Spinal cord stimulation (SCS) is an advanced procedure that has evolved in clinical use since the late 1960’s. It involves the placement of programmable electrodes into the epidural space where they emit signals to the spinal cord to mask pain signals.
If your physician recommends spinal cord stimulation, you will first undergo a trial placement in an outpatient clinic setting. Electrodes will be placed with x-ray guidance and custom programmed to provide relief of your pain condition. Over the next 3-5 days you will be able to test the spinal cord stimulation system to see how much it relieves your pain and improves your function.
If the trial is successful, then you will be scheduled to undergo surgical implantation at an area hospital. The implantation is like that required for placement of a pace-maker and does not require an overnight stay in-hospital.
Published studies on spinal cord stimulation have shown that when used in properly selected patients it can offer the following benefits:
The sympathetic nervous system helps control many functions in your body (blood pressure, sweating, peripheral blood flow) and is usually not involved in pain sensation. However, in some pain conditions, such as Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD), the sympathetic nerves become activated in an abnormal way and begin to transmit pain.
Blocking these sympathetic nerves can improve pain and a positive response is also useful in helping to provide a diagnosis for your pain.
Sympathetic blocks are done with either x-ray or ultrasound guidance, and all involve the injection of local anesthetic around bundles of nerves. The blocks may be done initially in a series of three over 6 weeks, but in some patients, are repeated several times per year.
Sympathetic blocks can be done at five different levels of the spine, depending on the area and type of pain involved:
This procedure, which does not require x-ray or ultrasound guidance, is for the treatment of painful areas of muscle tension or spasm. Muscle spasms in the neck, low or middle back can be quite painful and may persist for weeks to months.
Trigger point injections involve the placement of a thin needle directly into the worst areas of pain for injection of local anesthetic and sometimes steroid. They can provide pain relief for weeks to months, and can also be useful for treating pain associated with Fibromyalgia or tension-type headaches.
If you have joint pain due to osteoarthritis your physician may recommend joint injections as part of your treatment plan. Injections of steroid and local anesthetic can provide good lasting relief of pain arising from essentially any peripheral joint to include the knees, hips, shoulders and elbows.
Some joint injections are best performed with x-ray guidance, while others are performed with ultrasound guidance.
Platelet-Rich Plasma (PRP) therapy is an innovative approach to promote and stimulate healing from a tissue and bone injury using body’s own cells (autologous). Platelet-rich plasma therapy uses blood plasma that has a high concentration of platelet cells. Platelets are “first responders” of the body to the site of injury and contain growth factors and other cell types called cytokines that start the healing process.
Several clinical trials have shown this therapy to be effective and safe to treat various forms of muscle, tissue and joint disorders. It is also used to target pain generating from arthritis of the shoulder, knee, elbow and spine. It is also now commonly utilized to target soft tissue and fascia related pain in neck, feet and lower back.
It is an FDA approved non-surgical treatment that is safely performed in an office setting without the need for sedation or anesthesia. Platelet-rich plasma therapy has gained international attention from the medical communities and media by demonstrating its benefits in treatment of injuries sustained by several high profile professional athletes throughout the world.
Benefits of treating chronic pain with Platelet-rich plasma therapy therapy may include:
The facet joints are small joints on the back of your spine, and are found in all levels from your low-back to your neck. Facet joint pain is usually due to arthritis or degeneration of the joints and is usually described as an ache that stays along the spine and is worse with prolonged sitting, standing or driving. If your pain condition is consistent with facet joint pain, your physician will likely recommend one of the following procedures.
Facet Joint Injections
One method for relieving facet joint pain is to directly inject steroid and local anesthetic into the affected joints themselves. Facet joint injections are performed with x-ray guidance.
Medial Branch Blocks
The small nerve which transmits pain impulses from the facet joint is called the medial branch nerve. This nerve can be blocked by the injection of local anesthetic and steroid under x-ray guidance.
Medial Branch Radio frequency Ablation (RFA)
In cases where either medial branch blocks or facet joint injections provided good relief that did not last enough, radio frequency ablation may be performed to provide longer pain relief. RFA also targets the medial branch nerve, but uses radio frequency energy (a type of heat) to stun the nerves. This procedure can provide pain relief for up to 6- 12 months.
Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve pain. They are most commonly performed for patients with spine pain and radiating pain into either the arms or legs.
Injections are performed under X-ray guidance. If an initial series of three injections fails to provide lasting relief, your physician will discuss options for altering the treatment plan.
There are three different ways to do an epidural steroid injection and your physician will choose the route that offers the best chance of relieving your pain based on several factors.
Caudal Epidural Steroid Injections
The Caudal approach involves an injection at the base of your spine near your tail bone. An advantage of this approach is that it can be done easily even if you have had major spine surgery.
