Pain relief procedures
Physical Medicine and Rehabilitation (PM&R) is a specialty whose physicians – known as physiatrists—diagnose and treat injuries and illness that involve movement. They are experts at diagnosing and treating acute and/or chronic pain. The physiatrist seeks to help the patient achieve optimal function and quality of life through the reduction of pain, including physical therapies (massage, exercise, braces) and interventional pain management (epidural injections, facet injections, and spinal cord stimulation).
Epidural Steroid Injections
Epidural Steroid Injections (ESIs) are used in the treatment of acute or chronic pain in the back, neck, arms, or legs. Typically, patients who are candidates for an ESI are suffering from a pinched nerve caused by a herniated disc, or degenerative disc disease. The ESI is a minimally invasive procedure in which the physician delivers medicine – a long-lasting corticosteroid -- to the spinal nerve. This is accomplished by guiding a needle into the epidural space, the area between the spinal nerves and the bony vertebrae, with the help of an imaging technology called fluoroscopy. The pain relief can last from days to years— allowing your condition to improve with physical therapy and an exercise program. If prior injections were helpful, the procedure can be repeated. Corticosteroids are helpful in reducing inflammation and pain.
Facet Injections and Rhizotomy
Facet Joint Injections are used in the treatment of neck or back pain caused by inflamed facet joints. Arthritis, injury, and disc degeneration can cause pain in the facet joints that connect the bony vertebrae to each other. A facet injection is a minimally invasive procedure in which a long-lasting corticosteroid and numbing agent is injected into the painful facet joint with the help of an imaging technology called fluoroscopy. The injection can bring relief for several days to years. It also can be used to determine whether the facet joints are the true source of the patient’s pain. If the injection does provide relief, the procedure can be repeated if pain recurs.
Sacroiliac Joint Injections
Sacroiliac Joint Injections are used in the treatment of pain in a large joint in the area of the lower back (lumbar spine) and buttocks. Arthritis, injury, and disc degeneration can cause pain in the sacroiliac or referred pain in the groin, abdomen, hip, buttock, or leg. A sacroiliac joint injection is a minimally invasive procedure in which the physician injects a long-lasting corticosteroid and numbing agent into the joint. This is accomplished by guiding a needle into the joint with the help of an imaging technology called fluoroscopy. The injection also can help determine whether the sacroiliac joint is causing the patient’s pain or whether the pain is originating from another location.
Trigger Point Injections
Trigger Point Injections are used in the treatment of painful knots of muscle, called trigger points, which fail to relax. Trigger points can be painful and, by irritating surrounding nerves, can cause pain to radiate into other areas of the body. A trigger point injection is a minimally invasive procedure in which the physician injects a corticosteroid and numbing agent into the knotted area, usually in the lower back, neck, arms, or legs. The injection is usually effective in treating the problem.
Radiofrequency Ablation (Rhizotomy)
Radiofrequency Ablation (Rhizotomy) is used in the treatment of recurring pain caused by arthritis. It is a minimally invasive procedure in which the physician applies a radiofrequency current to burn the sensory nerves surrounding a painful joint and prevent pain signals from reaching the brain. Radiofrequency ablation is a treatment option for patients who have experienced successful pain relief after a diagnostic nerve block injection test.
Spinal Bracing can play a role in treatment following injury or surgery. Braces, called orthotics, can immobilize the neck or back during healing, can stabilize injured areas, and can control pain by restricting movement. Braces can be custom-molded and adjusted to the size and needs of individual patients. Braces should be worn at all times, even during sleep, unless the surgeon instructs otherwise.
Exercise Programs play a critical role in a patient’s recovery from injury or surgery and in the maintenance of a normal, healthy back. Regular exercise also can help prevent injury from occurring. Exercises for a healthy back are divided into three groups: those that strengthen the back through repeated muscle contractions; those that promote flexibility by stretching and lengthening muscles; and those that promote fitness through the steady use of large muscle groups. Exercises should be performed slowly and comfortably to avoid injury.
Physical Therapy is an important part of a nonsurgical approach to restoring, maintaining, and promoting overall health. In collaboration with a physician, a physical therapist helps patients who are recovering from surgery, injury, or disease. A physical therapist will evaluate a patient’s movement and body type and then design a personalized regimen to help restore function, relieve pain, and improve mobility and strength.
