Interventional Procedures

A multidisciplinary pain clinic is one that uses many different diagnostic tests to determine the best treatment plan for pain. It will also offer a treatment plan that will incorporate different disciplines of medicine to decrease pain and improve function. One of these disciplines is interventional pain medicine. All of the procedures require that the patient does not eat or drink for 6 hours prior to the procedure, stops all blood thinning medication for three days prior to the procedure, and bring a driver to the procedure. The procedures take anywhere from one half hour to one hour. All patients are monitored one hour after the procedure in a separate exam room. The patient is awake during the procedure and monitored as well. After the procedure, the patient may resume all medications. Pain and swelling may occur at the injection site, which may be alleviated with an ice pack at the affected area. Many patients experience instant pain relief with injections, but others may not feel any benefits for 3 to seven days after the procedure. Most patients return to work and other activities the day after the procedure.

What is an epidural injection?

The epidural space is located between the spine and the vertebrae. Medication such as a corticosteroid and or local anesthesia is injected in the epidural space by way of a needle. It reduces pain by blocking inflammatory chemical that sensitizes nerves and nerve receptors.

What sort of conditions are these injections used to treat pain?

Injections are used to treat conditions that affect the spine from the neck to the lower back. These conditions include herniated discs, osteoarthritis, spinal stenosis, and scar tissue or other changes following neck or lower back surgery.

How is the injection performed?

The needle is placed at the appropriate segment of the spinal column with the use of a laser guided rotating x-ray machine called a fluoroscope. A front to back and side to side image is used to determine the position of the needle in three dimensions. After determining the needle tip position with respect to the bony landmarks, contrast dye is injected to help confirm placement. After dye confirms proper placement, the medications are injected. These are often done ‘blindly” at pain clinics. At Michigan Spine & Pain we use X-ray guidance to significantly improve accuracy and safety.

What are the side effects and risks with injections?

Most patients will experience some injection site tenderness for 1-3 days following the procedure. This can be remedied with an ice pack on the site if pain persists more than 24 hours. Infections, bleeding, and nerve injury are very rare reported side effects. If you are a diabetic-you may experience an increased blood sugar reading for several hours after the injection. This is common and should subside after a few days.

Do the injections hurt?

There can be some local discomfort with the needle placement. Local anesthetic is used to numb the area beforehand.

How long does it take for the injections to work?

It usually takes one to 3 days for the corticosteroids to have their effect. However, some patients take up to seven days to notice the full effect. Most patients experience relief after the first injection. Subsequent injections are performed to increase the degree of pain relief.

How long does the relief last?

The injected medication is fat soluble and generally active for about one half month. However, the clinical relief achieved depends on several factors. The most important is the nature of the patient’s condition. In many cases, relief can be long lived. In other cases the condition is chronic and injections may be needed on an intermittent basis. Patients are encouraged to go through physical therapy for strengthening exercises during the period of time the pain has been reduced.

What about physical therapy?

Physical therapy and rehabilitation is essential in treating many patients with spinal conditions. One of the major goals of the injection is to reduce pain and allow the patient to participate more effectively in physical therapy.

What are Medial Branch Nerve Blocks?

Medial Branch nerve blocks are injections that are used to diagnose a problem area. These blocks are administered to determine if a patient will benefit from Radio Frequency Neurotomy.

What is Radio Frequency Neurotomy?

Radio-frequency lesioning involves the destruction or long term block of nerves. The radio-frequency unit allows heat to be generated in nerve tissue to either destroy or deactivate the nerve. Patients that have had pain originating from the facet joints are candidates for this procedure. Patients should have had at least two medical branch blocks that gave significant reduction of pain to be a candidate.

What chance is there that this procedure will work?

Studies have shown that there is a 90% chance of significant pain reduction following the procedure as far out as two years and beyond.

How long before I feel relief with RF and how long will it last?

Many patients experience relief immediately after the procedure. However, because of the RF site soreness, some may not have relief for up to two weeks. Only small peripheral sensory nerves are lesioned with this procedure. These nerves do not have the capacity to grow back Patients may require repeat lesioning in as early as a few months but may also have long-term relief as well.

What is discography?

Discs are the shock absorbers of the body. Like jelly donuts, they are capsules filled with a central core of soft disc material. As we get older, the capsules become drier and sometimes the center can rupture out. We perform a discogram to look at discs in detail to determine whether or not a patient’s problem is in this area. A needle is placed into the disc and dye is injected in. The pain specialists check the flow of the dye under x-ray and look for fissures or leaks. Additionally, they look to see if injecting the dye reproduces the patient’s normal pain. Once it is determined whether or not the disc is the patient’s problem, we can then decide on the best course of treatment to help the patient. Often, after the dye is injected, we have the patient undergo a CT-scan so we can look for fissures in better detail.