Involve?

 

There is very little preparation required for a trigger point injection. You may be asked to change into a gown depending on where the trigger point is. Once the trigger point has been identified by the practitioner, they will simply inject it with the steroid and numbing medication.

 

You will only require a band aid over the injection spot and can continue with your day as usual. If there is any bruising, swelling or pain in the area, an ice pack can be applied to relieve the symptoms. Depending on how well you react to the treatment, it may be advised that you should go back for a follow up injection at a later date.

 

What Are The Benefits?

 

The primary benefit of a trigger point injection is decreased pain. 85% of patients who receive a trigger point injection report an improved pain level and mobility. Patients also find that they can take part in more everyday activities without having to worry about pain and can typically sleep better at night. It is a quick and minimally invasive procedure that can be performed in an outpatient setting with no need for preparation or recovery.