Treatment Options
We provide multiple treatment options for
your patients, Including:
Non-Invasive
Consultation with consideration for
multidisciplinary pain management including referral to physical therapy
and pain psychology for multimodal care.
- Pharmacologic therapy
- Physical therapy
- Relaxation techniques
- Massage therapy
- Biofeedback
Non-Surgical Minimally Invasive
- Injection therapy including:
- Epidural steroid injections transforaminal/interlaminar
- Facet joint injections
- Trigger point injections
- Sacroiliac joint injections
- Diagnostic medial branch block
- Peripheral nerve block
- Sympathetic nerve blocks
- Chemical neuroablative techniques
- Provocative discography
- Radiofrequency facet joint denervation
- Lysis of adhesion
- Spinal opiate trials
Surgical
- LASE
- Percutaneous disc decompression – nucleoplasty
- Intradiscal electrothermic therapy (IDET)
- Annuloplasty or disctrode
- Vertebroplasty ganglionotomy
- Epiduroscopy
- Spinal cord stimulation
Interventional Therapies
Epidural Steroid
Injections
An Epidural Steroid Injection is a relatively
safe injection of a special medication into a small space in the back. A
lower back procedure is a Lumbar Epidural Steroid. A neck area procedure
is a Cervical Epidural Steroid. An anesthesiologist administers the
medication for controlling pain.
Facet Joint Injection
Irritation of facet joints in the spine can
cause significant pain which can be difficult to diagnose and treat.
This technique facilitates the diagnosis of certain pain syndromes. It
can also provide long term pain relief. The procedure is done in the
operating room with intravenous sedation. X-ray guidance is required.
Radio Frequency
Radio Frequency Neuroablation is similar to
cryotherapy, but the technique uses radio-frequency electric current to
heat a needle tip and thereby uses heat to achieve the same result.
Each technique has advantages and disadvantages, and the individual
patient situation dictates the best approach for any particular
situation.
Radio Frequency denervation is done as an
outpatient or office procedure. The physician generally sedates the
patient, and a needle is placed through the skin until it enters or
approaches the appropriately identified area. Once the needle is
positioned, and this position is checked with an X-ray (fluoroscope), a
little local anesthetic medicine is injected, again to verify needle
placement, and an electrical current is passed through an element in the
tip of the needle, which heats it to approximately 150-200 degrees. Once
the nerve is destroyed with the heat, the needle is withdrawn.
For approximately 2 to 4 weeks after the
procedure, pain may be experienced in the involved structures, a direct
result of the tissue burn. This pain resolves, and successful
resolution or reduction in pain levels can be expected in approximately
70% of patients. This treatment may have to be repeated about every six
months or so because nerves do grow back.
Epidural Blood Patch
This is a technique used to terminate a
severe headache sometimes experienced after having a spinal tap for a
myelogram, other diagnostic study or anesthesia administration. It is
done after all conservative measures have failed to give relief. It
consists of placing 10 cc of the patient's own blood, under sterile
technique, into the epidural space at the place where the spinal tap was
done. This seals the area so that no more spinal fluid will leak out.
The leaking of the spinal fluid is what caused the headache in the first
place.
Spinal
Endoscopy (Epiduroscopy)
Epidurscopy is a minimally invasive procedure
preformed in the operating room under x-ray guidance. The procedure is
indicated for patients suffering from radicular back pain and who have
failed conservative therapy. These patients often have nerve roots that
are encased in adhesive scar tissue, causing traction on the nerve root
and chronic inflammatory reactions. The epiduroscopy allows separation
of scar surrounding the inflamed nerve roots which will allow injected
medications to reach the nerve roots directly. I.V. sedation is
administered for this procedure. This new technology may provide long
term relief from pain.
Focused Neurolytic Blockade
Neurolytic blockade of peripheral nerves
should be reserved for instances in which other therapies (palliative
irradiation, TENS, pharmacotherapy) are ineffective, poorly tolerated,
or clinically inappropriate. Suitable targets for this approach include
intercostal nerves at the site of painful tumor, after maximal doses of
radiation and systemic analgesics, or nerves of the head and neck (e.g.,
gasserian ganglion). Pain recurrence due to neuritis is common because
an alcohol-damaged nerve regenerates over weeks to months. If the
mechanism of pain is partial or complete denervation, this will not be
corrected (and may potentially be worsened) by further chemical damage
to the nerve.
Implantation Therapy
Implantable Spinal Cord Stimulators can be
utilized in pain medicine to provide relief of chronic pain where all
pharmaceutical therapies have failed. We have forever been frustrated by
the inability to effectively treat patients who have received little or
no relief from multiple back surgeries while failing response to
conventional methods of pain control.
Dorsal Column Stimulation
One therapy offering possible hope to
patients is Spinal Cord Stimulation. SCS is the electrical stimulation
of a precise level of the spinal cord to generate parasthesia (tingling
sensation) in the appropriate areas to overlay the portions of the cord
producing the pain. An epidural lead is placed in the appropriate area,
connected with cabling subcutaneously (under the skin) to a power
source. The electrical stimulation can be externally controlled
according to the needs of the patient. Operation of the system is simple
enough that a majority of patients find it possible to self manage their
pain.
Rehabilitative Therapy
Occupational Therapy
Therapeutic use of self-care, work, and recreational activities to
increase independent function, enhance development, and prevent
disability; may include adaptation of tasks or environment to achieve
maximum independence and optimum quality of life.
Physical Therapy
The health profession concerned with promotion of health, with
prevention of physical disabilities, with evaluation and rehabilitation
of persons disabled by pain, disease, or injury, and with treatment by
physical therapeutic measures as opposed to medical, surgical, or
radiologic measures.