Treatments

Spinal Cord Stimulator Trials

Spinal cord stimulation is a safe and effective way to treatment several different types of pain. Spinal cord stimulator trials are conducted to determine if and how a spinal cord stimulator implant may help a patient enjoy long-lasting relief from pain. These trials can last a week or more to allow the patient to understand how the spinal cord stimulation affects them.


When undergoing a trial, the patient will have wires placed in the spine through a small needle insertion and an electrode secured to the skin. Once the patient has had time to evaluate how the spinal cord stimulation affects their pain and functioning, they can have the electrode wires removed from the skin and decide whether to have a more permanent system implanted.


Lumbar/Cervical/Thoracic Epidurals

Epidurals are injections that can be directed into different parts of the spine to relieve pain that is caused by irritation and inflammation in spinal nerves. These epidurals include steroids that provide pain relief by reducing nerve inflammation. Research into the effectiveness of epidural injections have shown that these injections can significantly help improve nerve root pain management.


Lumbar/Cervical/Thoracic Medial Branch Blocks


Medial branch blocks are used to treat back pain. They involve the injection of an anesthetic into the medial nerve of the facet joint. Randomized, double-blind controlled trials have shown that local anesthetic medial branch blocks provides both pain relief and functional improvements when used with or without steroids.

 

Lumbar/Cervical/Thoracic Radiofrequency Ablations


Radiofrequency ablations, also referred to as radiofrequency neurotomies, have been shown to significantly reduce pain. For people who have undergone medial branch blocks, radiofrequency ablation can help produce more long-lasting, dramatic results. 

This technique involves the insertion of a needle through the skin to deliver radio waves that prevent the neve from transmitting pain signals. 


Genicular Nerve Blocks


Genicular nerve blocks are used in people with chronic knee pain to reduce pain, enhance function, and combat inflammation. Though the results are often significant, they tend to last only a short time. Luckily, for those who respond well to genicular nerve blocks, genicular nerve radiofrequency ablations (described below) are a good option for longer-term impact.


Genicular Nerve Radiofrequency Ablations


Patients with knee pain who have previously enjoyed significant pain relief with a genicular nerve block may be advised to undergo a genicular nerve radiofrequency ablation for longer-lasting effects. Unlike genicular nerve blocks that anesthetize the knee with injections of medications, genicular nerve radiofrequency ablation involves creating a lesion around the genicular nerves to prevent nerve impulses that cause pain.

 

Genicular nerve radiofrequency ablation often provides relief that lasts several months. The procedure is performed using local anesthesia, and noticeable results can take up to about 6 weeks.


Major Joint Steroid Injections


Major joint steroid injections are used to reverse inflammation that causes joint pain. These injections can be used for several types of pain, including back pain, different forms of arthritis, tendinitis, bursitis, and gout. These injections are relatively simple and quick and can provide pain relief that lasts several months.


Major Joint Viscosupplementation Injections


Major joint viscosupplementation injections are injections of a compound known as hyaluronic acid into joints such as the knee to reduce swelling and pain. In healthy joints, the cartilage surrounding the joint contains hyaluronic acid, which acts as a lubricant to prevent bones from rubbing against one another. However, in certain conditions like osteoarthritis, the cartilage breaks down, decreasing the amount of hyaluronic acid that is available to protect against joint pain.


When hyaluronic levels decrease, hyaluronic acid levels can be replenished with joint viscosupplementation, thereby restoring function and reducing pain. Research has shown viscosupplementation can be helpful in a variety of conditions including hip and knee osteoarthritis.

 

Lumbar Discographies


Lumbar discography is a diagnostic procedure that helps determine what is causing a patient’s pain and to formulate the most appropriate treatment plan. The procedure involves injecting dye into discs of the spine and evaluating the patient’s pain response as well as the resulting x-ray images. 

Unlike other imaging techniques like magnetic resonance imaging (MRI), which cannot provide insight into which discs cause pain, lumbar discography can help the doctor pinpoint the specific pain-causing disc. It is critical that those who perform lumbar discography have specialized training and the appropriate technical skill to accurately interpret the results.

 

Occipital Nerve Blocks


Irritation in the occipital nerve can cause pain in different parts of the head and near the eye. To improve this type of pain, including pain associated with chronic headaches and migraines, we can block the occipital nerve by injecting steroids at the back of the head above the neck.


These treatments are especially useful for people with headaches and eye pain that have not been relieved through other conventional approaches, and research shows occipital nerve blocks help people with different headache types including cervicogenic headache, cluster headache, and occipital neuralgia.

 

Intercostal Nerve Blocks


Intercostal nerves are nerves that lie under the ribs. Irritation and inflammation in these nerves cause pain that can be relieved by anti-inflammatory. We can deliver such medication under the ribs with intercostal nerve blocks that are easily injected while the patient lies on their side. These procedures tend to take less than half an hour, and research shows that they can be quite effective in helping with pain in the ribs and chest.


Platelet-Rich Plasma Joint Injections


Injections of platelet-rich plasma (PRP) – or blood with a higher level of platelets – have become popular for treating pain and dysfunction using a patient’s own blood to help rapidly heal a specific part of the body. 

