Epidural Block
Epidural steroid block
An epidural block is performed under fluoroscopy to confirm a specific diagnosis and/or decrease pain and inflammation. This can be given in the cervical (neck), thoracic (upper back), and lumbar (lower back) area. The epidural space is a fairly tight bony canal containing fat that cushions the spinal cord and the nerve roots within the spinal canal.
Lower back pain, leg pain, and arm pain are usually caused by inflammation and irritation of nerve roots. This may be due to arthritis, ruptured or bulging disc and continued post-operative scarred or swollen tissues, all likely contributing to interference in the blood supply sources and contributing to chronic ischemia (oxygen and nutrients deprivation). By injecting a steroid into the epidural space that surrounds the nerve roots, the inflammation and swelling are decreased, and shrinking the boggy , angry tissues we can allow at least a temporary improvement in that toxic environment.
Frequently Asked Questions About Epidural Block
Epidurals are administered by a pain medicine specialist trained in chronic pain therapy. A local skin anesthetic is given. An epidural needle is then gently inserted into the epidural space of the cervical, thoracic, or lumbar area, depending on the area of your pain. A combination of local anesthetic (numbing medicine) and steroid (anti-inflammatory medicine) are injected into the epidural space.
When steroids are taken by mouth most of the medication is absorbed in the stomach and distributed equally throughout the entire body. Very little reaches the true source of the pain. The steroids reduce swelling and irritation which will reduce the pain.
You will be taken to a procedure room and positioned lying on your stomach. The area will be cleansed with a sterile solution and numbed with an injection of Lidocaine. Many describe a burning or stinging sensation for a few seconds. After that, you should just feel pressure. The physician will continuously communicate with you what to expect during the process.
Most will experience some immediate relief from pain due to the numbing medication that is mixed with the steroid. This will last from one to three hours and the pain will return. It will take about three days for the steroids to start working on the nerve root.
You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory. Approval will be needed from the doctor who ordered the blood thinner to stop taking the medication four days in advance for Coumadin, seven days for Aspirin and four days for anti-inflammatories and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin; You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.
If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call The Pain Center immediately at (870) 972-0411 or go to the nearest emergency room. Our office hours are from 7:45 a.m. to 4:45 p.m. Monday through Thursday and 7:45 a.m. to 12:00 p.m. on Friday.
An Epidural Block may be used to reduce the inflammation around the spinal nerves.
Watch Video
Facet (Medial Branch) Block
A Medial Branch Block (MBB) is a refined procedure used to identify arthritis, frequently not recognized by any other tests, including MRI or CT scans. It works by causing a temporary interruption of the nerve supply to a facet joint with a small amount of local anesthetic, placed through a precisely x-ray guided thin needle around the nerve branches that provide the supply to each facet joint. These nerves are called the medial branches.
Once the source of your pain is identified with MMB, Radiofrequency Ablation of those nerves will provide an extended period of pain relief, facilitating a rehabilitative protocol.
Frequently Asked Questions About Medical Branch Block
This simple and fast nerve block will be performed by a pain medicine specialist trained in chronic pain therapy and assisted by a trained clinician. With fluoroscopic guidance, an extremely thin needle is advanced to the target zone. The needle is placed in close proximity to the medial branch.
It will take less than 5 minutes for the actual procedure.
You will be prepped and taken to a procedure room. You will be positioned lying on your stomach and the area of focus will be cleansed with a sterile solution. The number of sticks depends on the span of the painful area. Many describe a momentary burning or stinging sensation followed by gradual pressure as the tip of the needle is advanced through the deeper tissues under continuous fluoroscopy (x-rays). Once the placement has been accomplished, you will only feel a slight tightness, pressure or tingle, as the anesthetic substance is placed around and onto the nerve.
Most will experience patient experiences pain relief. Vigorous physical therapy is necessary to try and strengthen the involved joints. Most will experience significant relief within the first half an hour.
A flow-sheet will be given to the patient with the request to mark pain scores on a scale from 0 to 10 every hour on the hour starting 30 minutes from the completion of the procedure.
While we encourage maintaining a typical rate of activity during this interval, if your pain has decreased, we recommend attempting some minor exertion or movements which would otherwise have been painful and noting if the procedure enabled a better tolerance to these activities.