Joint Injections are used in the treatment of painful, inflamed joints affected by arthritis or injury. Injections can be made in the hip, shoulder, elbow, hand, knee, and ankle. A steroid joint injection is a minimally invasive procedure in which a corticosteroid and an anesthetic numbing agent are delivered inside the joint capsule. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the joint. Second, it can be used as a treatment to relieve inflammation and pain caused by various conditions.
Chiropractic Care can play a role in the restoration of structure and function of the spine. Spinal vertebrae (bones) can undergo minor displacement (subluxation) because of stress, accidents, injury, or overexertion. A displaced vertebra can result in muscle tension or irritation to the spinal nerves, which in turn can cause pain and impairment to overall health. In the event of a minor displacement, a chiropractor can help restore systems to their proper function through an “adjustment” technique. While giving an adjustment, the chiropractor quickly applies firm pressure with the hand to reduce subluxation and restore movement.
Spinal Rehabilitation is supervised by a physician who specializes in physiatry, also known as physical medicine and rehabilitation. The physiatrist specializes in the diagnosis and treatment of patients with acute and/or chronic illness or pain, including back pain. The physiatrist seeks to help the patient achieve optimal function and quality of life through the reduction of pain and the adaptation to assistive devices, including braces and wheelchairs. Depending on the patient’s needs, the rehabilitation team may also include physical and occupational therapists, and social workers.
Self Care and Braces
Self Care and Braces - Patients can protect their back and further the healing process by using correct posture, by keeping the spine in alignment, by wearing a brace if recommended, and by following through with physical therapy or a regular exercise program. The lower back bears most of a person’s weight, so proper alignment can prevent further slippage and injury to the spinal nerves and discs. Proper lifting habits – keeping the back perpendicular and bending at the knees -- can also protect against injury. Wearing a back brace may be advisable while the abdominal and lower back muscles are being strengthened following surgery or an injury. The brace can decrease muscle spasm and pain as well as help immobilize the spine during the healing process.
Spinal Cord Stimulation for Chronic Back Pain
Spinal Cord Stimulation is used to treat severe, chronic pain that cannot be alleviated by conservative measures. In two stages, the surgeon implants one or two electrical leads to the spinal cord or targeted nerves and then a small generator in the patient's back or abdomen, just under the skin. The spinal cord stimulator generator transmits a low-voltage electrical current through the leads to the spinal cord, and the patient experiences a sensation of tingling instead of pain.
Medical Pain Management
Medical Pain Management involves treating and controlling acute or chronic pain with medications. Mayfield provides only injection and surgical treatment for pain, but numerous organizations offer medical options that also can include holistic treatment. Acute pain is directly related to tissue damage and has an obvious source. Chronic pain, whose origin can be difficult to pinpoint, is persistent and can last months. In some cases the brain will continue to receive pain signals even after an injury has healed. Chronic pain also is frequently present in ongoing conditions, such as arthritis or cancer.
Interventional Pain Management
Interventional Pain Management involves the diagnosis, management, and control of acute or chronic pain with minimally invasive techniques. It is an option for patients whose pain is not adequately relieved by standard medical pain management. A team of specialists provides interventional pain management, which can include epidural steroid injections, joint injections, nerve blocks, and radiofrequency ablation (rhizotomy). Acute pain is directly related to tissue damage and has an obvious source. Chronic pain, whose origin can be difficult to pinpoint, is persistent and can last months.
Nerve Block Injections
Nerve Block Injections are used in the treatment of nerve pain. Arthritis, injury, and degeneration can cause pain in the joints. A nerve block is a minimally invasive procedure in which an anesthetic is injected into the painful area. The injection temporarily “blocks” the pain in the same way a dentist uses an anesthetic injection to block pain in your jaw before working on your teeth. A nerve block injection test can determine whether the sensory nerves are the true source of the patient’s pain. The effects of a nerve/pain receptor block tend to be temporary and are rarely long term. If the injection does provide relief, the patient might benefit from a radiofrequency ablation (rhizotomy).
Part 1: Non-surgical treatment of sacroiliac joint (SI joint) dysfunction
Dr. Marc Orlando of Mayfield Brain & Spine discusses non-surgical treatment options of sacroiliac joint (SI joint) dysfunction.