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Abdominal pain from tumors of the pancreas, liver and stomach can often be treated by blocking the bundle of nerves that supply the upper abdomen, called the celiac plexus. To block the nerves, an anesthetic is injected on both sides of your body around your aorta. If successful, you will likely experience profound pain relief, and you and your doctor may elect to proceed with a more permanent numbing using alcohol or phenol to interrupt the nerves that supply the celiac plexus.

A discogram is an imaging test used to evaluate back pain. A discogram might help your doctor determine if a specific abnormal disc in your spine is causing your back pain.

Spinal discs are sponge-like cushions between the bones (vertebrae) of the spine. During a discogram, dye is injected into the soft center of one or more discs. The injection sometimes reproduces your back pain. The dye also moves into any cracks in the disc’s exterior, which can then be seen on an X-ray or CT scan. Once the culprit disc has been found there are several tools we can utilize to correct the problem and relieve the pain, such as, epidural steroid injections, injecting stem cells into the disc to help the regeneration of the disc, and minimally invasive removal or the portion of the disc causing the pain.

Epidural steroid injections are done in all areas of the spine: cervical, thoracic, and lumbar. They are a common treatment option for many forms of neck pain that may radiate to the arms as well as lower back pain that may radiate to the buttock, hips, legs, and feet. This pain is often associated with numbness, burning, and tingling as it is a result of inflammation and irritation to one or more nerves originating from the spine. The goals of an epidural steroid injection are to control pain by reducing inflammation in and around the nerve roots and improve mobility and function in the lower back and legs. By doing so, this allows the patient to participate in and make progress with a comprehensive physical therapy and rehabilitation program. The procedure involves injecting a local anesthetic and a steroid medication directly into the epidural space that surrounds the spinal cord and nerve roots. In the course of one’s care program, in most cases, an epidural steroid injection may be recommended after a series of nonsurgical treatments, such as medications and physical therapy have been tried, and before surgery is considered. The role of the injection is typically to provide sufficient pain relief to allow a return to everyday activities and to make progress in physical therapy.

Facet Joint Injections

Facet joints, which are located in pairs on the side of each vertebra in the neck and back, allow for motion and provide support and stability in the spine. Injury or conditions such as arthritis may cause pain and inflammation within the facet joints.

A facet joint block or injection is a minimally invasive procedure in which a physician injects a small amount of local anesthetic and/or medication to numb a facet joint and provide pain relief.

An interspinous spacer is a device that is inserted into the back of the spine, between the spinous processes. The device is used to treat spinal stenosis. Spinal stenosis occurs when the passageways of the spine are narrow and compress the nerves of the spine. The spinous processes are the part of the vertebra that stick out and form small bumps in the middle of your back. The spacer is placed between the spinous processes and gently opened. By opening the spacer, it functions similar to a car jack. It separates the spinous processes and thereby opens up compressed passageways in the vertebra. This frees up the nerves of the spine from compression.

Kyphoplasty is used as a treatment for spinal damage from compression fractures, not as a preventive measure. So, if you have osteoporosis, kyphoplasty will probably not be able to help you prevent osteoporosis-related injuries. It can, however, be used to treat damage caused by osteoporosis.

A type of spinal injection to temporarily block the pain signals coming from the medial branch nerves.

Medial nerves run through the facet joints. Facet joints are joints in your spine that allow for movement between vertebrae. When a facet joint is injured, pain signals from the facet joints travel along sensory nerves called the medial branches to the spinal cord and then to the brain. The injury may involve the cartilage, the capsule, or the ligaments that surround the joint and connect it to the other parts of the spine. Additionally, the joint injury may also cause muscle spasms. The location of the pain depends upon which facet joint has been injured.

If you are experiencing neck or back pain, an MBB can provide temporary pain relief, but is mostly a diagnostic tool to determine the source of your pain and the next steps in your treatment plan. If you experience substantial pain relief from a medial branch block, then the next step is radiofrequency ablation. Medial branch blocks are different from facet blocks in that the injection is placed outside the joint near the medial nerve. A steroid may be used in this injection to reduce inflammation.

(SCS, PNS, DRG)
Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical impulses directly to a target area. Neuromodulation devices and treatments are life changing. They affect every area of the body and treat nearly every disease or symptom from headaches to tremors to spinal cord damage to urinary incontinence. Similar to the way a cardiac pacemaker corrects abnormal heartbeats, neuromodulation therapies help to re-establish normal function of the nervous system. For every existing neuromodulatory treatment, there are many more on the horizon.

Spinal Cord Stimulation (SCS)
One of the most common examples of neuromodulation used for chronic pain management. SCS consists of a very thin lead (wire) that is placed in the space (epidural space) just outside the spinal cord. The lead is attached to a small generator device that is implanted under the skin and subcutaneous layer in the back or buttock. The devices will deliver frequent, low-voltage electrical impulses to the spine, with subsequent modulation of the pain signals in transit to the brain. Those impulses often feel like a gentle tingling or buzzing (paresthesia) on the body. Now there are newer methods of sending impulses that deliver no paresthesias.

Dorsal Root Ganglion (DRG)
Stimulators for extremity nerve pain and CRPS.

Peripheral Nerve Stimulators (PNS)
Stimulators for peripheral nerves located away from the spine, including the knee, shoulder, hip, groin, ankle and foot.

A lumbar RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the medial branch nerve. Once the needle and electrode are in the correct location, the nerve is heated with radio waves until that nerve is unable to pass pain signals to the brain. The heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals.

The SI joint functions to transfer force and energy from the spine to the pelvis. Proper functioning of the SI joint requires for these two bony structures (sacrum and ilium) to be both stable and flexible, relying on balanced muscular and ligamentous attachments. Imbalances between the two can result in increased or asymmetric stress through the joint leading to pathological motion and pain. When symptoms persist for several weeks or months and do not respond to nonsurgical treatment, sacroiliac joint fusion may be recommended. The most common method of sacroiliac joint fusion is a minimally-invasive procedure, performed through a small incision in the buttock. Open sacroiliac joint fusion is rarely used due to extensive healing processes and higher complication rates.

A trigger point injection can help soothe muscle pain, especially in your arms, legs, lower back and neck. It also can be used to treat fibromyalgia, tension headaches and myofascial pain. Trigger points are painful “knots” in your muscles. They form when a muscle can’t relax. Sometimes you can feel these knots when you rub your muscle. Injecting small amounts of anesthetic and steroid into the trigger point can help alleviate the pain.