
About Chronic Pain Relief
At My Pain KY, we provide life-changing, long term and comprehensive pain treatments. There are solutions to help. Click on the links below to find out more about your condition and possible treatments.

Information and Videos
The experts at My Pain KY are dedicated to finding the source and cause of your pain and helping you achieve your best functional lifestyle. We want you to be fully informed about the cause of your pain and how it is being treated. Your condition may also change with time or treatments. Our recommendations, too, may change, based on your situation.
Chronic Pain Treatment Procedures
Information and Videos About Chronic Pain Treatment Procedures
At My Pain KY, we are dedicated to finding the source and cause of your chronic pain while helping you achieve your normal lifestyle that may have been lost. In doing this, we may recommend that you undergo a minimally invasive, non-surgical procedure at a state-of-the-art, on-site procedure center. These chronic pain treatments are on the cutting-edge of pain management, and have all shown to be extremely successful in helping relieve pain. All procedures are out-patient procedures; you’ll be able to go home that day. Many of the chronic pain treatments we perform show instant results, and are able to help our patients reclaim their lives. Read about some of the treatments we offer at My Pain KY:
Overview
Acupuncture is a system of healing that originated in China thousands of years ago and is based on laws of nature and life energy known as qi, pronounced chee. The idea is that energy flows through human beings much like rivers and streams flow along the surface of the earth. Health is the result of free-flowing qi; conversely, illness is the result of qi that’s out of balance because of blockages. Through the use of very fine needles inserted into specific anatomical sites, acupuncture assists nature in unblocking the flow of qi and restoring overall balance.
Indications
The World Health Organization and the National Institute of Health recognizes acupuncture’s effectiveness for over 40 common disorders, such as muscular disorders, bladder and genital disorders, gynecological disorders, and psycho-emotional disorders. Neurological disorders as well as headaches and many more conditions have been treated successfully with acupuncture’s various techniques. For a more complete list please visit this excellent local practice’s web site, Artmesia.
What to Expect
You can expect to be referred or treated for your pain condition with acupuncture if requested or if indicated. Most insurances do not provide coverage for acupuncture therapy and the patient should expect to have to provide a means for payment. The provider will do a history, exam as indicated and give you a care plan prior to any needle placement or therapy. It may take several sessions to get the results expected. Note that there are many therapeutic interventions with this type of alternative medicine and needles are not the only means to achieving a good outcome. These can include acupuncture, cupping, moxibustion as well as the use of supplements and herbal formulas.
Outcomes
Outcomes with alternative and Chinese medical therapy are well documented throughout history. Like any form of therapy the outcome is individual and based on the experience on the patient and the use of the provider’s experience. It has been successful in many pain conditions and should be used as an adjunctive means to help with maintenance of an overall healthy lifestyle and pain management program.
Overview
Conscious Sedation for pain treatment procedures is usually reserved for procedures that may be more invasive than simple needle blocks or superficial procedures. It is usually done with monitoring capability to carefully watch vital signs as indicated. By mouth, or PO, medications may be used for longer office based procedures that are more painful. Modern techniques allow for the patient to be awake and comfortable yet able to answer important questions during the procedure to insure better outcomes.
Indications
Some of these procedures may include spinal cord stimulator trial and implants, radiofrequency ablation used to ‘burn’ nerves, deeper blocks such sympathetic blocks or stellate ganglion blocks, as well as other invasive procedures for pain management.
What to Expect
The patient can expect to be given instructions as to diet and eating prior to the conscious sedation. This is to insure safety while sedated. Instructions and policies as to afterwards will also be given and can include diet, activity, machine/car operation avoidance as well as avoiding decision making for 24-48 hours afterwards. Most procedures that require this type of sedation will require the patient to not self- transport as well and you will need a driver.
Outcomes
Outcomes of modern techniques for conscious sedation have come a long ways to insure comfort and analgesia for outpatient procedures. With low doses of proper medications even the most fearful patient can well tolerate invasive procedures as indicated. Minimal side effects are the norm with excellent recovery and return to pre sedation functionality is to be expected. In most cases this is achieved within hours after the procedure. Medical condition prior and tolerance to the procedure are the main indicators for the need of medications for conscious sedation.
Overview
This procedure is well suited to relieve pain from ‘pinched nerves’ in the spine. The nerve can be impinged or pinched due to multiple possible causes. The nerve or nerve root then swells due to this condition and the pain radiates along the path of the nerve causing pain in the places where the nerve endings terminate. The effect of the injection is too place anti-inflammatory steroid medication near the source of the painful swelling and decrease the pain by helping the nerve return to its normal state.
Indications
This procedure is indicated for radicular type pain coming from ‘pinched’ nerves in the spine. The caudal approach is best used for lower lumbar or sacral nerves. It also is good for patients with leg pain that have had major lower back surgery, as it can avoid scar tissue. Lumbar radiculopathy, lumbar stenosis, spondylosis with myelopathy, back injury, HNP or herniated disc of the lumbar spine, nerve root injury of the lumbar or sacral spine, coccyx pain or other lumbar/pelvic conditions that would cause nerve or nerve root swelling in the lower spine are all well suited for treatment with this procedure.
