Pain Management Procedures

Epidural Steroid Injection

Epidural Steroid Injections (ESIs) can relieve pain in the lower back and legs, as well as reducing numbness and weakness caused by inflamed nerves in the spine. These injections are delivered in the epidural space around the spinal cord.

The procedure may consist of injecting several medications into the epidural space, including a contrast material to visualize spread within the epidural space, a local anesthetic to reduce pain, and cortisone to reduce inflammation of the nerves.

Caudal and lumbar epidural steroid injections are used to treat lower back, buttock, and leg pain. Thoracic epidural steroid injections treat mid-back pain. Cervical epidural steroid injections treat neck, shoulder and arm pain.

Facet Joint Injection

Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back.

A lumbar, thoracic, or cervical facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and cortisone into or around the joint. 

Local anesthetic provides more immediate pain relief, while cortisone typically takes several days to reduce inflammation and provide pain relief. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine in order to rehabilitate his or her injury or back condition.

Medial Branch Block Injection

A medial branch nerve block is a procedure in which an anesthetic agent (numbing medication) is injected near small medial nerves connected to a specific facet joint. This procedure helps diagnose back or neck pain coming from a facet joint.

If the patient experiences marked pain relief immediately after the injection, then the facet joint is determined to be the source of the patient's pain. This type of injection is typically done to determine if a procedure called a Neurotomy or Rhizotomy can be used to provide longer-lasting pain relief than an injection of the facet joint.

Neurotomy/Rhizotomy

A radiofrequency Neurotomy/Rhizotomy is a treatment used to reduce pain from facet joints or the sacroiliac joint. Radiofrequency energy is used (either hot or cold) to partially destroy the nerves going to the facet or sacroiliac joints to reduce pain.

This procedure requires an IV and is done on an X-ray table. After numbing the skin, fluoroscopy (real time X-ray) is used to guide a radiofrequency probe onto the nerves that supply the facet or sacroiliac joint.

Radiofrequency waves are then used to create a lesion along the nerve pathway. The goal of a radiofrequency Neurotomy/Rhizotomy is to interrupt the pain signal to the brain, while preserving other functions, such as normal sensation and muscle strength. This procedure is done on an outpatient basis.

Sacroiliac Joint Injection

A sacroiliac joint injection is an injection of local anesthetic and steroid into the sacroiliac joint. The sacroiliac joints lie next to the spine and connect the sacrum (triangular bone at the base of the spine) to the iliac (hip) bone on both sides.

These injections reduce swelling and inflammation of the tissue in and around the joint space and are used to diagnose and treat back, hip, and buttock pain.

Trochanteric Bursa Injection

Trochanteric bursitis is an inflammation of a bursa, a fluid-filled sac that functions as a gliding surface to reduce friction between moving tissues of the body.

Greater trochanteric bursitis is the inflammation of the sac that lies over the outside of the thigh bone (femur) where it joins the hip. A bursa injection is typically performed with injections of local anesthetic and cortisone.

Psoas Injection

Psoas injections are often performed to diagnose and treat pain related to psoas muscle and tendon spasm or inflammation. The psoas muscle runs deep in the lower back and attaches to the hip joint. The injection is performed under ultrasound or fluoroscopy.

 

Selective Nerve Root Block

A selective nerve root block is an injection of local anesthetic and cortisone onto a spinal nerve root. This injection is used to both diagnose and treat pain, weakness, or numbness in an arm or leg related to an inflamed spinal nerve root.

This injection can help determine if a nerve at a specific level in the spine is causing a person’s symptoms of pain or numbness.