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Treatment Options
Treatment plans often include:
Physical Therapy
Spine Injections, Nerve Blocks
Joint, Muscle Injections
Botulinum toxin (Botox) Injections for Chronic Migraine or Limb Spasticity
Medication Management
Pain Neuropsychology
Consultation with Spine Surgery, Neurology, and Rheumatology as needed
Referral to Chiropractic, Acupuncture, or Complementary Medicine
Advanced Pain Intervention
Spine and Nerve Blocks
Epidural Steroid Injection (cervical/thoracic/lumbar)
Transforaminal Epidural/Selective Nerve Root Blocks (lumbar/sacral, cervical done w/catheter)
Occipital Nerve Blocks
Provocative Discography (cervical/lumbar): a diagnostic test to identify the most painful intervertebral disc in the spine
Facet Joint Injection (cervical/lumbar)
Medial Branch Block (cervical/lumbar)
Sympathetic Blocks (stellate/thoracic/lumbar/hypogastric)
Interscalene block
Intercostal nerve block
Ilioinguinal/Iliohypogastric block
Sciatic Nerve Block/Piriformis injection
Pudendal Nerve Block
Interdigital block for Morton’s Neuroma
Joint and Muscle Injections
Shoulder Injections
Knee injections
Hip injections
Ankle joint injections
Trigger Finger Injections
Tennis or Golfer’s Elbow Injections
Thumb joint injections
Plantar Fasciitis Injections
Trigger Point Injections: these injections in muscles are designed to help relieve pain associated with Myofascial Pain Syndrome, a condition in which regional muscle pain is experienced.
Advanced Pain Procedures
Spinal Cord Stimulation Trial/Implant
: a technology in which a battery and one or more electric wires or implanted in the body. The wires can be placed next to the spinal cord, peripheral nerves, or in soft tissue. When activated, these wires carry electric impulses that can block or disrupt ordinary pain impulses via the Gate Control Theory. Patients will feel a tingling sensation when this device is on. Note: this is not the same as a TENS unit.
Intrathecal Pump Therapy Trial/Implant/Management:
placement of an implantable pump inside the body to deliver pain medication directly into the Cerebrospinal Fluid which flows through the spinal cord and brain. This results in the most direct delivery of opioid medications with fewer side effects and less abuse potential than if these same opioid medications are taken by mouth.
Radiofrequency Ablation/Neurolysis of Medial Branch (cervical/lumbar)
: involves stunning and/or burning of small nerves that supply the facet joints of the spine. This procedure can provide 9-15 months of pain reduction if successful. The nerves that are burned in this procedure are expected to regrow with time and this procedure can be repeated.
Minimally Invasive Decompression Laminotomy (MILD)
is a new therapeutic option that reduces pain and increases mobility for patients with Lumbar Spinal Stenosis (LSS) due to ligamentum flavum hypertrophy only. LSS is a condition in which the central canal of lumbar spine is narrowed and can be due to thickening of a soft tissue structure in the spinal canal known as the ligamentum flavum. This procedure essentially removes some of the ligamentum flavum and restores space in the spinal canal. Initial studies suggest that complication rates for the MILD Procedure are lower and recovery times faster than other surgical procedures for treating Lumbar Spinal Stenosis. Patient with Lumbar Spinal Stenosis due to facet arthropathy or bony causes are not candidates for this procedure, and will be referred to Spine Surgery if conservative treatments fail.
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