What to Expect
The patient can expect to have the procedure done while gaining access to the back. Usually this is done while lying face down and having fluoroscopic guidance for the placement of the needle into the central epidural space from the caudal canal located near the top of the buttock. Local anesthesia to numb the skin and injection of steroid are usually done as an outpatient or office procedure without sedation needed.
Outcomes
The procedure may take several days to get enough of the nerve swelling down in order to understand how the pain relief will take effect. The pain relief can last for several weeks to months or even longer. If the area is reinjured or the nerve is impinged again, the pain may recur and the procedure can be repeated as indicated.
Overview
This procedure is well suited to relieve pain from ‘pinched nerves’ in the spine. The nerve can be impinged or pinched due to multiple possible causes. The nerve or nerve root then swells due to this condition and the pain radiates along the path of the nerve causing pain in the places where the nerve endings terminate. The effect of the injection is too place anti-inflammatory steroid medication near the source of the painful swelling and decrease the pain by helping the nerve return to its normal state.
Indications
This procedure is indicated for radicular type pain coming from ‘pinched’ nerves in the spine. Cervical radiculopathy, cervical stenosis, spondylosis with myelopathy, neck injury, HNP or herniated disc of the cervical spine, nerve root injury of the cervical spine, or other conditions that would cause nerve or nerve root swelling in the cervical spine are all well suited for treatment with this procedure.
What to Expect
The patient can expect to have the procedure done while gaining access to the back of the neck. Usually this is done while lying face down and having fluoroscopic guidance for the placement of the needle into the central epidural space. Mostly this is done in the midline of the intralaminal space, the middle of the neck below the spinous processes you feel in the back of your neck. Local anesthesia to numb the skin and injection of steroid are usually done as an outpatient or office procedure without sedation needed.
Outcomes
The procedure may take several days to get enough of the nerve swelling down in order to understand how the pain relief will take effect. The pain relief can last for several weeks to months or even longer. If the area is reinjured or the nerve is impinged again, the pain may recur and the procedure can be repeated as indicated.
Overview
This minimally-invasive pain management procedure, also called radiofrequency (RF) rhizotomy, reduces or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals to the brain. It is performed using local anesthetic to reduce pain.
Indications
Conditions that are well suited for this treatment are the same ones that can be treated by cervical medial branch nerve blocks. These include neck pain that is non radicular, motion sensitive, or associative with facet joint types of pain sources. Cervicalgia, degenerative joint pain, spondylosis, neck injury and some whiplash injuries are all treated with medial branch blocks and facet radiofrequency rhyzitomy if indicated.
This procedure is usually indicated for a more long lasting effect of pain relief after a prior medial branch block has shown effective relief. The same nerves are then indicated for the rhyziotomy procedure in order to prolong the pain relief. The area ‘burned’ is usually around 10 mm and the nerve can grow back with pain recurring after a prolonged period of pain relief.
What to Expect
1. Cannula Inserted – A needle like tube called a cannula is inserted and positioned near the irritated medial branch nerves. Fluoroscopic x-ray is used to help position the cannula properly.
2. Electrode Inserted – A radiofrequency electrode is inserted through the cannula. The physician tests the electrode’s position by administering a weak electric jolt. If the stimulation recreates the pain without any other muscular effects, the electrode is positioned correctly.
3. Nerve Treated – The physician uses the electrode to heat and cauterize the nerve. This disrupts its ability to communicate with the brain, blocking the pain signals. The physician may treat multiple nerves if needed.
Outcomes
Although pain may increase for the first week after the procedure, the patient usually has full relief from pain within a month. Successful radiofrequency neurotomies can last longer than steroid block injections. The nerve may grow back and pain may recur with good pain relief for up to several months or years.
Overview
Although a wide diversity of ideas currently exists among chiropractors they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractors examine the biomechanics, structure and function of the spine, along with its effects on the musculoskeletal and nervous systems and what they believe to be its role in health and disease.
Indications
A holistic approach to health and the spine is the basis for why most people seek chiropractic care. The main reason people seek out chiropractor care is low back pain. Muscular pain of the spine, hip and back issues can be well treated with the manipulation and adjustments based on chiropractic principles. It is an adjunctive therapy to a healthy lifestyle and pain program and can be used to help with many different conditions causing pain of the spine and muscular system.
What to Expect
You can expect to be referred to a chiropractor as indicated for the treatment of spinal or muscular type pain. They should do a history, exam and give you a care plan for treatment. Most insurance will cover some chiropractic care but not all chiropractors will accept payment, such that most patients should expect to pay for each session. It may take multiple visits to achieve the desired results and it may take additional sessions over time to maintain the holistic state of health desired.
Outcomes
Chiropractic therapy has achieved good results in many different conditions and is used as an adjunctive therapy commonly for low back painful conditions. Like most therapy, it may need to be repeated in order to achieve the expected results along with other pain management therapy and holistic therapy used for a total pain management.
Overview
Deep brain stimulation involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or, the electrical impulses can affect certain cells and chemicals within the brain. The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.
