Interventional Pain Management

Interventional Pain Management

Interventional Pain Management

When conservative options like physical therapy, home exercise programs, medications, stress reduction, and psychology are not completely effective in treating neck (cervical), mid back (thoracic), and/or low back (lumbar) pain, interventional pain management techniques are the next treatment alternative to try to avoid surgery.

These procedures include:

Interlaminar epidural injections

The needle is introduced, and medication injected, in the posterior space between two vertebrae.

Intra-articular facet blocks

Medication is injected in the joint, called a facet, formed by two vertebrae.

Selective nerve root injections

The needle is advanced into the foramen, or small orifice, where the spinal nerves are located to block their pain signals.

Sacroiliac jointinjections

Injecting medication into the joint formed by the hip bone and the tail bone.

Diagnostic medial branch block

Blocking the medial branch, which sends pain signals to ligaments, muscles and the facet joints, with an anesthetic (Marcaine). If effective in decreasing pain, this block is followed by a radiofrequency ablation.

Radiofrequency ablation

With the use of a special needle, heat is used to burn the medial branch, therefore eliminating the nerve signals that cause pain in the ligaments, muscles and facet joints. This procedure could last from 6 to 24 months.

These modalities are used to treat multiple conditions, for example:

  • Sciatica – A condition caused by pressure or inflammation on the longest nerve of the body, the sciatic nerve. Most of the time, it presents as numbness, tingling, weakness and shooting pain from your back or buttock, down the leg into your foot. This painful condition can be caused by prolonged sitting, being overnight, direct trauma, pregnancy, and Piriformis Syndrome.
  • Radiculopathy – A compression or irritation of spinal nerve as it branches away from the spinal cord. Commonly called “a pinched nerve,” it mostly presents as tingling, numbness, weakness and pain down your arms or legs. Causes of radiculopathy include spinal stenosis, arthritis, disc herniation, degenerative disc disease and spondylolisthesis ( when a vertebra slips forward or backward).
  • Headaches – When headaches are caused by cervical spine arthritis and degeneration or neuralgia, they can be treated with a radiofrequency ablation.
  • Failed back syndrome – Persistent pain in the neck, back, upper or lower extremities after undergoing spine surgery. It has been reported that about 40% of patients experience intractable, recurrent pain after surgery that prevents them from returning to their normal activities.
  • Sacroilitis – Inflammation of the sacrolliac joint. Even though it does not move much, it can cause low back pain and, at times, leg pain. This joint connects the spine to the pelvis, and functions as a shock absorber and stabilizer of the upper body.
  • Disc herniations – Discs are cushions of fibrocartilage located between the bones, or vertebrae, that make up our spine. Their main responsibilities are to absorb shoch, transmit loads through the vertebral column and allow movement between adjacent vertebral bodies. A herniated disc occurs when its inner gel-like structure, or nucleus, slips out through a tear of its fibrous, outer layer called the annulus. As a result, these hermiations can irritate nerves which send pain signals to your neck, back, and your upper or lower extremities. The most common causes are the natural aging process, as well as any event that will create greater pressure inside the disc than what it can handle like, for example, heavy lifting, trauma, motor vehicle accidents, and sport activities.
  • Spondylosis – The term is used to describe spinal arthritis, or when Osteoarthritis starts to affect the spine, specifically the facet joints formed between adjacent vertebrae. Most commonly, it presents with pain in the neck, mid-back and/or low back areas without radiculopathy, although at times it can also radiate down the extremities. Usually, symptoms are worse with extension and rotation of the spine.
  • Spinal Stenosis – When the space in the spine canal narrows causing compression and creating pressure on the nerve roots. Since it is most frequently caused by degeneration of the spine as we age, it is more common in patients over 50 years of age. Other causes of spinal stenosis include disc herniations, spondylolisthesis, tumors, fractures, a congenital condition and scoliosis. Typically patients present with neck or back pain accompanied by arm or leg pain, numbness, tingling, burning, heaviness, or weakness. In the lower back, these symptoms are worse with prolonged standing or walking, and Improved with lumbar flexion, or bending forward.

To maximize proper needle placement, treatment success and, more importantly, patient safety, all of these injections should be performed under fluoroscopy, or x-ray guidance. For that reason, Dr. Jeannot is a staff physician at Outpatient Surgical Services and Cypress Creek Outpatient Surgical Center, located in Plantation and Ft. Lauderdale respectively.

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