Pain Management

Pain is more than just a discomfort. It can be described as an emotional experience associated with actual or potential tissue damage. It propagates within the sensory nervous system but can physical implications throughout the body.

What are the types of Pain?

Pain can be somatic, neuropathic or visceral depending on its origin:
Somatic pain is coming from structures like bone, muscles, joints etc and is often a dull, achy type of pain.
Neuropathic pain comes from nerves and is usually burning, throbbing, with tingling and numbness.
Visceral pain originates from internal organs like pancreas, liver, bowel, kidney, uterus.

Any of these types of pain can result in limitations in daily function and potentially diminished quality of life.

Who gets affected by pain and what causes it?
Approximately 90% of the U.S. population will have some type of pain condition in their lifetime. Often times, a traumatic injury sets off a cascade of inflammation, which then precipitates the pain symptoms. This pain may be short-lived and brief, or can continue and require further care.
What are common conditions of pain?
While low back pain remains the most common location for pain, other sites include cervical neck pain, mid-back, arms, legs, and virtually any part of the body.

Conditions such as lumbar radiculopathy, cervical radiculopathy, carpal tunnel syndrome, tarsal tunnel syndrome, headaches, osteoarthritis, rheumatoid arthritis, fibromyalgia, and post-operative surgical pain are also commonly seen and treated.
What should you do when you are in pain?
Pain may be an indicator of something abnormal in your body. Most often, pain may resolve within a few days with minimal or no treatment at all. However, if your pain remains disruptive, we encourage you to seek medical attention. Always speak with your primary care physician and consider a consultation with a pain management specialist.
Who should you see?
There are different categories of pain specialists. We offer highest level of expertise, a Board Certified Pain Management Physician to assess and treat your pain.
How do we treat pain?
We offer a multidimensional approach to pain including medications and physical therapy. Additionally, interventions (like epidural, facet, sacroiliac injection, selective nerve block, radiofrequency, occipital nerve block, etc) may be highly beneficial in select populations. Whatever the need, we work with our patients to provide the safest and best relief possible.

 

Our Pain Services

Epidural Injection
An epidural injection places anti-inflammatory medication into the space that covers nerve roots in order to reduce inflammation of these roots. By stopping or limiting this nerve root inflammation, we may be able to reduce your pain, aid in healing of the roots, and improve overall function over the course of the following days and weeks. It may even provide permanent relief or provide enough pain relief to allow for other treatments such as physical therapy.
Cervical Thoracic & Lumbosacral Nerve Root Block
Nerve roots exit your spinal cord and form nerves that travel into your arms or legs. Nerve roots may become inflamed and painful due to irritation or trauma, for example, from a damaged disc or a bone spur. A selective nerve root block provides important information to your physician regarding which nerve is causing pain by placing numbing medicine over the nerve root. Additionally, this procedure may also provide long term pain relief.
Spinal Cord and Peripheral Nerve Stimulation
Neurostimulation works by intercepting pain signals before they reach the brain. To do this, a small system is implanted within the body to replace pain with a sensation of gentle massage or the absence of pain altogether. Prior to the permanent placement of this device, there is a trial period during which we assess your response to the stimulator leads. If you obtain significant pain relief during the trial period with improved function, the next step would involve permanent implantation of the lead, a minor outpatient surgical procedure.
Sacroiliac Joint Injection
The sacroiliac joint is a large joint in the region of your low back and buttocks. When the joint becomes painful it can cause pain in its immediate region or it can refer pain into your groin, abdomen or leg. The sacroiliac joint injection serves both diagnostic and therapeutic purposes. Initially, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. Thereafter, the pain relief of the numbing medicine may better allow a physical therapist to treat the joint.
Discography
The discs are soft, cushion-like pads that separate the hard vertebral bones of your spine. A disc may be painful when it bulges, herniates, tears, or degenerates, and may cause pain in your neck, mid-back, low back, and/or arms and legs. A discography confirms or denies the specific disc(s) as a source of your pain. It uses a small needle to inject contrast dye into your disc and can determine if the disc itself is a source of your pain while MRI and CT scans only demonstrate anatomy and cannot absolutely prove your pain source.
Diagnostic Medial Branch Block - Cervical/Thoracic/Lumbar
Facet joints are connections between the bones (vertebraes) of the spine. Like any other joint in the body they enable bending or twisting movements, specifically of the spine. The facet joints can get inflamed secondary to injury or arthritis causing pain and stiffness. They are innervated or “supplied” by nerves called “medial branches” which carry the pain signals to the spinal cord and eventually reach the brain. With a medial branch block, these nerves are numbed and will not carry pain sensation to the spinal cord in the short term. If successful, we can use a procedure called “Radio-Frequency Neurotomy” and prevent the conduction of pain information for several months.
Cervical, Thoracic and Lumbar Medial Branch (Facet) Radiofrequency Neurotomy (Rhizotomy)
A medial branch neurotomy is a non-surgical procedure which cauterizes the nerves (through very localized heating) that cause you to feel the pain in your facet joints. Prior to this procedure, we often previously numb the medial branch nerves (through a medial branch block) to see if you were a candidate for the neurotomy. By performing the Rhizotomy, you will have pain relief for longer duration, possibly for several months or may never return at all. The neurotomy, if successful, theoretically prevents the pain signal from traveling through these nerves (from your joints to your brain) so you cannot feel or sense your injured and/or diseased spinal joints.
Sympathetic Block
The purpose of this injection is to calm down or “block” the hyperactivity of the sympathetic nerves. The procedure involves the injection of a local anesthetic around a group of nerves in your neck or low back. The long term goal is for reduction and elimination of pain, swelling, and temperature change of the extremity as well as to increase dexterity.
Occipital Nerve Block
Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing or electric-shock-like chronic pain in the upper neck, back of the head and behind the ears, usually on one side of the head. An Occipital Nerve Block is an injection of a small amount of local anesthetic and a small amount of steroid into the area of the occipital nerve to alleviate these symptoms.
Hip Joint Injection
The hip joint is a large joint where the leg connects to the pelvis. This connection can become inflamed from arthritis, causing pain and decreased mobility. The hip joint injection helps to confirm the joint as a source of the pain and treats any inflammatory component that may exist.