Indications
Deep brain stimulation is used to treat a number of neurological conditions, such as:
• Essential tremor
• Parkinson’s disease
• Dystonia
Deep brain stimulation is also being studied as an experimental treatment for epilepsy, cluster headaches, Tourette syndrome, chronic pain and major depression. Many candidates for deep brain stimulation are participants in clinical trials. Most patients will need to be referred to a center that does this procedure on a regular basis and has experience in treating the types of conditions that can benefit from the therapy.
What to Expect
Deep brain stimulation is an established treatment for movement disorders, such as essential tremor, Parkinson’s disease, and dystonia, and more recently, obsessive-compulsive disorder. This treatment is usually reserved for people who aren’t able to get control of their symptoms with medications.
After proper evaluation and referral for consideration of the therapy, if you undergo the procedure for deep brain stimulation your doctor will provide you details of the procedure. In short, you are fitted with a devise for the surgery to enable the surgeon to find with precision the target area and after access is gained with local anesthesia through the skull, the patient is able to respond to the stimulation once the leads are properly placed. The effects can be immediate as to movement and control issues.
Outcomes
With proper patient selection, psychological evaluation and trail the outcome of Deep Brain Stimulation can be life changing for patients with otherwise severe disability due to the indicated conditions. A permanent solution to the problem with the control of movement and/or tremor man mean a return to a more functional and satisfactory lifestyle.
Overview
The purpose of facet joint injection is to ‘numb’ suspected facet joints that are causing painful conditions. In this way the blockade will reduce or eliminates the pain of damaged facet joints by blocking the painful joint that carries the pain signals to the brain. It is performed using local anesthetic to reduce pain with anti-inflammatory steroid added if inflammation of the joint is also a contributing factor. The procedure is very similar to the medical branch block but with a different target of the actual facet joint, rather than the nerve to the joint.
Indications
Conditions that are well suited for this treatment are the same ones that can be treated by cervical/lumbar medial branch nerve blocks and rhizotomy. These include neck or back pain that is non radicular, motion sensitive, or associative with facet joint types of pain sources. Cervicalgia, lumbago, degenerative joint pain, spondylosis, neck or back injury and some whiplash injuries are all treated with medial branch blocks and later facet radiofrequency rhyzitomy if indicated.
This procedure is usually indicated for mostly non radicular pain. This can include facet arthropathy, facet joint or disc degeneration and the facet joint syndrome. The same joint is then indicated for the rhyziotomy procedure in order to prolong the pain relief. The area ‘burned’ is usually around 10 mm and the nerve can grow back with pain recurring after a prolonged period of pain relief.
What to Expect
Patients usually have injections of the facet joint done on an outpatient basis using fluoroscopy or other image guidance for proper needle placement. The skin will be numbed and the needles placed with sometimes small amounts of contrast used to confirm placement. Then a solution of steroid and/or local anesthetic is injected in small amounts. The effects of the local anesthetic will wear off before the steroid takes full effect such that the immediate effects of the anesthesia may wear off and the pain recur prior to the longer lasting effect of the steroid.
Outcomes
Although pain may increase for the first week after the procedure, the patient usually has full relief from pain within a month. Successful radiofrequency neurotomies can last longer than steroid block with local anesthesia injections. Medial branch nerve blocks are usually done to both treat and diagnosis the cause and effect of the suspected pain condition. For a return of the pain the blocks can be repeated or a rhizotomy can be done on the same nerves.
Overview
Piriformis muscle syndrome can mimic pain like sciatica, or the large nerve pain that produces sharp shooting pain down the leg. Piriformis muscle syndrome pain starts in the lower back and/or buttocks, sometimes feeling as if it’s deep inside the buttock muscles. It may be too painful to sit on the affected buttock. The pain and/or tingling can radiate down the backs of the legs as well.
Indications
The piriformis muscle runs behind the hip joint and aids in external hip rotation, or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many working people can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.
The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, like a compressed lumbar disc. Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause. Runners, cyclists and rowers are the athletes most at risk for piriformis syndrome. Other people that are risk are anyone who over pronates the foot in their gait. It can also be seen after treatment for spinal stenosis and/or neurogenic claudication with the mild® procedure as the once leaning forward walking motion is replaced with a straighter, more upright gait, thereby staining the sciatic nerve with the piriformis muscle.
What to Expect
Treatment of the syndrome is easy and straight forward. It is done on an outpatient basis usually in the office using fluoroscopy (x-ray) or ultrasound guidance. Proper placement of a single needle to the depth of the piriformis muscle, located deep to the gluteus Maximus and Minimus muscles in the buttock area is why imaging guidance is needed. Once access to the buttock area is obtained, the skin is prepped and skin numbed with the needle placed by way of imaging confirmation. Contrast may be used to ensure proper placement. Injection of local anesthetic to help relief of the pain and spasm (trigger point) of the piriformis muscle with steroid for the inflammation is undertaken and the spread noted via imaging. A band aid is used for dressing and physical therapy, home stretching and exercises are given.
Outcomes
Many patients note immediate relief after this injection. Outcomes for this procedure are excellent and usually only one or two injections, along with home therapy and exercises are all that are needed for prolonged relief. The spasm and sciatica type pain may recur and if not relieved by conservative management the injection can be repeated. Many mild® procedure patients note that after this injection they can now fully understand the benefit from the mild® procedure and the gait changes that is has produced, enabling them to walk straighter, longer, and with less pain now that the piriformis muscle syndrome has been treated.
