Pain Management Procedures

Lumbar Epidural Steroid Injection (without sedation)
Epidural Steroid Injection (with sedation)
Transforaminal Epidural Steroid Injection
Facet Joint Nerve Block
Facet Joint Radiofrequency Lesioning (Rhizotomy)
Intercostal Nerve Block
Trigger Point Injections
Spinal Cord Stimulator Trial and Implant
Intrathecal Infusion Device Trial and Implant
Stellate Ganglion Block (Cervical/Thoracic Sympathetic Nerve Block)
Lumbar Sympathetic Nerve Block

Lumbar Epidural Steroid Injection (without sedation)

An epidural steroid injection is given for relief of pain from lumbar spine nerve root irritation. The cause of irritation may be a bulging or herniated disc, leaking disc, arthritis, a fracture, or a tumor. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You can continue light eating and drinking, and do not forget to continue your medications.

In the pre-procedure area, you will change into a patient gown. A Nurse will take a brief medical history from you and prepare you for your procedure. Your vital signs will also be taken. Your Physician will also be there to talk to you, and obtain consent for the procedure.

In the procedure room, you will meet a Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Physician will then inject a local anesthetic into your low back area right above your buttocks. A needle will then be inserted into the epidural space near the location of the affected nerve root(s). The epidural space is a fat filled sac right outside the sac that holds the spinal cord and spinal fluid. All of the spinal nerve roots run through this area, and this space runs the entire length of the spinal cord. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). The steroid is then injected. This steroid is specifically made for the epidural space, and is the most potent anti-inflammatory medication available. The steroid will decrease the swelling in the spinal nerve roots, which in turn will decrease your pain and symptoms. The relief will not be immediate, but the following day or two will bring relief.

The actual injection takes about 20 minutes. You will be in the hospital for no more than 2 hours. You have no activity restrictions after the injection. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time.

Side effects of epidural steroids are rare. This injection may be repeated three times in a 6-month period for pain relief. You will be re-evaluated after each injection for effect.

Epidural Steroid Injection (with sedation)

An epidural steroid injection is given for relief of pain from cervical, thoracic, or lumbar spine nerve root Irritation. The cause of irritation may be a bulging or herniated disc, tear in the disc, arthritis, shingles, a fracture, or a tumor. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the pre-procedure area, you will change into a patient gown. A Nurse will take a brief medical history from you and start your IV. Your vital signs will also be taken. Your Physician will also be there to talk to you, and obtain consent for the procedure. You will also meet your Anesthesiologist.

In the procedure room, you will meet a Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A needle will then be inserted into the epidural space near the location of the affected nerve root(s). The epidural space is a fat filled sac right outside the sac that holds the spinal cord. All of the spinal nerve roots run through this area, and this space runs the entire length of the spinal cord. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). The steroid is then injected. This steroid is specifically made for the epidural space, and is the most potent anti-inflammatory medication available. The steroid will decrease the swelling in the spinal nerve root(s), which in turn will decrease your pain and symptoms. The relief will not be immediate, but the following day or two will bring relief.

The actual injection takes about 10 minutes. You will be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time.

Side effects of epidural steroids are rare. This injection may be repeated three times in a 6-month period for pain relief. You will be re-evaluated after each injection for effect.

Transforaminal Epidural Steroid Injection

A Transforaminal Epidural Steroid Injection is performed to treat pain and inflammation of a specific nerve root irritation. The cause of irritation to a nerve root may be a bulging or herniated disc, tear in the disc, arthritis, a fracture, or a tumor. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the procedure room, you will meet a Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A needle will then be inserted into the area next to the nerve root, which is causing your pain. This may be a single level, or multiple level injection. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). The steroid is then injected. The steroid will decrease the swelling in the nerve root(s), which in turn will decrease your symptoms. The relief should occur within 48-72 hours after the procedure.

The actual injection takes about 15 minutes. You are expected to be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time. Assume a comfortable position at all time.

Side effects of epidural steroids are rare. This injection may be repeated three times in a 6-month period for pain relief. You will be re-evaluated after each injection for effect.

Facet Joint Nerve Block

A facet joint nerve block is done to confirm-that neck or low back pain is coming from the facet joints and can possibly treat the pain. Facet joints are small joints outside the spinal column at all levels on both sides that guide and restrict movement in your back. Sometimes conditions such as arthritis can cause inflammation and pain in the small nerve fibers that control the joint. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

The actual injection takes about 20 minutes. You are expected to be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time.

