Services

  • Acute and chronic pain management
  • Trigger Point Injection
  • Lumbar Epidural Injection
  • Thoracic Epidural Injection
  • Cervical Epidural Injection
  • Diagnostic Lumbar Facet Nerve Block
  • Lumbar Facet Radiofrequency Rhizotomy
  • Cervical Facet Nerve Block
  • Cervical Facet Radiofrequency Rhizotomy
  • Selective Transforaminal Epidural Injection
  • Stellate Ganglion Block
  • Lumbar Sympathetic Block
  • Celiac Plexus Block
  • Peripheral Nerve Block
  • Selective Nerve Block
  • Provocative Discography/IDET Rx
  • Invasive and Non-Invasive Cancer Pain Management

What does the Advanced Pain Clinic treat?

  • Low back injury
  • Neck injury
  • Spinal disc herniation or derangement
  • Spinal facet syndrome
  • Radiculopathy
  • Neuropathy
  • Work-related injury
  • Sports-related injury
  • Vehicular accident injury
  • Myofascial (trigger point) syndrome
  • Arthritis
  • Sacroiliitis
  • Chronic pain syndrome
  • Cancer pain
  • Compression fracture



 

Procedures We Perform

Epidural Blocks

An epidural block is an injection of pain medication into the epidural space, the area around your spinal cord and spinal nerves. The medicine stops the nerves from transmitting pain signals, providing pain relief.
Epidural blocks can be used for neck, mid-back or the low back pain.

How it's performed
This block is performed after numbing the area with a local anesthetic. Using fluoroscopy, a moving X-ray for guidance, the physician directs a needle toward the epidural space. The entire procedure takes between 15-30 minutes.

When should this be used?
Epidural injections can be used for a variety of pain conditions including disk herniation, degenerative disc disease, sciatica, spinal stenosis, nerve root compression and inflammation in the spine.

Results
Epidural injections successfully relieve many pain symptoms. They may be used to delay or even eliminate the need for surgery or other procedures, particularly in patients with severe pain caused by a herniated disc, degenerative disc disease or spinal stenosis.

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Selective Nerve Blocks

Nerve roots are branches from every level of the spinal cord, which carry signals throughout the body from the skin to the muscles. Irritation of a nerve root may result in pain, numbness, tingling and sometimes weakness down an arm or a leg.

How it’s performed
Using a local anesthetic, the region around the effected nerve root is isolated using a fluoroscopic X-ray picture and injected with an anti-inflammatory medication. The procedure takes 20-30 minutes.

What patients are candidates?
Nerve root blocks are used to treat symptoms of a herniated disc, sciatica or swelling and/or irritation in the nerve roots.

Results
Selective nerve root blocks successfully relieve many pain symptoms. They may be used to delay or even eliminate the need for surgery or other procedures, particularly in patients with severe pain caused by a herniated disc, degenerative disc disease or spinal stenosis.

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Facet Blocks

Facet joints are located along the entire length of the spine from the neck to the lower back, where one vertebra slightly overlaps another. These joints guide the spine’s movement. A facet block is performed to determine whether a facet joint is a source of pain, and/or to treat pain.

How it’s performed

After the patient is given a local anesthetic, a needle is inserted in the area of the facet joint(s). Using fluoroscopic guidance, a small amount of anesthetic and anti-inflammatory medication is injected in the area.

What patients are candidates?

Pain (neck, back or leg) caused from inflammation, irritation or arthritis of your facet joints can be treated with a facet injection.

Results
If the facet joints are cause of the pain, the patient will experience pain relief. The pain may be relieved for several hours to several months. Radiofrequency lesioning may be needed to provide longer relief.
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Facet Rhizotomies

A facet rhizotomy is similar to a facet block, however , instead of injecting medication, a wire is passed through the needle and the small nerve is coagulated with radiofrequency electricity. The radiofrequency lesioning used in a rhizotomy may provide months or years of pain relief in those where the steroid blocks wear off too quickly.
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Sacroiliac and Other Joint Injections

A diagnostic and therapeutic injection into the sacroiliac or other joint can provide short or long-term pain relief.

