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Pain Management Center

The following is a list of treatments at the Pain Management Center at ACMH.  For more info or if you don't see what you are looking for, please call (724) 543-8622.

  • Discography
  • Epidural Steroid Injection
  • Facet Injections (DX & TX)
  • Selective nerve root injection
  • Occipital nerve block
  • Sacroiliac joint injection
  • Sympathetic block
  • Nucleoplasty
  • Trigger Point injections
  • Manipulation
  • Radiofrequency Denervation (rhizotomy)
  • Intrathecal pain pump (trial/implantation/maintenance)
  • Dorsal column stimulator (trial/implantation/maintenance)
  • Medical management (medication maintenance/weaning)
  • Kyphoplasty
  • Vertebroplasty
  • ICE procedure (infusion catheter epidural)
  • Bracing
  • Electrical Stimulation Units

 

 

 

Epidural Steroid Injection

Anatomy Overview

The spinal cord runs within the bony structure of the vertebral column and is encased by a membranous sac called the dural sac.  This sac contains spinal fluid that baths and nourishes the spinal cord.  The epidural space is the space between the outer surface of the dural sac and the bones of the vertebral column.

Nerves from the upper and lower limbs enter the vertebral column and pierce the dural sac to reach the spinal cord.  For various reasons these nerves can become irritated as the enter the vertebral column and cause pain in the upper and lower limbs.  This pain is felt as shooting down the lower limb and is referred to as nerve root pain, or technically, radicular pain.

What is Epidural Steroid Injection?

The term epidural steroid injection refers to the injection of corticosteroids into the epidural space of the vertebral column as a means of treating pain caused by irritation of the spinal nerves.  There are diagnostic and therapeutic ways epidural steroid injection can help:

  1. The first benefit is that some leg pain involves the inflammation of one or more of the nerves, their covering, or their roots, in the neck or back.  The injection of steroids directly into the part of the spinal column called the epidural space is thought to aid in reducing inflammation.
  2. The second benefit is that the anesthetic/cortisone solution blocks the pain long enough to allow the body to begin the process of repairing itself.
  3. The last benefit involves the accurate diagnostic information provided by the nerve block when it relieves your pain.

How is an Epidural Steroid Injection Administered?

A local anesthetic will be injected into the skin and underlying tissues to decrease the discomfort of introducing the epidural needle.  Once the local anesthetic is working, the epidural needle is advanced into the epidural space, using the bones as landmarks to ensure the needle is in the right place.  When the needle is in the epidural space, a syringe containing the corticosteroid solution is connected to the needle.  After making sure the needle is not in a blood vessel or in the spinal fluid, the physician injects the solution slowly.  The corticosteroid will be injected in a form that may include a saline solution and/or a local anesthetic, however, the dosage and the volume of the steroid and the other components will vary according to her judgment.

What are the Typical Risks of Epidural Steroid Injection?

With any operation or injection procedure there are risks.  In the case of epidural steroid injection, these risks are small.  The most common side effect is a temporary increase in pain.  It occurs in about one percent of epidural steroid injections.  Headaches can also occur, with an incidence of one percent.  If you are allergic to one of the additives in the steroid solution, you may experience a hot flush and develop a rash.  As with any injection with the skin, it is possible for bacteria to gain entry causing an infection.  There is also a risk of bleeding, which is why it is very important to follow your pre-injection instructions and discontinue any medications that may thin your blood and cause you to bleed easily.  It is also theoretically possible that the nerve could be temporarily or permanently irritated secondary to the procedure.

 

Facet Joint Injections

The facet joints are the joints that are made up of the overlapping arches of the bones that make up your spinal canal.  This is the portion that supports your back from one vertebral bone to the next.  The facet joints are located in the entire spine, cervical, thoracic, and lumbar.  Your sacrum, which is one solid bone, does not have a facet joint.

The technique of performing facet joint injections is as follows:

  • You will be placed on the fluoroscopy (x-ray) table.
  • The portion of the body over the facet joint block will be sterilely prepped and draped.
  • The physician will administer sedation if it is necessary.
  • Using the fluoroscopy, your facet joints will be identified and marked.
  • Small, thin needles will be inserted into or adjacent to the facet joints after anesthetizing the skin over the facet joints.  Medication will then be injected into the facet joints.

After the procedure, you will be monitored in the recovery area.  You should not engage in heavy activity the first day post procedure.  The risks of the procedure are injection of medication into a spinal nerve resulting in numbness or decreased function of the extremity for a short time; injection of medication into a blood vessel; bleeding; or the risk of infection.  Due to the highly skilled techniques employed by our physicians, these risks are very minimal.

The purpose of facet joint injections is to decrease your pain and to help determine if it is the facet joints that are causing your pain.  These injections are often performed in conjunction with physical therapy to increase the efficacy of your physical therapy.

 

Medications Used To Treat Persons With Chronic Pain

A number of medications are used by doctors to treat chronic pain.  We believe that it is very important that you understand the nature, purpose, and limitations of the medications you are taking.  If you are not sure about a particular medication, you should ask the doctor who is prescribing it to you, or ask a pharmacist.

Goals of Pain Medications

When considering use of pain medications, four goals should be kept in mind:

  1. Reduction in pain intensity.  This goal is obvious.  However, it is not always realistic to expect that medications will totally eliminate your pain.  A more realistic goal may be to relieve pain to a level that can be more easily tolerated and that enables you to continue functioning.
  2. Improve ability to function.  This goal is very important, but is sometimes overlooked.  We have seen patients receive significant pain relief from medications; however, these same medications also greatly interfered with the person's ability to function.
  3. Minimize adverse side effects.  Keep in mind there is no such thing as a totally safe pain medication.  All have the potential for negative side effects.  The goal is to find medications, which maximize the benefits while keeping the side effects to a minimum.
  4. Prevent addiction.  Most people don't like the idea of getting addicted to their pain medications.  however, many people fail to understand what addiction really means and are unaware of the fact that the majority of people who use pain medications as prescribed do not get addicted.