Facet Joint Radiofrequency Lesioning (Rhizotomy)

A facet joint nerve block is done first to confirm that neck or low back pain is coming from the facet joints. Facet joints are small joints outside the spinal column at all levels on both sides that guide and restrict movement in your back. Sometimes conditions such as arthritis can cause inflammation and pain in the small nerve fibers that control the joint(s). If you did obtain pain relief from a facet joint nerve block, but it did not last, then you are a candidate for radiofrequency lesioning of the facets (AKA Rhizotomy). This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the procedure room, you will meet another Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A special insulated needle will then be inserted into the facet joint(s) which are causing your pain. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). You will be awakened from anesthesia at this point in the procedure to ensure that needle placement correlates with your area of pain. The needle is then heated to 80 degrees Centigrade for 90 seconds. An increase in localized back pain, usually due to muscle spasm, can be expected for several days. The pain relief will last for 3 to 18 months. If the nerve fibers grow back and pain returns, the procedure can be repeated.

The actual procedure takes about 20 minutes. You will be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time.

Intercostal Nerve Block

An intercostal nerve block is given for relief of pain from misfiring nerves that run along the muscles between your ribs. Most commonly, this pain can be caused by shingles, a surgical procedure called a thoracotomy, or cancer that has traveled to the bone. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the procedure room, you will meet another Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A needle will then be inserted into your back by the rib(s) that your Physician has previously identified as causing your pain. The steroid and local anesthetic solution is injected by the nerves along the affected rib(s). The needle is correctly positioned with the guidance of a fluoroscope (a real time x-ray). The steroid will decrease the inflammation in the nerves, which will decrease your pain and symptoms. The local anesthetic should provide some immediate relief of pain.

The actual injection takes about 15 minutes. You will be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room. You will have a chest X-ray performed to make sure that the lung was not damaged. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and do not participate in any physical activities that you have not done in quite some time.

If you have good pain relief from this procedure, and it is not long lasting, you may be a candidate for an Intercostal Cryolysis, which entails destroying those painful nerves by freezing them.

Trigger Point Injections

Trigger point injections are given for relief of pain due to chronic muscle spasm and mild inflammatory changes due to physical or emotional stress. Trigger points elicit pain when pressed, and are located in the muscle or soft connective tissues. Trigger point injections are used to eliminate myofascial pain in the body.

Your Physician or Nurse Practitioner will identify and mark your trigger points. After the area is cleansed with an alcohol pad, a local anesthetic will be injected into the area using a very small needle. The local anesthetic will numb the area, relieve the pain, decrease muscle spasm, and increase blood flow to the surrounding tissue to promote healing. The numbness will be temporary, but the pain relief will be longer lasting.

This procedure, which is done in the office, takes approximately 10 to 15 minutes. Some patients may experience soreness, bruising, or swelling after the injections. This is temporary. We recommend using ice on the area, and take anti-inflammatory medications as needed.

Spinal Cord Stimulator Trial and Implant

Spinal Cord Stimulators work well in those patients who suffer from chronic pain in the legs, arms, and low back. These patients have not obtained adequate relief from oral medications or other procedures. Before the-actual generator is implanted, a trial is done to ensure you obtain adequate pain relief. The affected area of your body will experience a gentle tingling sensation replacing the pain. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the pre-procedure area, you will change into a patient gown. A Nurse will take a brief medical history from you and start your IV, Your vital signs will also be taken. Your Physician will also be there to talk to you, and obtain consent for the procedure. You will also meet your Anesthesiologist.

The actual procedure takes about 60 minutes. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room for approximately 30 to 60 minutes. You will also be given something to eat and drink. You will be given a control device so you can regulate the strength of the impulses by yourself, as well as turn the leads on and off. You will be monitored for pain relief. Then you will be discharged home with your trial device and asked to perform activities of daily living, especially those that normally produce pain. If you have good pain relief, the leads will be internalized for your long-term use, along with a generator (battery source). If you do not obtain relief, the leads will be discontinued (this will NOT damage the spinal cord or nerves). Ether procedure will be done as an ambulatory procedure the following week. Implantation of a generator requires general anesthesia.

Intrathecal Infusion Device Trial and Implant

Intrathecal medications are given to those patients who suffer from severe chronic pain, and have not obtained adequate relief from oral medications, or cannot tolerate the side effects of oral medications. Before the actual device is implanted, a trial is done to ensure that you can tolerate the medication and you do not have bad side effects. The trial is done through a single injection placed into your back. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the procedure room, you will meet a Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. The needle is then inserted into the intrathecal space in your back. The intrathecal space is the area surrounding your spinal cord, where the spinal fluid is located. The needle is positioned correctly with the guidance of a fluoroscopy (real-time x-ray). Your Doctor may also inject some dye through the needle to ensure its position. Medication (like morphine) is then injected through the needle. The dose will be much smaller than oral doses.

