Pain Management Procedures
Selective Nerve Root Block
A Selective Nerve Root Block injection is used to diagnose or treat pain in an inflamed spinal nerve. Typically, a medication (an anesthetic or an anesthetic with a steroid) is injected at a specific root nerve. This is done under fluoroscopic or X-ray guidance. If the injection reduces the amount of pain the patient experiences, the source of the pain becomes clear. The procedure could also trigger discomfort and pain and the patient is usually required to be awake during the procedure to explain their symptoms. After the procedure, the patient may feel some muscle weakness but this should fade away in a few hours.
For treatment purposes, steroids are usually mixed with the anesthetic in the selective root block injection. Steroids work to inhibit the actions of certain enzymes that cause pain and block C-fibers in the nerve to reduce transmission of pain. This is useful in treating patients with cut was well as chronic pain.
Transforaminal Epidural Cortisone Injections
Epidural glucocorticoid injections are used to treat leg and back pain non-surgically. The method has been proven to relieve pain, improve mobility and buy time for the body to heal, and become stronger to handle surgery. It is usually suggested only if conventional pain-management methods have been tried and proven ineffective.
During a Transforaminal injection, a small gauge blunt needle is injected into the epidural space through the bony, spinal opening for the existing root nerve. The procedure is performed with the patient lying on their abdomen, under real-time fluoroscopy or X-ray guidance. This helps ensure that the glucocorticoid is placed in the correct location. The patient is sedated but awake during the procedure, as the patient needs to give feedback to the doctor about their pain levels.
A Transforaminal epidural cortisone injection is a safe, minimally-invasive non-surgical technique for pain relief for lower-back or leg pain.
Cervical Medial Branch Blocks
The spine has small bony joints called facets, connecting the different vertebrae. These facets enable movements like bending and twisting and provide stability to the back. These joints can also become arthritic or cause pain in the joints in the arms and legs. The goal of a cervical medial branch block is to determine if the patients back pain originates from the facets of the upper spine.
The Cervical medial branch block is performed by injecting an anesthetic to temporarily block any pain signals from the medial nerves in the upper back. The injection is administered under X-ray to ensure proper placement.
After the procedure, the patient is usually kept for observation for a few hours and then discharged. The patient may be asked to maintain a pain journal to record the time, duration, location and intensity of the pain, as well as when they feel noticeable relief. If the patient experiences relief from this procedure, their pain is likely facet-related and they may be recommended radio frequency ablution therapy for long-term relief.
A lumbar discography is performed on patients with severe, persistent back pain, to locate it source. It is performed when conventional methods of alleviating back pain, such as medication or physical therapy are ineffective. The procedure is usually performed before a spinal fusion. The advantage of a discography is that it isolates the location of the pain and allows the surgeons to plan a better surgical approach.
During the discography, the radiologist injects a dye into the spinal disc with CT or MRI visualization and observes the patient’s pain response. The patient is awake and responsive during the procedure, and asked to describe their pain level and location. The process is repeated on each of the discs to be examined to isolate the source of the pain.
Discography is designed to replicate the pain the patient usually experiences, so a certain amount of pain is to be expected during the process. The doctor may give patients a mild sedative to keep them calm.
Ortho-biological therapies (PRP)
Platelet-rich Plasma Therapy (PRP) is a cutting-edge therapy, with scientific evidence suggesting it supports accelerated healing of spinal fusions and other bone fusion surgeries. PRP therapy uses the patient’s own platelets to accelerate tissue growth by increasing the concentration of the body’s natural growth factors.
PRP injections are prepared by passing a small amount of the patient’s blood through a centrifuge. This concentrates the plasma and platelets into a clear fluid. This fluid is then injected directly into the site of injury. Injections of PRP in the spine are performed under X-ray guidance to ensure accurate placement at the affected site.
Platelet-rich Plasma Therapy has proven effective in improving recovery rates of patients who have undergone spinal fusion. PRP offers decreased inflammation, shorter recovery time and negligible risk of side effects. While undergoing Platelet-rich plasma therapy, the patient must avoid anti-inflammatory drugs, as these will interfere with the natural healing process.
Medial Branch Blocks (Facet Joint Blocks)
A medial branch block procedure is performed to diagnose as well as treat persistent back pain due to facet joint degeneration. The procedure is performed by injecting a local anaesthetic to temporarily block any pain signals from the nerves supplying the small joints in the back. The injection is administered under X-ray guidance to ensure proper placement.
After the procedure, the patient is usually kept for observation for a few hours and then discharged. The patient may be asked to maintain a pain journal to record the time, duration, location and intensity of the pain, as well as when they feel noticeable relief. Based on the time taken for the recurrence to occur and its frequency, the doctor will decide on the course of treatment.
The concept that energy from laser beams could reduce inflammation, improve cell regeneration, relieve pain, relax muscles and stimulate nerve regeneration seems counter-intuitive – but medical science has a significant body of evidence to support laser therapy. During a Percutaneous Laser Disc Decompression (PLDD), lasers are used to remove the masses of tissue compressing the nerve in the disc associated with the back pain. The nerve compressions could be caused by herniated disks, tumors, or any other soft tissue growths.
Less invasive than a traditional open-surgery approach, laser surgery has quicker recovery time and less chances of post-operative infection. Laser spinal surgery is done under local anesthesia. In some cases, the patient may be sedated. It can be performed in an out-patient setting. The patient recovery time varies but is usually about 6 weeks. Additional follow-up surgeries are often to be expected when undergoing a Percutaneous Laser Disc Decompression.
Radio-frequency Ablation (RFA) is a minimally invasive, out-patient procedure that destroys the small nerve fibers carrying pain signals to the brain. It can provide lasting relief for patients with untreatable chronic pain, especially in the lower back, neck and arthritic joints. Radiofrequency ablation, also known as Rhizotomy, uses heat to ablate or “burn” the small nerve endings, eliminating the transmission of pain signals to the brain. The procedure is performed under fluoroscopy or X-ray guidance by a radiologist.
Radio-frequency ablation is recommended to patients who experience pain relief after a diagnostic pain/nerve receptor blocker injection. Before the procedure, the doctor reviews the patient’s medical history and does a series of imaging tests to ascertain the best location for ablation. Patients who are on blood thinners or aspirin must stop taking their medications a few days before the procedure, as advised by the doctor.
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