Overview
Intracapsular glenoid injection is a procedure in which anesthetic and anti-inflammatory steroid medication is injected as a mixture between the glenoid and the head of the humerus. This is done for shoulder pain and discomfort that has not responded to conservative management. Frozen shoulder is a common complaint that can respond to this injection. The injection is done with ultra sound guidance to insure proper placement of the needle.
Indications
Several painful conditions may be treated with this procedure, including rheumatoid arthritis and osteoarthritis in the shoulder joint. Adhesive capsulitis, commonly known as “Frozen Shoulder,” may also benefit from intracapsular glenoid injections. Often this this treatment is used if other more conservative methods, like physical therapy, have already been attempted. However, injections may also be used in conjunction with other conservative treatments in order to help with physical therapy and range of motion exercised. The effects of the injection may wear off and need to be repeated.
What to Expect
The procedure is easy and with ultra sound guidance the patient can be assured that the successful placement of the needle is greatest vs other so called ‘blind’ injections. The skin is prepped and the area numbed. A small needle is used to enter the capsule of the joint under direct vision with the ultra sound guidance procedure. Once placed the injection of the solution of steroid and/or local anesthesia is done. A small band aid is placed. Many patients can get quick onset of relief and some may then go to physical therapy with the shoulder pain relief in place.
Outcomes
The prevention of the frozen shoulder syndrome is the ultimate outcome for this procedure. If a patent develops a frozen shoulder they may lose the ability for proper function of the affected sides hand and arm. Pain control and restoration of shoulder function is the intended outcome. The pain control is achieved and used as an adjunctive therapy with physical therapy, topical creams or applications, and home exercises. The effects of the injection may wear off and the injection may need to be repeated.
Overview
An intrathecal pump, or ‘pain pump’, is a medical device used to deliver medications directly into the space between the spinal cord and the protective sheath surrounding the spinal cord. Medications such as baclofen, morphine, or other medication combinations may be delivered in this manner to minimize the side effects often associated with the higher doses used in oral or intravenous delivery of these drugs. It is used first on a trial basis and after a successful trial is determined, and then a permanent implant is undertaken and maintained with refilling of the pain needed on a regular basis.
Indications
There can be multiple indications for inthecal pump, or ‘pain pump’, implant after a successful trial. These can include the treatment of chronic pain after failed back surgery, sometimes called FBS or post laminectomy syndrome, non-radicular back pain that does not go below the hip area, cancer pain, or response to narcotic therapy traditionally that has now has produced tolerance or side effects.
What to Expect
After a successful trial of narcotics, usually morphine at low dose, by way of a small catheter and trialed over several days the implant will be undertaken. The procedure is done as an outpatient with local and IV sedation with the catheter place again in a similar fashion and now connected to a pump reservoir that is usually placed in the abdomen, buttock area or other choice of access position. You will go home the same day usually and the pump will have been filled and programmed accordingly. Infection precautions will be given and usually antibiotics maintained for a brief period of time.
Outcomes
Outcomes and long term results of placement for interthecal pain pumps using single drug low dose morphine are well documented as effective in the treatment for chronic pain. Infection and mechanical dislodgement of the catheter are the main concerns. Refill and maintenance of the pump with possible battery replacement after prolonged use are longer term maintenance issues.
Overview
This procedure is well suited to relieve pain from ‘pinched nerves’ in the spine. The nerve can be impinged or pinched due to multiple possible causes. The nerve or nerve root then swells due to this condition and the pain radiates along the path of the nerve causing pain in the places where the nerve endings terminate. The effect of the injection is too place anti-inflammatory steroid medication near the source of the painful swelling and decrease the pain by helping the nerve return to its normal state.
Indications
This procedure is indicated for radicular type pain coming from ‘pinched’ nerves in the spine. The lumbar approach is best used for lumbar or sacral nerves. It also is good for patients with leg pain that have had no responsive to a conservative management approach. Lumbar radiculopathy, lumbar stenosis, spondylosis with myelopathy, back injury, lumbar degenerative disc disease, HNP or herniated disc of the lumbar spine, nerve root injury of the lumbar or sacral spine, coccyx pain or other lumbar/pelvic conditions that would cause nerve or nerve root swelling in the lower spine are all well suited for treatment with this procedure.
What to Expect
The patient can expect to have the procedure done while gaining access to the back. Usually this is done while lying face down and having fluoroscopic guidance for the placement of the needle into the central epidural space from the canal located near the central area just below the lamina. Local anesthesia to numb the skin and injection of steroid are usually done as an outpatient or office procedure without sedation needed.
Outcomes
The procedure may take several days to get enough of the nerve swelling down in order to understand how the pain relief will take effect. The pain relief can last for several weeks to months or even longer. If the area is reinjured or the nerve is impinged again, the pain may recur and the procedure can be repeated as indicated.
Overview
This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a common treatment for shingles and complex regional pain syndromes affecting the lower back and legs, feet and joints of the lower extremities, and help increase blood flow to the lower extremities’ due to neuropathy. Usually a series of these injections is needed to treat the problem.