How it’s performed
Usually using a fluoroscope for guidance, a needle is introduced into the correct portion of the sacroiliac or other joint. The position may be confirmed by injecting a small amount of contrast dye. The local anesthetic and anti-inflammatory steroid is injected. Local injections into the ligaments may be helpful. The procedure last 10-20 minutes.

What patients are candidates?
Patients with pain caused by arthritis, injury, or strain of the sacroiliac joint or other joint are good candidates for the procedure.

Results
The effects of sacroiliac or other joint injections may be temporary, providing relieve from one week up to years, or in some cases permanently.

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Occipital Nerve Block

The most common symptoms related to occipital nerve injury are local tenderness or a tension type of headache.

What patients are candidates?
A headache located at the top of the head and occipital area that is usually described as a sustained, low intensity aching. The headache can be bilateral or only one side. It is associated with stiffness of the muscles of the neck. Migraine headaches may also be related to occipital neuralgia.

How it is performed
The nerve is identified under the scalp by palpation. Typical pain or headache may be reproduced with pressure over the nerve. After cleaning the scalp, a small amount of local anesthetic and a small dose of long acting steroids are injected.

Results
Numbness over the top and back of the head, after the injection, is a sign of a successful block. The numbness may last several hours. Relief of pain can be immediate and is occasionally permanent. The block can be repeated if necessary.
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Stellate Ganglion Block

The stellate ganglion is a group of sympathetic nerves in the neck area. Stellate ganglion block is performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body and sometimes carry painful impulses.

How it’s performed
A stellate ganglion block is an injection of a local anesthetic around this group of nerves to relieve pain on the side of the head or neck, the upper arm, or the upper part of the chest. It involves inserting a needle through the skin and deeper tissues of the neck. Most patients receive intravenous sedation and pain medication to make the procedure easy to tolerate. After the injection, you may feel warmth in the arm, some hoarseness of the voice, a droopy eyelid, a larger pupil, or nasal congestion.

What patients are candidates?

Conditions such as reflex sympathetic dystrophy, phantom limb pain, Herpes Zoster and causalgia can be treated with a stellate ganglion block.

Results
Multiple blocks are often required, but there is usually a progressive increase in the interval between when blocks are needed due to the pain relief provided by the procedure.
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Sympathetic Nerve Blocks

Performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body and sometimes carry painful impulses.

How it’s performed

Unlike other blocks, sympathetic nerve blocks involve injecting anesthetic into different nerves. These may include stellate ganglion, celiac plexis, hypogastric plexis, ganglion of impar and lumbar sympathetic nerve blocks. The procedure lasts 10-20 minutes

What patients are candidates?

Patients with nerve (neurogenic) pain, most commonly the constant burning pain of Reflex Sympathetic Dystrophy (RSD) Complex Regional Pain Syndrome (CRPS) in the arm or leg are candidates for the procedure.


Results

Multiple blocks are often required, but there is usually a progressive increase in the interval between when blocks are needed due to the pain relief provided by the procedure.
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Epidural (RACZ) Catheter Lysis of Adhesions

A procedure involving passing epidural catheter (usually Racz) into the epidural space and injecting medicine directly at the site of nerve injury or adhesion to decrease the pain and break up adhesions. The epidural space is the area around your spinal cord.

How it’s performed
A catheter is placed in the epidural space and medication is delivered directly into the space. It is optimal to place the epidural catheter close to the patient’s painful dermatome as possible. The procedure lasts 10-20 minutes.

What patients are candidates?
Patients in members with epidural adhesions, adhesive arachnoiditis, or failed back syndrome from multiple previous surgeries for herniated lumbar disc are candidates.

