Pain Management

The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space before they form the nerves that travel down the arms, along the ribs and into the legs. The nerves leave the spine from small bony openings called foramen. Inflammation of these nerve roots may cause pain in the arms, chest or legs.

These nerve roots may become inflamed and painful due to irritation, such as from a damaged disc or a bony spur. Selective epidural injection (therapeutic nerve root block) places anti-inflammatory medicine over the root and into the epidural space to decrease inflammation of the nerve roots, therefore reducing the pain. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

Medial branch nerves are the very small nerve branches that communicate pain caused by the facet joints in the spine. These nerves do not control any muscles or sensation in the arms or legs. They are located along a bony groove in the low back and neck and over a bone in the mid back. If this procedure has been scheduled, there is strong evidence to suspect that the facet joints are the source of your neck/back pain.

Therefore, benefit may be obtained from having these medial branch nerves blocked with an anesthetic to see if a more permanent way of blocking these nerves would provide long-term pain relief. Blocking these medial branch nerves temporarily stops the transmission of pain signals from the joints of the spine to the brain.

The sacroiliac joints are large joints in the region of the low back and buttocks where the pelvis actually joins with the tailbone. If the joints become painful, they may cause pain in the low back, buttocks, abdomen, groin, or legs. A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief experienced will help confirm or deny the joint as a source of pain. Additionally, steroids will help to reduce any inflammation that may exist within the joint(s).

Chronic muscular pain can result from an injury to a muscle and over time, it can escalate by posturing and non-use of the muscle. This is called myofascial pain syndrome. TPI’s are intra-muscular (IM) injections of local anesthetic (like Novocain), into the muscle sites as a part of myofascial pain syndrome treatment. It is usually used when conservative approaches like, oral medications (anti-inflammatory and muscle relaxants) and rest, are ineffective. TPI’s temporarily numb and relax the muscle sites involved in the pain process. This allows the patient to participate in a more effective physical therapy and stretching of these muscles, and may also increase blood flow to that muscle. Steroids can be used for TPI’s in selected patients.

Clearly, if the first set of TPI’s results in acceptable sustained relief, then there is no need to perform any more injections. If the first set of injections provides no relief, there is no point to repeat any further TPI’s and other causes of pain, or other treatment modalities should be sought. If the first set of trigger point injections results in partial sustained relief, then a series of these injections may provide a greater degree of sustained relief as compared with only one set of injections. Botox® Injection is a good alternative for more prolonged relief, but only if the patient has had positive results with a series of local anesthetics trigger point injections.

Radiofrequency lesioning is a procedure that uses heat to destroy only the pain fibers to the facet or sacroiliac joints. To the patient, radiofrequency lesioning is very similar to a facet injection or medial branch nerve block. The difference is the administration of heat instead of local anesthetic and steroid.