At Northwest Pain Care we use fluoroscopy and advanced fluoroscopic techniques when performing all spinal injections, providing the utmost effectiveness and safety for our patients.
Placement of steroids into the epidural space, a space just outside the spinal space, through which the nerves travel, can help with acute disc herniation pain, sciatica, pain from spinal stenosis and discogenic pain. There are 3 types of epidural steroid injections.
A very specific epidural that places a very small amount of local anesthetic (numbing medicine) and steroid (anti-inflammatory) around the inflamed nerve as it exits the spine. These can be performed in the cervical and lumbar region.
This injection places a larger volume of local anesthetic and steroid throughout the epidural space, targeting more than one spinal level. These can be performed in the cervical, thoracic and lumbar regions.
This injection places an even larger volume of local anesthetic and steroid at the lowest part of the epidural space near the tailbone. The medication diffuses upward to affect multiple levels.
This injection is often used when there is diffuse spinal arthritis, or when the patient has had previous surgeries, making a transforaminal or interlaminar injection difficult or impossible.
The facet joints are small joints located at every level of the spine on both sides that allow a person to twist and bend. Like any other joint, these joints can become injured and can get inflamed. They are a fairly common cause of neck pain, mid-back pain, and low-back pain. Steroid and local anesthetic can be placed directly into the joint to reduce inflammation and provide pain relief. These injections are generally done in the cervical or lumbar region.
Sometimes facet joints are not accessible, due to severe arthritis or facet joint injections do not provide long term relief. The medial branch nerve is a specialized nerve that supplies the facet joint. These nerves can be blocked with local anesthetic to diagnose facet joint pain. If two medial branch nerve blocks provide 80 % or more pain relief, a patient is then a candidate for radiofrequency ablation of these nerves for long term pain relief. These injections can be performed in the cervical, thoracic and lumbar region.
If a patient gets 80% or more pain relief with 2 medial branch nerve blocks, they are a candidate for radiofrequency ablation of those nerves. Radiofrequency ablation, in effect, “melts” the nerve. The procedure can provide long term pain relief. On average, patients can expect 8-12 months of relief. This procedure can be performed in the cervical, thoracic or lumbar region.
An inflamed sacroiliac joint can cause back and leg pain. The sacroiliac joint is commonly a pain generator in patients who have had previous back surgery. Sacroiliac joint disfunction can also be caused when a patients foot and leg is “jammed” into the pelvis during a motor vehicle accident. Injection of steroid and local anesthetic into the joint can provide significant pain relief.
The piriformis muscle, in the buttock region, can spasm, compress the sciatic nerve and cause sciatica. Injection of local anesthetic and steroid into the muscle can relax the muscle and provide significant pain relief.
Muscles can develop areas of tenderness with radiation of pain to areas outside of the tender point. Injections of a small amount of local anesthetic and steroid into the trigger point(s) can provide pain relief.
Some nerves can be injured,which can lead to pain syndromes. A common example is when the ilio-inguinal nerve is injured after hernia surgery. Nerve blocks can be effective in relieving pain.
To diagnose what nerve is causing pain, a small amount of local anesthetic can be placed near the nerve. If the pain goes away, that specific nerve is the likely cause of the pain. Often, spine surgeons will refer patients for these nerve blocks to determine in surgery will be effective.
Specialized nerves called sympathetic nerves can be “ tricked” into causing pain, leading to a pain syndrome called Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS). Sympathetic nerve blocks can diagnose and treat these syndromes. A stellate ganglion block, blocks the sympathetic nerve supply (link here, stay tuned) to the arm while a lumbar sympathetic block blocks the sympathetic nerve supply to the leg.
Pancreatic cancer can cause severe debilitating abdominal pain. The celiac plexus is a collection of nerves that supply the abdominal organs including the pancreas. Injection of alcohol around the celiac plexus temporarily kills the nerves and provides months of pain relief.
Chronic migraine headaches are very debilitating. When other medications and therapies have not been effective, botox injections into specific regions of the head can provide significant, long-lasting reduction in chronic migraine. It is a simple 10 minute procedure that is very well tolerated and repeated every 3 months.