Interlaminar Epidural Steroid Injections
The Interlaminar approach can be performed at all levels of the spine from the low- back to the neck. This approach may not be possible if you have had spine surgery in the injection area. An advantage of this approach is that medication may be delivered closer to the area of pain.
Transforaminal Epidural Steroid Injections
The Transforaminal approach involves placement of the needle into the area where your spinal nerve exits the spine. It can be done throughout the spine, but is done most frequently in the low-back. This approach can be used in areas of prior surgery, and may deliver medication most accurately to the area of nerve irritation.
The greater trochanter is located at the side of your hip on each side. The trochanter has a cushioning bursa that overlies it, and this bursa may become inflamed causing trochanteric bursitis. This pain is typically felt as a severe tenderness over the hip pointer that is worse with any pressure or when you lie on that side to sleep.
Injections of local anesthetic and steroid under either x-ray or ultrasound guidance can provide good lasting relief of this pain, and may be done every several months.
Myofascial Release Overview
Pressure on sensitive points in the muscle may result in pain. Myofascial pain syndrome can occur after repeated injury or overuse of muscles. Sometimes it manifests a tender muscle knot and pain can be persistent.
A focus of treatment is the release of muscle tightness for symptoms of decrease in flexibility, soft tissue dysfunction in any part of the body. Conditions such as muscle dysfunction from injuries, fibromyalgia, and migraines, etc. may benefit from treatment. Myofascial release may be followed by trigger point injections to provide additional benefit.
FAQs about Myofascial Release
How long does it take?
Depending on the number of areas to be treated, may take 10 minutes to 45 minutes or more.
How will I feel afterward?
Relief of a percentage of muscle tightness is appreciated during and after treatment. Continued relief may be felt beyond that point. May experience muscle soreness in treated areas for a few days.
How long will the relief last?
Pain relief is variable from individual to individual, but can last up to 1 week to 1 month or beyond.
Sacroiliac joint Dysfunction Overview
Sacroiliac joint is formed from the connection of sacrum with the pelvis on either side. Sources of pain or inflammation can result from degenerative joint changes, decreased or increased range of motion, injury, dysfunction of surrounding soft tissue structures. This can cause pain on either side of buttocks just below the lumbar spine.
Sacroiliac Joint injection
Under Fluoroscopic guidance, Injection of steroid and local anesthetic into the joint space to aide in decreasing the inflammation, relieve pain, and improve functioning.
Lateral Branch Blocks
The lateral branch nerves are small nerves that branch off the sacral spinal nerves and provide sensation to the sacroiliac joint. These nerves can be blocked by the injection of local anesthetic with or without steroid under X-Ray guidance. If beneficial, radiofrequency ablation of the nerves can be performed to provide longer lasting relief.
Lateral Branch Radiofrequency Ablation (RFA)
In cases where either the sacroiliac joint injection or the lateral branch blocks provided good relief but did not last long enough, radiofrequency ablation may be performed to provide longer lasting relief. RFA targets the nerves by using heat energy to stun the nerves. RFA can provide relief for up to 6-12 months.
FAQs about Sacroiliac Joint Treatments
Piriformis Overview
Tightness and inflammation of the piriformis muscle can cause back or buttock pain that is usually worse with prolonged sitting. The sciatic nerve may be irritated by tightness of this muscle which may lead to nerve pain in the lower extremity that can be similar to that caused by a herniated disc in the lumbar spine.
Under Fluoroscopic guidance, Injection of steroid and local anesthetic into the piriformis muscle with can aide in decreasing the inflammation, relax the muscle and relieve pain.
FAQs about Piriformis Injections
How long does a Piriformis injection take?
Injections into the piriformis muscle usually take 10 to 15 minutes.
How will I feel afterward the injections?
Relief of buttock and sciatica pain is usually noticed shortly after the injection due to the use of local anesthetic, but steroids take effect in 24-48hrs.
How long will the relief last?
Pain relief is variable from individual to individual, but can last up to 2-3 months.
Genicular nerve/knee pain overview
Knee pain can be chronic, debilitating, and can lead to loss of function. Genicular nerve blocks are indicated for those who have osteoarthritis (DJD), those who want to avoid knee replacement, those who have had knee replacement or any type of knee surgery, and those with chronic knee pain.
Genicular Nerve Blocks
The genicular nerves transmit pain impulses to the knee and surrounding structures. These nerves can be blocked by the injection of local anesthetic and with or without steroid under x-ray guidance.
Genicular Radio Frequency Ablation (RFA)
In cases where the genicular blocks provide good relief that did not last enough, radio frequency ablation may be performed to provide longer pain relief by stunning the nerves.
FAQs about Genicular Nerve Blocks/RFA Treatments