Indications
This procedure is indicated for use with pain conditions caused from complex regional pain syndromes of the lower extremity, peripheral neuropathy, RSD of the lower extremity, pelvic type pain, shingles in the mid thoracic, lumbar and lower extremity region, and some sympathetic nerve mediated pain syndromes of the thoracic and lumbar areas area. For sympathetic pain from the pelvic area, the lower ganglion may need to be blocked in the L5 and sacral areas or even in the coccyx area.
What to Expect
The patient will be face down under the fluoroscopy (x-ray) with a cushion under their abdomen in order to arch the back in a ‘mad cat’ type of position. This brings the lower lumbar ganglion area closer to the surface. The operator will feel and identify the muscles of the lumbar spine after injection local of anesthesia in the skin to numb the area first. Using the x-ray guidance, a needle will be placed through the numb skin and down to the lumbar ganglion on the anterior surface of the bone. Contrast can be used to identify proper placement and then injection of local long lasting anesthetic and steroid medications can be done in small intermittent doses while keeping contact with the patient.
Outcomes
Some patients get immediate relief of the pain and most will experience a change over time for a longer lasting relief and return to less painful state. Warmth increase in a cold extremity can be seen as well. The reflex of pain producing decreased blood flow can be broken with repeated blocks. The pain may recur in hopefully a lower intensity level and the injection may need to be repeated in a series of injections. The procedure can be used to both diagnosis and treat peripheral neuropathy and it may also be used to indicate if the patient is a candidate for a lumbar spinal cord stimulator trial.
Overview
This procedure is well suited to relieve pain from ‘pinched nerves’ in the spine. The nerve can be impinged or pinched due to multiple possible causes. The nerve or nerve root then swells due to this condition and the pain radiates along the path of the nerve causing pain in the places where the nerve endings terminate. The effect of the injection is too place anti-inflammatory steroid medication near the source of the painful swelling and decrease the pain by helping the nerve return to its normal state.
Indications
This procedure is indicated for radicular type pain coming from ‘pinched’ nerves in the spine. The lumbar approach is best used for lumbar or sacral nerves. It also is good for patients with leg pain that have had no responsive to a conservative management approach. If there is lumbar back surgery this approach is sometimes helpful to target specific nerves and/or avoid scar tissue from the surgery. Lumbar radiculopathy, lumbar stenosis, spondylosis with myelopathy, back injury, HNP or herniated disc of the lumbar spine, nerve root injury of the lumbar or sacral spine, coccyx pain or other lumbar/pelvic conditions that would cause nerve or nerve root swelling in the lower spine are all well suited for treatment with this procedure.
What to Expect
The patient can expect to have the procedure done while gaining access to the back. Usually this is done while lying face down and having fluoroscopic guidance for the placement of the needle into the central epidural space from the canal located near the central area below the spinal lamina. Local anesthesia to numb the skin and injection of steroid are usually done as an outpatient or office procedure without sedation needed.
Outcomes
The procedure may take several days to get enough of the nerve swelling down in order to understand how the pain relief will take effect. The pain relief can last for several weeks to months or even longer. If the area is reinjured or the nerve is impinged again, the pain may recur and the procedure can be repeated as indicated.
Overview
The purpose of medial branch blocks is to ‘numb’ suspected facet joints that are causing painful conditions. In this way the blockade will reduce or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals to the brain. It is performed using local anesthetic to reduce pain with anti-inflammatory steroid added if inflammation of the joint is also a contributing factor.
Indications
Conditions that are well suited for this treatment are the same ones that can be treated by cervical/lumbar medial branch nerve rhizotomy. These include neck or back pain that is non radicular, motion sensitive, or associative with facet joint types of pain sources. Cervicalgia, lumbago, degenerative joint pain, spondylosis, neck or back injury and some whiplash injuries are all treated with medial branch blocks and later facet radiofrequency rhyzitomy if indicated.
This procedure is usually indicated for mostly non radicular pain. Medial branch nerves are involved in pain coming from the facet joint. This can include facet arthropathy, facet joint or disc degeneration and the facet joint syndrome. The same nerves are then indicated for the rhyziotomy procedure in order to prolong the pain relief. The area ‘burned’ is usually around 10 mm and the nerve can grow back with pain recurring after a prolonged period of pain relief.
What to Expect
Patients usually have injections of the medial branch nerves done on an outpatient basis using fluoroscopy or other image guidance for proper needle placement. Because the nerves give off branches both above and below the joint, there usually are three or four needles used to block all the contributing nerves of the suspected levels. The skin will be numbed and the needles placed with sometimes small amounts of contrast used to confirm placement. Then a solution of steroid and/or local anesthetic is injected in small amounts. The effects of the local anesthetic will wear off before the steroid takes full effect such that the immediate effects of the anesthesia may wear off and the pain recur prior to the longer lasting effect of the steroid.
Outcomes
Although pain may increase for the first week after the procedure, the patient usually has full relief from pain within a month. Successful radiofrequency neurotomies can last longer than steroid block with local anesthesia injections. Medial branch nerve blocks are usually done to both treat and diagnosis the cause and effect of the suspected pain condition. For a return of the pain the blocks can be repeated or a rhizotomy can be done on the same nerves.
