Treatment
As reflected in our name, we provide a wide range of valuable resources, including:
patient education/wellness program
medication management
psychological counseling (individual and group therapy)
physical therapy, conditioning and rehabilitation
transcutaneous nerve stimulation
epidural and subarachnoid blocks
peripheral and regional blocks
sympathetic plexus blocks
sympathetic ganglion blocks
intra articular and bursa injections
cranial and facial nerve blocks
trigger point injections
continuous epidural infusions
narcotic/medication infusion pump implantation
implantation of spinal cord stimulator

EPIDURAL STEROID INJECTION

EPIDURAL STEROID INJECTION has recently been found to be an effective treatment for some patients who are suffering from low back pain due to nerve impingement. Commonly, nerves which supply the back or legs are compressed near the spine either by a bulging disc, a bone spur or scar tissue. This causes the nerve to become irritated or swollen. Steroids have powerful anti-inflammatory activity. They act to decrease the swelling and inflammation in the nerves and surrounding tissues. The most common steroids used for epidural injection are Depomedrol (methylprednisolone acetate) or Kenalog (triamcinolone acetonide). Epidural injection of steroids can be performed by experienced pain practitioners in the cervical (neck), thoracic (mid-back), lumbar (low back) or caudal (sacral) approach depending on the patient's condition. In our experience, about 80 percent of patients who have not had previous back surgery obtain some relief from epidural steroid injections. For those patients who have had previous back surgery, the effect may be less. Many patients obtain relief after one injection. Others may require more than one injection depending on the initial response. Injections are usually spaced apart, and it is rare to receive more than three injections within a six month period. Some patients may not benefit from epidural injections and may require other type of pain treatments which your doctor can discuss with you.

HERNIATED DISK

OVERVIEW: The spinal column is composed of a series of 24 bones called vertebrae that are separated from each other by a disk. The disks are about the size of four silver dollars stacked on one another. Their structure is like a jelly doughnut with tough surrounding ligaments and a jelly center called a nucleus. This nucleus will flatten out the bulge depending on the stress applied to the back. If the force is too much, the nucleus can rupture and break through the surrounding ligament. When this happens, it will pinch a nerve either in the low back or neck.

DIAGNOSIS: A ruptured disk does not always produce low back pain, but instead, can cause pain that follows a nerve down the arm or leg into the hand or foot, respectively. It can be associated with tingling, numbness or weakness in the extremity. The onset may have been associated with excessive physical activity or a traumatic incident such as a car accident. When the doctor examines the patient, he or she will look for signs of nerve involvement through a careful neurologic exam checking sensation, strength and reflexes. To confirm the presence of a ruptured disk, the doctor may order a CT scan, MRI or possibly a myelogram. These tests provide very sophisticated ways of viewing the spinal column that are far superior to traditional x-rays.

TREATMENT: Depending on the pain and potential for nerve damage, there are a number of ways of treating a herniated disk. In some patients, the nerves can be severely injured causing loss of bowel or bladder function. In this case, it is an emergency and the disk must be surgically removed. Fortunately, in most patients, this rarely occurs. Patients usually present with pain and minimal loss of nerve function. They can elect to be treated conservatively with a combination of physical therapy, medications, and injections. Physical therapy is useful in reducing a bulging disk and taking pressure off of the nerve. If physical therapy and medications are inadequate for control of pain, injections can be given to ease the discomfort. Epidural steroid injections apply powerful anti-inflammatory drugs to the involved nerve root, which eases pain and swelling secondary to disk irritation. The injections can be given as a series of three over a period of several weeks. Relief can begin within 72 hours of the first injection. Patients experiencing severe pain despite medications, physical therapy and injections may find it necessary to have surgery.

SHINGLES

OVERVIEW: Shingles is an infection of an individual nerve root by the same virus that causes chicken pox, also known as the herpes zoster virus. The disease presents with pain almost anywhere in the body but most commonly in the face, chest or abdomen. A day or two after the pain begins, a characteristic rash erupts composed of small fluid-filled blisters on top of reddened skin. The blisters are limited to a band on the right or left side of the body. If the rash crosses over the middle of the body, it is not shingles. That is because the shingles virus affects one nerve corresponding to an area of the skin. Each cutaneous or skin nerve in the human body stays on the right or left side and does not cross over the middle. We first get infected with the shingles virus when we contract chicken pox as children or young adults. The body's immune system forces the virus to settle in inactive form inside the nerve cells called neurons. When the chicken pox virus reactivates, it moves down the nerve fibers to the skin and the telltale rash erupts. In addition to the skin, the nervous system is very much involved. In fact, if the virus attacks the optic nerve of the eye, it may leave the patient with temporary blindness. In most patients, after the eruption of shingles, the rash will heal and the pain will go away after a period of three to five weeks. However, there are exceptions. In older patients the risk is high that the virus can actually leave permanent nerve damage and this can cause pain long after the rash is healed. In some patients, the pain may persist for the rest of their lives.

TREATMENT: Medical science is now developing antiviral drugs. One of the first antiviral drugs developed was acyclovir. This drug can help resolve infections in the herpes virus. As soon as the rash breaks out, acyclovir is prescribed in large doses for a period of approximately 10 days. This can help alleviate the attack and prevent permanent nerve damage in some patients. Additionally, there is literature that shows early interventions with nerve blocks done by pain management specialists can also prevent the development of Post-herpetic neuralgia. Post-herpetic neuralgia is the name given to the painful condition that exists long after the viral infection is over. Combination therapy of the acyclovir and the nerve blocks is the most effective treatment strategy for preventing this painful development. Even patients in whom post herpetic neuralgia develops, there is treatment.

SACROILIAC JOINT PAIN

OVERVIEW: The sacroiliac joint can be a common cause of low back pain.  It can occur after a traumatic injury or spontaneously as well.   Pain from the sacroiliac joint usually causes buttock pain and referred mechanical symptoms.  Areas of referral include hip, groin, anterior thigh, and calf.   Patients with sacroiliac joint pain frequently report that their pain is at its worst when they first arise in the morning and lessens over the next several hours.   Compression tests are frequently painful and distraction tests often reveal a poorly mobile joint.

DIAGNOSIS: The diagnosis of sacroiliac joint pain can be made through specific injections of the joint.  With the use of specialized equipment, such as C-arm fluoroscopy, local anesthetic can be injected to anesthetize the joint and further refine the diagnosis.  Selective, low-volume anesthetic blockade of the posterior capsule of the sacroiliac joint can give useful diagnostic and predictive data.

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