Results
Most patients report pain relief and increased mobility for few months or longer.
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Discography

A procedure utilized to identify if the source of pain is from the disc or in the case of multiple level herniations, which levels are the source of the discomfort.

How it’s performed
Using x-ray guidance, a needle is placed in the discs of the spine at the level of interest. A pressure gauge is used to measure the pressure of the discs. Then, using contrast media, the shape of the disc is identified as the dye is injected. The procedure usually lasts 20 to 60 minutes.

What patients are candidates?
Persistent spinal (cervical, thoracic, lumbar) pain, suspected disc abnormality, non-invasive tests have not provided an explanation or source of pain, and if pain correlation is desired.

Post procedure
After the procedure, the patient may be required to have a CT scan of the back to further visualize the discs. If there are no complications, the patient is discharged 40 to 60 minutes after the procedure.
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Spinal Cord Stimulator

When oral medications and/or nerve blocks do not sufficiently control chronic pain, implantable systems may be more effective. These systems are designed to interrupt transmission of pain signals from the spinal cord to the brain. By blocking this signal to the brain, the patient will not feel the pain.

How it’s performed
Spinal cord stimulation (SCS) for pain control passes low levels of electricity to the back portion of the spinal cord by inserting a thin catheter lined with electrical wires called electrode. This blocks the sensation of pain. The device is implanted during a surgical procedure and may include a system with an external power source or a fully implanted system similar to heart pacemakers.

What patients are candidates?

Spinal cord stimulators may be used to manage pain from failed back surgery syndrome or radiculopathy (sciatica or leg pain), chronic neuropathic pain (i.e. complex regional pain syndrome / RSD, nerve injury).

Results

About 50 to 60 percent of patients will get a 50 percent or better pain relief with this procedure. A trial is first performed to see if it is effective and how the patient reacts before the surgery is performed. The procedure is reversible and the implantable system can be removed.
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Trigger Point Injection

Trigger point injection is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that form when muscle fails to relax. The knot often can be felt under the skin.

What patients are candidates?

Patients with myofascial pain syndrome (chronic pain involving muscle and the tissue that surrounds muscle) that does not respond to other conservative treatments. Many muscle groups, especially those in the arms, legs, lower back, and neck are treated by this method.

How it’s performed

Injections are given in the physician’s office and takes approximately 10 minutes. A small needle is inserted into the trigger poTint and a local anesthetic (i.e. lidocaine, marcaine) with or without a corticosteroid is injected. Injection medication inactivates the trigger point and thus alleviates pain.

Results
Sustained relief usually is achieved with brief course of treatment. The injection may cause a twitch or pain that lasts a few seconds to a few minutes.
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Trufuse Facet Stabilization

TruFuse is a minimally invasive spinal technique, which is used to treat number of conditions that cause chronic, severe back pain. TruFuse addresses back pain resulting from facet joint degeneration and from mild spinal instability.

What patients are candidates?

Back pain sufferers often initially try clinical solutions such as pain medications, exercise, physical therapy, acupuncture, steroid injection and others. When pain becomes intolerable, particularly due to facet joint disease, osteoarthritis, minor instability, mechanical back pain, degenerative joint disease and similar indications. Isolated facet based back pain that is refractory to conservative measures.

How it’s performed
This is a simple, minimally invasive procedure involves using fluoroscopy (x-ray) to localize the affected facet joint using a small guide pin. Through a small incision in the patients back at the vertebral level, a small TruFuse dowel is impacted between the two opposed bones that form the facet joints, thereby restriction motion and stabilizing the spine and reducing inflammation. The TruFuse procedure uaually takes about 30 minutes.

Results
TruFuse has proven to be beneficial to patients and surgeons because of its low-risk, highly effective and minimally invasive approach. 90% of the patients reported significant pain relief. The TruFuse procedure is intended to stabilize the facet joint through a natural healing process for a long-term solution.
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