The actual procedure takes about 20 minutes. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room for approximately 30 minutes. You will also be given something to eat and drink. Then you will be admitted to the hospital. You will be monitored closely for pain relief and side effects of the medication. More than one dose of medication, or another medication may be tried during your hospital stay, which will entail repeating the above procedure. If you obtain adequate pain relief with minimal side effects, you will be discharged home and the actual pump and permanent catheter will be implanted at a later date as an ambulatory procedure.

When the device is implanted, you will need to arrive at the hospital through the Admitting office the morning of your procedure. Again you cannot eat of drink anything after midnight the night before. The pump, which stores the medication, will be surgically implanted under the skin on your abdominal wall. The catheter will be inserted through a spinal needle in your back and connected to the pump. Your Physician will use the pump computer to program the pump motor to deliver prescribed amounts of medication into your spinal canal for pain relief. You may need frequent office visits postoperatively for adjustments in your dose before an optimal level of pain relief is met.

Stellate Ganglion Block
(Cervical/ Thoracic Sympathetic Nerve Block)

A stellate ganglion block is given for relief of pain generated from a damaged sympathetic nervous system in the cervical or upper thoracic areas. The damage is usually from surgery or trauma to the affected area. The sympathetic nerves are responsible for the involuntary functions of the arms, such as the opening and closing of blood vessels. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure. You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the pre-procedure area, you will change into a patient gown, A Nurse will take a brief medical history from you and start your IV. Your vital signs will also be taken. Your Physician will also be there to talk to you, and obtain consent for the procedure. You will also meet your Anesthesiologist.

In the procedure room, you will meet a Nurse and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A needle will then be inserted into the front of your neck next to the cervical (at C6) vertebrae where the sympathetic nerves from the affected arm come together. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). The anesthetic is then injected. The anesthetic will block the misfiring of the sympathetic nerves, which in turn will decrease your pain and symptoms. The first procedure done is primarily for diagnosis, but it may provide pain relief.

The actual injection takes about 10 minutes. You are expected to be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room as well as temperature changes in your upper extremities. If you do not obtain a good block as noted by temperature change, the procedure will be repeated immediately to ensure a good block. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and participate in any physical activities that you are already involved with. If you are involved with Physical Therapy, we ask that you make an appointment for a PT visit immediately after your block.

You may note redness or a feeling of warmth in the arm after the procedure. You may also experience redness of the eye, drooping of the eyelid, a hoarse voice, or a constricted pupil for up to 8 hours after the procedure. This is normal. If you do receive pain relief from this procedure, and a diagnosis is made, you may need to have stellate ganglion blocks in a rapid series. It is important to monitor how much relief you receive (including location and duration of relief), and to remain active to “test” the amount of relief you receive.

Lumbar Sympathetic Nerve Block

A lumbar sympathetic nerve block is given for relief of pain generated from a damaged sympathetic nervous system in the lumbar area. The damage is usually from surgery or trauma to the affected area. The sympathetic nerves are responsible for the involuntary functions of the legs, such as the opening and closing of blood vessels. This is an outpatient procedure. You will need to report to the hospital Admitting office one hour before your scheduled procedure.

You cannot eat or drink anything after midnight the night before your procedure. Please continue all of your medications with a sip of water unless otherwise instructed by your Physician.

In the procedure room, you will meet another RN and an X-ray Technician. They will help you get properly positioned on the procedure table. Your Anesthesiologist will administer a light sedative through your IV line. The sedative will make you fall asleep, as we do not want you to move during your procedure. A needle will then be inserted into your low back next to the bony lumbar vertebrae (at L3) where the sympathetic nerves from the affected leg come together. The needle will be correctly positioned with the guidance of a fluoroscope (a real-time x-ray). The anesthetic is then injected. The anesthetic will block the misfiring of the sympathetic nerves, which in turn will decrease your pain and symptoms. The first procedure done is primarily for, diagnosis, but it may provide pain relief.

The actual injection takes about 10 minutes. You will be in the hospital for no more than 2 hours. After your procedure, your heart rate, blood pressure, EKG and oxygen level will be monitored in the Recovery Room as well as temperature changes in your lower extremities. If you do not obtain a good block as noted by temperature, the procedure will be repeated immediately to ensure a good block. You will also be given something to eat and drink. Your restrictions for that day will include no driving and no alcohol intake. That means you will need someone else with you to drive you home from the hospital. Continue to use good body mechanics and participate in any physical activities that you are already involved with. If you are involved with Physical Therapy, we ask that you make an appointment for a PT visit immediately after your block.

You may note redness or a feeling of warmth in the leg after the procedure. This is normal, if you do receive pain relief from this procedure, and a diagnosis is made, you may need to have lumbar sympathetic nerve blocks in a rapid series. It is important to monitor how much relief you receive (including location and duration of relief), and to remain active to "test" the amount of relief you receive.

Pain Management Procedures

Lumbar Epidural Steroid Injection (without sedation)

Epidural Steroid Injection (with sedation)