Interventional pain management including percutaneous diagnostic and therapeutic techniques continue to evolve in the management of acute and chronic pain. The variety of interventional procedures are used to deliver high-quality patient care, improve diagnosis and enhance quality of life.

Several interventional pain management procedures briefly discussed on this website. The more detailed discussion will take place during the visit in the clinic.  Among the interventional procedures that are used for the treatment and not already discussed are:

• Platelet rich plasma

• Sympathetic blocks

• Vertebroplasty and kyphoplasty

• Intradiscal electrothermal therapy

• Referral blocks

• Intramuscular botulinum toxin injections

The treatment options will be discussed with the patient during the clinic visit after a comprehensive evaluation and diagnostic testing. The patient will be provided with all educational materials necessary to make a right decision which is appropriate for the patient's condition with the main goal to regain the function and life back.

Piriformis steroid injection

Spinal cord stimulator (dorsal column stimulator) is a medical device surgically placed under the patient’s skin with an lead (special electrical wire) placed in the epidural space at an appropriate level to send mild electric current to the spinal cord to produce a feeling of tingling in the area over the typical everyday pain. The pain reduction is achieved due to the suppressing of the pain signal as the main pain generator the pathologic structure.  It was found that the signal of the tingling sensation is much stronger compared to the signal of the pain and able to compete with the pain signal or even suppress it completely.

This particular treatment modality is offered only to the patients that failed conservative treatment, interventional procedures, and not a surgical candidates at that point. Patients need also to have psychological or neuropsychological evaluation to make sure that they are capable to use/operate the device and its remote control.

The procedure starts with the trial first. The spinal cord stimulator lead is placed into the epidural space at the appropriate level and the effect of the stimulation is checked by external device by the representative from the company producing the spinal cord stimulator generator kit.  Upon the appropriate placement and testing of the leads in the epidural space, the generator is temporarily placed externally. The position of the leads are secured with sutures and the generator with special dressing. The patient is sent home with a remote control to see if the spinal cord stimulator provides sufficient pain relief for the patient.  There are different modalities over the stimulation available and to be discussed with the physician and company representative during the appointment. The company representative provides the patient with education and discuss in detail with the patient how to operate the remote control and recharge the device as needed.  The patient comes back to the clinic 5 days later to discuss the effect of the spinal cord stimulator trial and assess the patient for possible side effects or complications.  The external generator with the lead is removed.  Patient will be scheduled to have surgical placement of the leads of the spinal cord stimulator into the epidural space connected to the permanent generator placed under the skin in the low back area if the trial is successful.  Patient will be provided with the further education regarding the remote control operation, maintenance and recharging the system on their own.  This spinal cord stimulator system will be frequently checked by the physician and the company representative to ensure the appropriate functioning and maintenance.

Provocative discography or discogram could be performed in the cervical or lumbar area in order to see if the intervertebral disc is the primary pain generator. This procedure is usually performed after the treatment of the facet arthropathy and radicular pain if present. Discography is the last diagnostic approach for the patient before a surgical evaluation  and should be performed after at least diagnostic blocks are performed to assure that other structures are not the main pain generator for the patient.

The procedure is performed by injecting contrast material into the nucleus pulposus of the intervertebral disc (center of the disc). Patient usually is provided with intravenous antibiotic prior to the procedure to prevent infection.  Pain is produced in the abnormal disc due to intolerance of increased intradiscal pressure or contrast material leaking through the walls of the injured disc.  The patient is asked whether he or she feels pain vs. only pressure sensation first.  The feeling of pressure only confirms that this particular intervertebral disc is not the main generator for the pain.  If patient reports having the pain with the introduction of the contrast material into the intervertebral disc, the pain needs to be specified whether it is a concordant pain ( resembling the typical daily pain for the patient and more intense at that moment) or a different new pain. The existence of the concordant pain confirms that injected intervertebral disc can possibly be the main generator for the pain.

The cervical or lumbar discogram procedure primarily serves as a prerequisite before performing a minimally invasive procedure or surgery.

Occipital nerve blocks are performed to place anesthetic and steroid medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area with the goal to reduce headaches and the pain from the involved area.

Radiofrequency ablation of the occipital nerves is the preferred treatment modality when occipital nerve steroid injections do not provide long-term pain relief and patient requires frequent injections to reduce the pain and suffering from headaches.

Hip and Shoulder Joints steroid injections are performed to deliver anesthetic and corticosteroid medications into the joint space to relieve the pain, regain range of motion and function.  The anesthetic portion of the injection may reduce pain from specific structures and corticosteroids may reduce inflammation which usually is the main source of the pain.

There are several treatments available for the sacroiliac joint dysfunction.

Sacroiliac joint diagnostic injection involves the placement of the anesthetic medication only to see if the pain is related to the sacroiliac joint pathology.  Patient’s report instant pain relief, however, the pain returns back after the anesthetic medication effect is diminished.

Sacroiliac joint steroid injection involves the placement of the anesthetic and steroid medication into the joint space or the close proximity of the joint with the goal to provide long-term pain relief.