Overview
There are many individual and changing ways to treat pain. Each patient has different objectives and outcome expectations and finding a clinic that can help can be important in achieving the desired outcome. Commonwealth Pain Physicians use medications, minimally invasive techniques and procedures as well as blocks and injections to facilitate treatment based on objective diagnostic criteria in order to develop a plan of care. We call this individual plan of care the Pain—Personalized Care Plan or P—PCP™.
Indications
Patients who have had pain for usually longer than three months from the same source or in the same region can be said to have chronic pain. This may due to injury, surgery, trauma, or no identifiable source. Chronic pain sources can be treated by various means in order to help control the pain and keep the process of pain management moving forward. Patients who have pain that is causing them difficulty with functioning daily in life can also be good candidates for pain management. These may be conditions that are chronic, intermittently painful, but cause the person to have to manage and deal with pain daily in order to get through the normal activity of day to day living.
What to Expect
Patients can expect to have some type of evaluation of the cause and generator of the pain done. It may include a physical exam, a history of the process and health conditions of the patient, and may need to have review of prior treatments and medications. Also, an objective diagnostic study may be done or reviewed if recent, such as CT or MRI scan of the suspected pain generation area. This can be ordered after the evaluation to help confirm the findings and suspected generation of pain based the prior evaluation. A treatment plan can be formulated at some point and the expected and reasonable outcomes of pain management discussed. Not every situation can be improved upon and simply because something done prior was not successful does not mean it would not be appropriate at a different time in the plan of care. There are many different conditions and different treatments can be suggested and used to help with both improved outcome, function and diagnosis.
Outcomes
Outcomes for pain management are as varied and individual as the patients that have pain, as all people respond differently to the various management techniques. A reasonable goal for the patient is determined between the physician and the patient and a course of therapy set upon, which needs to be monitored and reevaluated frequently in order to achieve the best overall outcome for the individual patient. That is why a Personalized and Tailored approach to pain management has the best opportunity to achieve a satisfactory outcome for patients.
Overview
This pain management injection procedure is performed to relieve pain caused by arthritis in the sacroiliac (SI) joint where the spine and hip bone meet. The steroid medication can reduce swelling and inflammation in the hip joint.
Indications
This procedure is used to help with pain from the SI joint or hip area. The SI joint can become inflamed from arthritis of the joint, degeneration, injury or trauma to the area. The sciatic nerve that comes from the lumbar area and down the entire leg can also be affected as it comes close to the joint. This procedure is used to treat sacroililitis, SI joint pain, lower lumbar pain, pelvic region or hip pain, and other painful conditions of the pelvic region.
What to Expect
1. SI joint is Located – The patient lies face down. A cushion is placed under the stomach for comfort and to arch the back. The physician uses touch and either a fluoroscope (x-ray) or ultra sound probe to find the SI joint.
2. Anesthetic is Injected – A local anesthetic numbs the skin and all of the tissue down to the surface of the SI joint.
3. Needle is Inserted & Steroids are injected – The physician advances a needle through the anesthetized track and into the SI joint. A steroid-anesthetics mix is injected into the SI joint, bathing the painful area in medication. The needle is then removed and a small bandage is placed over the injection site.
Outcomes
Outcomes of the procedure can be to reduce the inflammation and increase use and function of the painful limb. It may also be used in conjunction with other pain management procedure or conservative management in order to increase walking, functionality and reduce the need for medications to treat pain.
Overview
Spinal Cord Stimulation (SCS) is the electrical stimulation of a precise level of the spinal cord to generate paresthesia to the area(s) the patient feels pain. Spinal Cord Stimulation is an accepted pain management treatment for certain intractable pain conditions.
Indications
Indications for spinal cord stimulation include the following:
. Failed Back Surgery Syndrome (FBBS)
. Adhesive Arachnoiditis
. Peripheral Causalgia / Neuropathy
. Reflex Sympathetic Dystrophy (RSD)
. Phantom Limb / Stump Pain
. Ischemic Pain of a Vascular origin
Observing careful patient selection criteria ensures successful outcomes. Patients typically do best when most of their pain involves the limbs or lower back area. The patient will be required to have a psychological evaluation prior to approval for a trial in order to insure that there are no contraindications for a trial or permanent implant.
What to Expect
The injection site is numbed using a local anesthetic. One or more insulated wire leads are inserted through an epidural needle or through a needle into the space surrounding the spinal cord, called the epidural space. Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals to the brain. The patient gives feedback to help the physician determine where to place to place the stimulators to best block the patient’s pain. The lead is connected to an external trial stimulator, which will be used for three to seven days to determine if Spinal Cord Stimulation will help the patient. If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the lead is removed.
Permanent Implantation
The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more leads are inserted into the predetermined location in the epidural space. Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. Most often, it is implanted in the buttocks, back or abdomen. The lead is then connected to the IPG battery. The implant’s electrical pulses are programmed with an external control unit. The patient can use the external control unit (remote) to turn the system on or off and adjust the stimulation power level and switch between different programs. After surgery, patients may experience mild discomfort and swelling at the incision sites for several days.
Outcomes
With proper patient selection, psychological screening for contraindications and careful use of proper lead placement to cover the painful area as much as possible at the trial phase the outcome of spinal cord stimulation can be a life changer. It can cause the pain to be controllable for the patient with programing available for different pain throughout the day if indicated. The goal is activity and functional improvement to reasonable levels determined in the initial patient evaluation process.
