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The Center for Interventional Pain Medicine at Mercy is proud to provide the most advanced interventional pain treatment options available. There have been dramatic advances in the field of Interventional Pain Medicine resulting in numerous techniques that work in concert with medical management to provide patients with improved outcomes. The Center for Interventional Pain Medicine is committed to a collaborative approach to implement effective treatment plans. Techniques offered to provide leading-edge interventional pain options include:
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Epidural InjectionsEpidural injection is one of the most common and useful interventions available in the modern interventional pain clinic. The epidural space allows unique access to the spinal cord and nerve roots at every level of the spine. Epidural injections provide a safe, low-risk, nearly painless means of delivering a variety of medications directly to the nervous system. Once delivered into the epidural space, these medications may block pain impulses, stabilize irritated nerve structures, reduce inflammation and swelling, and reverse the biochemical changes that are known to occur within the nervous system when pain persists. Epidural therapy is an effective treatment for many painful conditions including intervertebral disc injury, sciatica, acute herpes zoster, post-herpetic neuralgia, reflex sympathetic dystrophy, cancer pain, and post-surgical pain. It also is used as an adjunct to noninvasive therapy and may allow the patient to participate more fully in physical therapies and comprehensive rehabilitation programs. Transforaminal Epidural InjectionsTransforaminal injections can be used to alleviate leg and back pain. Using a fluoroscope, a small gauge needle is inserted into the epidural space through the bony opening of the exiting nerve root. The foramina are small openings between the vertebrae through which the nerve roots exit the spinal canal and enter the body. This technique allows the medication to be placed closer to the irritated nerve root than in conventional epidural steroid injections. Selective Nerve Root Blocks (Cervical/Thoracic/Lumbar)Selective nerve root blocks help determine which nerve roots are causing pain. This is a very selective injection around a specific nerve root. By injecting numbing medication around a specific nerve root, the doctor can determine if the nerve root is the principal source of pain. This type of injection is used often for diagnostic purposes. If the pain decreases, then the correct nerve most likely has been located. By determining the pain source, proper treatment can be further prescribed. Facet InjectionsThe amazing strength and flexibility of the spine is due in large part to the unique interaction of the disc in the front part of the spinal column with the facet joints in the back part of the spinal column. Spinal facet joints are true "synovial joints". Like the shoulder and the knee, spinal facet joints have a joint capsule lubricated with fluid and richly innervated by a network of pain-sensitive nerve fibers. Facet joints are numerous, with two at each spinal level. These small, delicate joints are prone to injury, deterioration, and inflammation, and they sometimes become sources for chronic neck and back pain independent of intervertebral discs and spinal nerves. Facet joints become especially vulnerable when the intervertebral disc is injured. This is true because as the disc degenerates, the volume of the disc is reduced and the disc space tends to flatten out. The disc therefore loses height and the space between the vertebral bodies becomes narrowed. The flattening disc space provides much less support for the facet joints at that particular level, and the joints become subject to increased stress. Facet joint pain is often felt in the spinal area rather than in an arm or leg. Facet joint injections are sometimes used to diagnose and treat pain emanating from the facet joints. Injections of steroids directly into the facet joints may reduce pain and facilitate rehabilitative therapy. If pain recurs after joint injection, the small sensory nerve to the joint (medial branch nerve) can be identified and ablated to obtain long-term pain relief with a technique called radiofrequency medial branch ablation. Radiofrequency Medial Branch AblationFor this intervention, the medial branch nerve is first blocked with local anesthetic in order to confirm that the joint is the true source for pain. If the nerve block reduces pain for the duration of the local anesthetic, then the nerve can be coagulated with radiofrequency heat current, rendering the joint anesthetic and reducing pain long term. Sacroiliac Joint (SIJ) InjectionThe sacroiliac joint is a large joint in the region of the low back and buttocks. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into the groin, abdomen, or leg. A SIJ injection involves placing numbing medicine and steroid into the joint using fluoroscopic guidance. The pain relief assists patients in improved participation in physical therapy and an exercise program. The medication will also serve to reduce presumed inflammation within the joint to help obtain sustained relief. Intervertebral Disc TherapiesThe intervertebral disc is often a primary source for chronic pain and has been the focus of much recent research. Scientific advances in the past five years have led to an improved understanding of disc pain and to new and improved methods for the diagnosis and treatment of pain caused by spinal discs. The Center for Interventional Pain Medicine at Mercy is able to use the most advanced technology to both diagnose and treat disc-related pain. When making the diagnosis of disc related pain it is common to undergo provocative discography, a technique that involves inserting a small needle into the disc using x-ray guidance. Contrast is injected to both visualize the disc for anatomic abnormalities and to pressurize the disc to determine if it is a "pain generator". Following discography a decision can be made regarding further treatment options which may include procedures such as percutaneous discectomy, IDET, or surgical evaluation. Spinal Cord StimulationSpinal cord stimulation delivers low voltage electrical stimulation to the spinal cord to block the sensation of pain. This is an advanced therapy that can be used for many conditions including radicular pain (sciatica), low back pain, Reflex Sympathetic Dystrophy (RSD), post-herpetic neuralgia. A trial is almost always conducted prior to permanent implantation to determine if this is an effective treatment for the patient's painful condition. A small wire (called a lead) connected to a power source is inserted percutaneously into the epidural space using fluoroscopic guidance. Low-level electrical signals are then transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain. Using a magnetic remote control, patients can turn the current on and off, or adjust the intensity. The sensations derived from the stimulator are different for everyone; however, most patients describe it as a pleasant tingling feeling. Lumbar Sympathetic and Stellate Ganglion BlocksThe lumbar sympathetic block targets the sympathetic nerves in the lower back for pain typically in the leg or foot. A stellate ganglion block targets the sympathetic nerves in the neck for pain treatment in the arm, shoulder, or face. The sympathetic nerves, which are a chain of nerves running on the front of the spinal column, can transmit pain following an injury. These blocks are used to help diagnose and alleviate certain pain conditions. These procedures are typically done as part of the treatment for Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain Syndrome, and Herpes Zoster (shingles). VertebroplastyThis minimally invasive treatment results in pain relief from vertebral compression fractures. Using fluoroscopy to guide a small tube into the vertebrae (small bones that make up the spinal column), a cement mixture is injected to strengthen the fractured bone. This procedure is most beneficial within a short timeframe of the fracture occurring. FluoroscopyFluoroscopy is a powerful tool used in advanced pain treatment centers. Physicians utilize live images to precisely guide needle placement and see the size, shape, and structure of a patient's internal bony structures. Fluoroscopic injection allows the interventional pain physician to perform minimally invasive treatment procedures with great precision, more comfort, fewer complications, and better results. Fluoroscopy is utilized for various procedures including:
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