You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, aspirin or an anti-inflammatory or have an infection or are sick; stop taking Plavix four days before the procedure. When taking Coumadin, blood will need to be drawn prior to the procedure to make sure it is not too thin; DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE; we need you to have a baseline level of discomfort in order to appreciate the effectiveness of the block. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to two hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.
Learn more about the medical branch block injection. Watch Video
Medial Branch
Medial Branch Radiofrequency (RF) ablation follows a successful diagnostic Medial Branch Block (MBB) that identifies the source of pain. Radiofrequency Rhizotomy will provide an extended period of pain relief, enabling a rehabilitation and a reparative process to be adopted with more ease.
It is a procedure which causes an interruption of the nerve supply to a facet joint. This interruption, known as a
Frequently Asked Questions About Medial Branch Radiofrequency Rhizotomy
The Radiofrequency Rhizotomy will be performed by a pain medicine specialist trained in chronic pain therapy and assisted by a trained clinician. A local skin anesthetic is given. With fluoroscopic guidance, a radiofrequency needle is advanced to the base of the transverse processes. The needle is placed along the course of the medial branch. The needle is heated to 80 degrees C for 90 seconds. At least two branches for each joint are treated in the same manner.
It will take less than an hour, for the actual procedure.
You will be prepped and taken to a procedure room. You will be positioned lying on your stomach and the area of focus will be cleansed with a sterile solution. The area will be numbed with an injection of lidocaine. Many describe a burning or stinging sensation for a few seconds. The probe will be fluoroscopically guided and placed. A very small electrical current will be passed through the probe. This is not painful. You will only feel a slight tightness, pressure or tingle. When the desired area has been located, the nerve will be bathed in a numbing medication before the cauterization begins.
Most will experience a sunburn-like feeling for about three weeks. Following the Radiofrequency Rhizotomy, there is a 60% chance of pain relief. This typically lasts for three months to one year. The nerve eventually grows back and the procedure may be repeated. While the patient experiences the pain relief. Vigorous physical therapy is necessary to try and strengthen the involved joints.
You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; Notify the nurse if you are taking blood thinner, Aspirin or an anti-inflammatory or have an infection or are sick; Stop taking Aspirin seven days in advance; and four days for anti-inflammatories, and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin. DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery and review of discharge instructions.
Provocative Discogram
A discogram is a diagnostic test performed to view and assess the internal structure of a disc and determine if it is a source of pain.
This procedure will diagnose a disc injury which may be the cause of your ongoing pain. It also will help determine if you are a suitable candidate for disc surgery. A small amount of intravenous medication will be administered as a relaxant and pain reliever and a local anesthetic is injected
Frequently Asked Questions About Provocative Discogram
The procedure is performed by a pain medicine specialist trained in chronic pain therapy and assisted by a licensed radiological technologist and a licensed registered nurse.
It will take from one to two hours including recovery time.
You will be dressed in a gown and have an IV started. You will be then taken to the procedure room and positioned on your stomach with pillows underneath. You will be asked to lay very still and quiet during the placement of the needles. Once the needles are in place, we will start to inject the dye and antibiotic solution.
No, a discogram will not relieve your pain. This is a diagnostic, not a therapeutic procedure. Our goal is to locate the source of your pain by reproducing it entirely.
You may eat lightly before the procedure. ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory; or have an infection or are sick. You will have to get approval from the doctor who ordered the blood thinner to stop taking the medication three days in advance for Coumadin, seven days for Aspirin, and four days for anti-inflammatories or Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office for one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.
When you start to feel some discomfort, you will be asked to respond with only one of the following statements:
- The pain is identical to my usual pain;
- The pain is not identical to my usual pain;
- I feel pressure, not pain.
Depending on your answer, we’ll decide if the procedure is over or we need to continue. Once the procedure ends you will be given a pain reliever through IV, then sent to the hospital for a CT scan. This will give us images of the dye distribution and show any tears, scarring, and degeneration of the disc.