Overview
Spinal Cord Stimulation (SCS) is the electrical stimulation of a precise level of the spinal cord to generate paresthesia to the area(s) the patient feels pain. Spinal Cord Stimulation is an accepted pain management treatment for certain intractable pain conditions.
Indications
Indications for spinal cord stimulation include the following:
. Failed Back Surgery Syndrome (FBBS)
. Adhesive Arachnoiditis
. Peripheral Causalgia / Neuropathy
. Reflex Sympathetic Dystrophy (RSD)
. Phantom Limb / Stump Pain
. Ischemic Pain of a Vascular origin
Observing careful patient selection criteria ensures successful outcomes. Patients typically do best when most of their pain involves the limbs or lower back area. The patient will be required to have a psychological evaluation prior to approval for a trial in order to insure that there are no contraindications for a trial or permanent implant.
The injection site is numbed using a local anesthetic. One or more insulated wire leads are inserted through an epidural needle or through a needle into the space surrounding the spinal cord, called the epidural space. Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals to the brain. The patient gives feedback to help the physician determine where to place the stimulators to best block the patient’s pain. The lead is connected to an external trial stimulator, which will be used for three to seven days to determine if Spinal Cord Stimulation will help the patient. If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.
What to Expect
The trail implant will be done as an outpatient basis with fluoroscopic (x-ray) guidance with local anesthesia and lite sedation. The patient needs to tell the operator if the sensations from the stimulation pattern are covering the painful area and adjustment may need to be made for the final position/placement of the leads. The trial will last for 3-10 days with contact made with the patient during this time period. Once the trial is over the leads are simply removed and a decision will be made regarding a permanent implant. If a permanent implant is done a similar pattern of stimulation using the leads and a stimulation generator, or IPG, will attempted. All components will be self-contained and under the skin in such a way as to be controlled by way of a small remote.
Outcomes
With proper patient selection, psychological screening for contraindications and careful use of proper lead placement to cover the painful area as much as possible at the trial phase the outcome of spinal cord stimulation can be a life changer. It can cause the pain to be controllable for the patient with programing available for different pain patterns throughout the day if indicated. The goal is activity and functional improvement to reasonable levels determined in the initial patient evaluation process.
Overview
This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a common treatment for shingles and complex regional pain syndromes affecting the head, face, neck, and arms. It can help treat and increase pain control of low blood flow states caused by neuropathy of the upper extremities. Usually a series of these injections is needed to treat the problem.
Indications
This procedure is indicated for use with pain conditions caused from complex regional pain syndromes of the upper extremity, peripheral neuropathy, RSD of the upper extremity, facial pain, shingles in the head, face neck and shoulder region, and some sympathetic nerve mediated pain syndromes of the thoracic area.
What to Expect
The patient will be face up under the fluoroscopy (xray) with a cushion under their shoulders in order to arch the neck in ‘hanging head over the edge’ type of position. This brings the lower stellate ganglion area closer to the surface. The operator will feel and pull the muscles out of the way after injection local anesthesia in the skin to numb the area first. Using the x-ray guidance, a needle will be placed through the numb skin and down to the stellate ganglion of the upper surface of the bone. Contrast can be used to identify proper placement and then injection of local long lasting anesthetic and steroid medications can be done in small intermittent doses while keeping contact with the patient.
Outcomes
Some patients get immediate relief of the pain and most will experience a change over time for a longer lasting relief and return to less painful state. Warmth increase in a cold extremity can be seen as well. The reflex of pain producing decreased blood flow can be broken with repeated blocks. The pain may recur in hopefully a lower level and the injection may need to be repeated in a seris of injecitons. The procedure can be used to both diagnosis and treat peripheral neuropathy and it may also be used to indicate if the patient is a candidate for a cervical spinal cord stimulator trial.
Overview
This procedure is well suited to relieve pain from ‘pinched nerves’ in the spine. The nerve can be impinged or pinched due to multiple possible causes. The nerve or nerve root then swells due to this condition and the pain radiates along the path of the nerve causing pain in the places where the nerve endings terminate. The effect of the injection is too place anti-inflammatory steroid medication near the source of the painful swelling and decrease the pain by helping the nerve return to its normal state.
Indications
This procedure is indicated for radicular type pain coming from ‘pinched’ nerves in the spine. The thoracic approach is best used for lower thoracic or high to mid-lumbar nerves. It also is good for patients with leg pain that have had no responsive to a conservative management approach. It is often used to treat post herpetic neuralgia from shingles or ‘zoster’. Thoracic or Lumbar radiculopathy, lumbar stenosis, spondylosis with myelopathy, back injury, HNP or herniated disc of the thoracic or lumbar spine, nerve root injury of the lumbar or sacral spine or other lumbar/pelvic conditions that would cause nerve or nerve root swelling in the spine are all well suited for treatment with this procedure.
What to Expect
The patient can expect to have the procedure done while gaining access to the back. Usually this is done while lying face down and having fluoroscopic guidance for the placement of the needle into the central epidural space at the indicated level. Local anesthesia to numb the skin and injection of steroid are usually done as an outpatient or office procedure without sedation needed.
