Precision Nerve Injections
A precision nerve injection is a minimally invasive procedure used to relieve pain caused by inflamed facet joints or pinched nerves. It is often used to relieve neck pain or back pain. This treatment effectively relieves pain and results can last up to several months or even several years.
The injection numbs the medial branch nerves (the nerves that supply the facet joints with sensation). This allows a doctor to determine if the pain is actually coming from the facet joint. If the joints are determined to be the source of pain, the doctor will inject the joints with a combination of local anesthetic and steroid. If the pain is determined to be a result of a pinched or damaged nerve, doctors will inject in and around that particular nerve with the same combination of local anesthetic and steroid. All injections are done with the help of x-ray guidance to ensure the injection is as precise as possible.
Dr. Malone Explains How Precision Nerve Injections Work:
Radiofrequency ablation is a minimally invasive medical procedure used to reduce pain by destroying nerve tissue. Radiofrequency ablation uses heat generated from a radio wave to remove nerve tissue, thus decreasing pain signals from that area.
Because radiofrequency ablation does not directly stimulate the nerves, it can be used without the need for general anaesthetic. Radiofrequency ablation has become increasingly accepted in the last fifteen years with promising results.
Intradiscal Electrothermal Annuloplasty
Intradiscal electrothermal annuloplasty (IDET) is a minimally invasive procedure that can be used to reduce lower back pain caused by the lumbar disc. The procedure was developed in the late 1990s, so it is still relatively new. The entire process takes about an hour. Here is how it works:
- Before beginning the procedure, the patient will be given local anesthetic and mild sedation.
- The doctor will then inset a hollow needle into the lumbar disc. This is done using x-ray guidance to ensure precision.
- Next, the doctor will place a heating wire through the hollow needle. The tip of the heating wire will reach about 90 degrees Celcius.
- The heat will change the collagen fibers located within the lumbar disc. This process should burn the nerve endings, thus damaging or destroying the pain receptors.
- The heating wire and the needle is then removed from the patient’s lumbar disc. After a short period of observation, the patient will be allowed to leave.
- Following the procedure, the patient is to wear a lumbar support for 6 to 9 weeks. Physical therapy may also be prescribed as well.
Spinal Cord Stimulation
Spinal cord stimulation, also referred to as neurostimulation therapy, works to relieve pain by blocking pain signals from reaching the brain. This procedure pulses electrical signals to the area surrounding the spinal cord. It is often used to relieve lower back pain and leg pain.
The neurostimulator is a small, pulse generator which is implanted just beneath the patient’s skin near the spinal cord. The patient is provided with a control to turn the neurostimulator on and off as needed. This control can also be used to adjust the levels of stimulation the patient experiences. The electric pulses produce a mild, tingling sensation in the place of pain.
Unlike many other surgeries, spinal cord stimulation is completely reversible. At any point in time, the patient is able to turn off or even completely remove the neurostimulator.
Dr. Malone Explains How Spinal Cord Stimulation Work:
Epidural Steroid Injection
Implantable Morphine Pumps
Intrathecal pumps are used to administer medication straight into the spinal fluid of patients. Only a small amount of medication is needed since it is delivered directly to the pain receptors. As you may have guessed, an implantable morphine pump is an intrathecal pump which delivers morphine to the patient’s spinal fluid.
The entire arrangement consists only of a pump and a catheter. The pump is the small, battery-powered device which holds and administers the morphine. The catheter is a thin tube which is connected to the pump and inserted into the patient’s spine. Both devices are implanted just beneath the skin.
Using a small needle, the doctor will fill the pump with morphine. The pump will send the morphine through the catheter and into the spinal fluid.
The physical therapy department at Advanced Pain Care focuses on the musculoskeletal needs of our patients.
The physicians, physical therapists and occupational therapists all work together with the patient (and his or her family members) to better aid in the recovery process. To begin, the physician will determine the extent of the patient’s injury or condition and, if necessary, the type of surgery required. Based on this initial medical evaluation, the physician may recommend physical and occupational therapy. The rehabilitation program is based upon this initial evaluation. The physician then provides the physical therapist with prescriptions for the patient’s recovery process. The physician will include a diagnosis if possible and provide a recommendations for treatment.
Treatment plans are designed to meet the both the patient’s and the doctor’s specific goals. The physical therapist develops a personalized exercise program for each patient based on their medical condition; the program may include a muscle strengthening program, a flexibility and general conditioning program, or a pain management program.
Pharmacologic treatment is the foundation of pain therapy. Nearly half of individuals who suffer from pain choose a non-prescription analgesic (e.g., Advil, Excedrin, Tylenol ) as their initial choice for pain relief. When necessary, physicians will prescribe their patients prescription-strength pain medication.
Although invasive methods are sometimes required, most pain can be relieved through prescription and non-prescription analgesics. There are three basic categories of pain medications: non-opioids, opioids and co-analgesics. A doctor will individualize the pain management regimen by prescribing the appropriate medication. Before prescribing pain medication, a physician should gather important history of the patient including age, coexisting diseases, other medications currently being taken, preferences, responses to previous treatments, allergies, an accumulation of toxic metabolites and for addiction potential. Once all factors have been examined, the pain care team can establish a management plan.