Discography (also called a discogram) is a diagnostic procedure used to determine if one or more discs are the cause of back pain. Watch Video
Selective Nerve Root Block
A selective nerve root block is intended to target and determine if and which particular specific spinal nerve root is your source of pain. It will reduce inflammation around the nerve
The pain you are experiencing in the upper or lower extremities is usually caused by inflammation and irritation of a nerve root. Another possible explanation is ischemia caused by swelling that squashes the tiny blood vessels supplying vital nutrients to the nerve root tissue. The combination of numbing medication and steroids will offer pain relief as well as decrease of the edema, providing much needed respite to the suffering nerve.
Frequently Asked Questions About Selective Nerve Root Block
The blocks are administered by a pain medicine specialist who is trained in chronic pain therapy. A local skin anesthetic is given. A very thin spinal needle is inserted with the guidance of an x-ray to the area desired. An x-ray dye is then injected to confirm correct placement, once the placement is achieved a mixture of numbing medication and steroids will be injected.
The procedure will take less than an hour including recovery time.
When steroids are taken by mouth most of the medication is absorbed in the stomach. Very little would reach the true source of pain. The same is also true for intramuscularly injections.
The block takes place in a procedure room. You will be positioned lying on your stomach. The area will be cleansed with a sterile solution and numbed with an injection of Lidocaine. Many describe a burning or stinging sensation for a few seconds.
Most patients will experience immediate relief from pain due to the numbing medication that is mixed with the steroid. This will last from one to three hours after which the pain may return but to a lesser degree.
You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory. Approval will be needed from the doctor who ordered the blood thinner to stop taking the medication four days in advance for Coumadin, seven days for Aspirin and four days for anti-inflammatories and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin; You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.
Cervical selective nerve root block, or SNRB, is an injection used to identify the source of nerve pain in the neck and sometimes to also provide longer-term pain relief. Watch Video
Spinal Cord Stimulation
A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Further applications are in motor disorders. The lumbar spinal cord is a preferred target for the control of spinal
Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or
This interactive video gives a clear picture of a spinal cord stimulator implant. Watch Video
Stellate Ganglion Block
A stellate ganglion block is an injection of local anesthetic to block the sympathetic ganglions (sometimes described as relay stations in the pain transmission channels) located on either side of the neck. Blocking these areas may reduce symptoms such as pain, swelling, color, sweating changes in the upper extremity and may also improve mobility. It works by delaying and interfering with the pain sensation processing and transmission mechanisms. It s useful for pain located in the head, neck, chest or arm caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), herpes zoster (shingles), or intractable angina (pain related to decreased blood flow to the heart). Stellate ganglion blocks are also used to see if blood flow can be improved in those patients with circulation problems related to vascular disease.
Stellate ganglion blocks may be therapeutic (to relieve pain) and/or diagnostic (to determine the source of your pain). In many cases, they may be an essential component to a long term program of keeping your pain within tolerable limits, especially for cases where even the strongest medications have little benefit, and significant as well as dangerous side effects
Frequently Asked Questions About Stellate Ganglion Block
The blocks are administered by a pain medicine specialist who is trained in chronic pain therapy. A local skin anesthetic is given. A very thin spinal needle is inserted in the base of the neck on the affected side, near the transverse process of the cervical spine. A small amount of x-ray dye is injected to confirm the position. Once the placement is achieved, a mixture of numbing medication and steroids will be injected.
It will take less than an hour, including recovery time.
The block takes place in a procedure room. You will be placed in a gown and positioned on your back. The area will be cleansed with a sterile solution and numbed with an injection of lidocaine. Many describe a burning or stinging sensation for a few seconds. You can expect hoarseness of your voice, redness of the eye, drooping of the eyelid, and papillary constriction for four to eight hours after the injection. The duration of relief is variable.
The patient may notice increased warmth and color in the affected arm and pain relief may be noted immediately.
You may eat lightly before the procedure. ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory; or have an infection or are sick. You will have to get approval from the doctor who ordered the blood thinner to stop taking the medication three days in advance for Coumadin, seven days for Aspirin, and four days for anti-inflammatories or Plavix.
Blood will need to be drawn prior to the procedure to make sure it is not too thin. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office for one to two hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions. NOTE: This procedure cannot be performed if you have an active infection, flu, cold, uncontrolled cough, fever or very high blood pressure. Please make your nurse or doctor aware of any of these conditions.