Pain Management
Pain Management
Caudal Steroid Injections are particularly effective for the pain caused by sciatica, bone spurs, herniated discs and other problems that affect the lower back and legs. It is estimated that 40-70% of adults suffer from this type of pain. Caudal Steroid Injections contain a combination of an anesthetic and a steroid to reduce pain and help minimize inflammation.
It is a simple outpatient procedure and patients often feel some relief from pain within 30 minutes of the injection. The benefits of Caudal Steroid Injections can last a few weeks to several months. For more chronic and recurrent pain, a series of injections may be recommended. Facet joints are found on both sides of the spine. They not only connect the vertebrae, but they also help guide the spine during movement. If there is an irritation or injury to the cervical facet joint it produces pain which could range from simple tension in the muscles to more severe pain.
This pain often occurs from the head down to the shoulder blades. An Epidural Steroid Injection (ESI) reduces inflammation and pain caused by nerve root compression. Herniated discs, bone spurs, and spinal stenosis may all contribute to nerve root compression causing major inflammation and pain. The injection itself combines a local anesthetic with a corticosteroid.
Since corticosteroids are powerful anti-inflammatory medicines they significantly reduce swelling and inflammation thereby taking pressure off the nerves and relieving pain. Once inflammation is reduced and the nerve root is no longer compressed, the healing process can begin. At each segment of the spine there are small joints called facets. These facets help provide stability as well as guide motion. Facet joint injections are used for cervical, thoracic or lumber facets. A small amount of anesthetic such as lidocaine along with an anti-inflammatory steroid is injected into the facet joint to block pain.
The procedure is commonly done without sedation, however if the patient is particularly anxious, an IV line can deliver relaxation medication. Interventional Pain Management provides patients with multiple specialists to create the best treatment plan to alleviate pain. Since there are various components to a person’s pain, there is a collaboration between specialists to provide therapies that will work best to treat each patient.
Chiropractors, Pain Doctors and Acupuncturists may work together to provide all options a patient may need for a successful outcome. A joint injection is usually an injection of a medication into a joint or any place where two bones may rub against each other. An anesthetic such as lidocaine may provide immediate pain relief to the area of the injection. If it does, this also provides a diagnosis as to the source of the patient’s pain.
To provide more long term pain relief, a time-release steroid such as cortisone would also be administered to reduce inflammation. Spinal injections are used both for diagnosis and treatment. Your doctor will choose a diagnostic spinal injection based on a physical and neurological examination as well as your medical history. It can administered to diagnose the source of pain in the back, neck or limbs. |
Nerve blocks are used for pain treatment and management. Often a group of nerves called a ganglion causes pain to a specific organ or area of the body. This pain can be blocked with an injection of medication into that particular group of nerves. The injection of this nerve-numbing medication is called a nerve block. Radiofrequency Ablation, also called Radiofrequency Neurotomy is a type of injection procedure used to treat nerve pain in the facet joints. This technique is useful for patients who may have experienced only short term relief following anesthetic blocks. Radiofrequency energy has the ability to completely disrupt specific nerves so they can no longer transmit pain.
Several factors can contribute to facet joint pain such as injury to the back, spinal stenosis and osteoarthritis. Once the specific nerves have been identified, radiofrequency waves are passed through the tip of needle creating heat. This heated tip is then used to create a heat lesion directly on the nerve. Once this occurs the nerve’s ability to send pain signals to the brain is diminished and the patient’s pain is reduced or completely eliminated. Pain in the arms or legs often occurs when a nerve is compressed, what we commonly refer to as a “pinched nerve”. An Epidural or spinal injection can relieve this pain by delivering an anesthetic along with a steroid near the compressed nerve.
The anesthetic helps to immediately relieve the pain while the steroid acts as an anti-inflammatory. Along with spinal injections a doctor may recommend an exercise program to improve or maintain spinal mobility. Spinal cord injury may be the most devastating orthopedic injury to deal with physically as well as emotionally. The goal of rehabilitation is achieve maximum physical recovery as well as prevent secondary complications. Along with the trauma of the physical injury there may be emotional as well as behavioral concerns. For these reasons Spinal Rehabilitation is always a team effort.
The Spinal Rehabilitation Team works under the direction of a Physiatrist, a physician whose specialty is physical medicine and rehabilitation. Those specialists include Physical Therapists, Occupational Therapists, Psychologists, Rehabilitation Nurses, Speech Language Pathologists as well as Case Managers and Social Workers. The combination of each specialist’s expertise is essential to the patient’s highest level of recovery. Trigger points are painful areas in the body that can develop due to injury or overuse. They can develop after a single injury or through a series of repetitive movements. Muscles can even be strained by incorrect posture. They are often thought of as a “knot” which produces spasms of pain. The most common areas are in the back, neck and shoulders although they can also develop in the arms and legs as well. These trigger points may contribute to symptoms such as dizziness, headaches, carpal tunnel syndrome and jaw pain.
As muscles begin to tighten and sometimes shorten, spasms of pain are felt in the trigger point. This pain is temporarily relieved by massage or hot compresses but the trigger point will remain. Trigger point therapy is needed to eliminate the tissue and muscle tightness in the affected area. A Chiropractor may feel for lumps or bands in the muscle itself. Once the trigger point is found, deep pressure is applied with the thumbs and fingers. Depending on how the muscle responds to pressure, the Chiropractor will continue this pressure until the trigger point relaxes. Deep tissue massage is then performed to help eliminate the trigger point. An acupuncture needle may also be used to help inactivate the trigger point and increase the blood flow to the area. Workers Compensation is an insurance program that provides compensation for lost wages due to a work-related illness or injury. Benefits also include services such as rehabilitation and physical therapy to help an employee recover and eventually return to their job. |