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.