Outcomes
The procedure may take several days to get enough of the nerve swelling down in order to understand how the pain relief will take effect. The pain relief can last for several weeks to months or even longer. If the area is reinjured or the nerve is impinged again, the pain may recur and the procedure can be repeated as indicated.
Overview
Trigger point injections are an effective treatment modality to inactivate trigger points and provide prompt relief of symptoms from myofascial pain syndrome. Myofascial pain syndrome is a common painful muscle disorder characterized by myofascial trigger points. It is distinguishable from fibromyalgia syndrome, which involves multiple tender points, although these pain syndromes may be concurrent. They produce pain focally and in a referred pattern and often co-occur with chronic musculoskeletal pain disorders.
Indications
Various modalities for the treatment of trigger points include spray and stretch, ultrasound, manipulative therapy, and trigger point injections. Not all trigger points require injection or needling. Many active trigger points will respond to physical therapy, especially in the early stages of trigger point formation. However, for chronic trigger points, trigger point injection and needling is an effective treatment.
Trigger point injections are indicated for patients who have symptoms and examination findings consistent with active trigger points. Latent trigger points are clinically asymptomatic and do not require treatment. Trigger points should be limited in number and should be appropriate for injection.
Conditions involving widespread pain complaints, such as fibromyalgia or endocrine disorder, are not suitable for injections. Treatment is indicated for endocrine diagnoses or fibromyalgia before considering trigger point injections. In addition, the finding of tenderness alone is not an indication for trigger point injection because patients with fibromyalgia may also have myofascial pain trigger points.
What to Expect
Trigger point injections are done as an outpatient in office procedure. Once access to the affected site is obtained, the skin aseptically cleaned, all after proper identification of the trigger point site the injection will precede. Sometimes the procedure is done with ultra sound guidance to avoid complications of injection too deep or puncture of the plural (lung) lining. Small amounts of local anesthesia and/or steroid mix are injected into the trigger point area to help break up the hard fibrous area. This may be seen with ultrasound use as well. Multiple areas can be done during the same session.
Outcomes
Some patients receive immediate relief from the injections and most will note the effects are long lasting as the steroid provides anti-inflammation response. With the recurrence of the trigger point the injection may need to be repeated.
Overview
This non-operative, outpatient procedure is designed to provide relief for patients with arthritis of the knee. The technique allows the physician to inject the pain relieving drugs of local anesthesia, anti-inflammatory steroid and /or other medications with maximum accuracy. The ultra sound probe is used to visualize the proper depth and placement of the needle to help overcome the ‘up to 70% miss’ rate seen in non- ultra sound guided injections of the area.
Indications
Indications for this procedure are the same conditions that cause pain of the knee area. These can include patella syndrome, patella bone injury, trauma, and degeneration of the knee, arthritis, knee joint injury, knee tendon injury, or other tendinitis or injury of the knee’s complex bone, joints or tendons that enable knee joint movement. It is one of the most complex areas of the body.
What to Expect
The procedure is done as an outpatient, usually as an office procedure. Once access to the affected knee is obtained, the skin is numbed and a small needle is guided into the area of concern after identification with the ultra sound probe. A small amount of local anesthesia or normal saline is injected to ensure proper needle placement and the injection of the solution of steroids, local anesthesia and/or other medications is under taken. A band aid is applied and rotation of the area as tolerated is encouraged to facilitate medication distribution.
Outcomes
Many patients experience good to moderate relief at the time of injection. Most will need several days to realize the effects of the injection and the steroid effect noted after the local anesthesia wears off. Physical therapy, home exercise and increased functionality and activity are encouraged as the injections’ purpose is to increase all of those while reducing pain. The injection may need to be repeated if pain recurs.
Overview
This non-operative, outpatient procedure is designed to provide relief for patients with arthritis of the shoulder. The technique allows the physician to inject the pain relieving drugs of local anesthesia, anti-inflammatory steroid and /or other medications with maximum accuracy. The ultra sound probe is used to visualize the proper depth and placement of the needle to help overcome the ‘up to 70% miss’ rate seen in non- ultra sound guided injections of the area.
Indications
Indications for this procedure are the same conditions that cause pain of the shoulder area. These can include frozen shoulder syndrome, rotator cuff injury, trauma, degeneration of the shoulder, arthritis, AC joint injury, biceps tendon injury, or other tendonitis or injury of the shoulder’s complex bone, joints or tendons that enable a rotational movement. It is one of the most complex areas of the body.
What to Expect
The procedure is done as an outpatient, usually as an office procedure. Once access to the affected shoulder is obtained, the skin is numbed and a small needle is guided into the area of concern after identification with the ultra sound probe. A small amount of local anesthesia or normal saline is injected to ensure proper needle placement and the injection of the solution of steroids, local anesthesia and/or other medications is under taken. A band aid is applied and rotation of the area as tolerated is encouraged to facilitate medication distribution.
Outcomes
Many patients experience good to moderate relief at the time of injection. Most will need several days to realize the effects of the injection and the steroid effect noted after the local anesthesia wears off. Physical therapy, home exercise and increased functionality and activity are encouraged as the injections’.
We understand how chronic pain and the burden of dealing with it can change your life.