Plasma is the liquid part of the blood, and platelets are a type of blood cell that contains proteins that can trigger tissue regeneration. To use a patient’s platelet-rich plasma, we take a sample of a patient’s blood and spin in it in a device known as a centrifuge, which separates out the parts of the blood so the PRP can be captured and used for treatment.


PRP joint injections are especially beneficial for improving joint pain and disability in osteoarthritis, musculoskeletal disease, or injuries to tendons, ligaments, or muscles. PRP can also help people heal following surgeries. The best results are usually seen following several weeks of treatment.



  • References

    References

    1. Successful Spinal Cord Stimulator Trial and Permanent Implant in Patient with Diabetic Peripheral Neuropathy on Chronic Dual Antiplatelet Therapy - PubMed. Accessed January 27, 2022. https://pubmed.ncbi.nlm.nih.gov/26431144/

    2. Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. StatPearls. Published online September 29, 2021. Accessed January 27, 2022. https://www.ncbi.nlm.nih.gov/books/NBK555994/

    3. Rock AK, Truong H, Park YL, Pilitsis JG. Spinal Cord Stimulation. Neurosurgery clinics of North America. 2019;30(2):169-194. doi:10.1016/J.NEC.2018.12.003

    4. Joshi A, Bin WH. Epidural Steroid Injections. Medical Radiology. Published online July 19, 2021:93-104. doi:10.1007/978-3-030-65463-4_10

    5. Abdi S, Datta S, Trescot AM, et al. Epidural Steroids in the Management of Chronic Spinal Pain: A Systematic Review. Pain Physician. 2007;10:185-212. Accessed January 26, 2022. www.painphysicianjournal.comwww.painphysicianjournal.com

    6. Manchikanti L, Singh V, Falco FJE, Cash KA, Pampati V. Effectiveness of thoracic medial branch blocks in managing chronic pain: a preliminary report of a randomized, double-blind controlled trial. Pain Physician. 2008;11(4):491-504. doi:10.36076/ppj.2008/11/491

    7. da Rocha ID, Cristante AF, Marcon RM, Oliveira RP, Letaif OB, de Barros Filho TEP. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics (Sao Paulo, Brazil). 2014;69(8):529-534. doi:10.6061/CLINICS/2014(08)05

    8. Belghazi K, Bergman JJ, Pouw RE. Radiofrequency Ablation. Barrett’s Esophagus: Emerging Evidence for Improved Clinical Practice. Published online June 20, 2021:151-169. doi:10.1016/B978-0-12-802511-6.00011-9

    9. Leggett LE, Soril LJJ, Lorenzetti DL, et al. Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials. Pain Research & Management : The Journal of the Canadian Pain Society. 2014;19(5):e146. doi:10.1155/2014/834369

    10. Lee DW, Pritzlaff S, Jung MJ, et al. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). Journal of pain research. 2021;14:2807-2831. doi:10.2147/JPR.S325665

    11. Elsaman AM, Maaty A, Hamed A. Genicular nerve block in rheumatoid arthritis: a randomized clinical trial. Clinical rheumatology. 2021;40(11):4501-4509. doi:10.1007/S10067-021-05821-5

    12. Sobel J, Oswald J. Novel Use of 3-Point Genicular Nerve Block for Acute Knee Pain in the Emergency Department. The Journal of emergency medicine. 2021;61(4):416-419. doi:10.1016/J.JEMERMED.2021.04.012

    13. Cheppalli N, Bhandarkar AW, Sambandham S, Oloyede SF. Safety and Efficacy of Genicular Nerve Radiofrequency Ablation for Management of Painful Total Knee Replacement: A Systematic Review. Cureus. 2021;13(11). doi:10.7759/CUREUS.19489

    14. Kidd VD, Strum SR, Strum DS, Shah J. Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How. JBJS Essential Surgical Techniques. 2019;9(1):e10. doi:10.2106/JBJS.ST.18.00016

    15. Lee DG, Cho YW, Jang SH, Son SM, Kim GJ, Ahn SH. Effectiveness of intra-articular steroid injection for atlanto-occipital joint pain. Pain medicine (Malden, Mass). 2015;16(6):1077-1082. doi:10.1111/PME.12474

    16. Testa G, Giardina SMC, Culmone A, et al. Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature. Journal of Functional Morphology and Kinesiology. 2021;6(1):15. doi:10.3390/JFMK6010015

    17. Schiavi P, Calderazzi F, Pedrini MF, Tacci F, Vaienti E, Pogliacomi F. Efficacy and safety of viscosupplementation with hyaluronic acid for hip osteoarthritis: results from a cross-sectional study with a minimum follow-up of 4 years. Acta Bio Medica : Atenei Parmensis. 2020;91(Suppl 14):1-7. doi:10.23750/ABM.V91I14-S.11110

    18. Conrozier T, Monfort J, Chevalier X, et al. EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis. Cartilage. 2020;11(1):47. doi:10.1177/1947603518783455

    19. Reid MC. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians. Advances in therapy. 2013;30(11):967. doi:10.1007/S12325-013-0068-6

    20. Walker J, III, Abd O el, Isaac Z, Muzin S. Discography in practice: a clinical and historical review. Current Reviews in Musculoskeletal Medicine. 2008;1(2):69. doi:10.1007/S12178-007-9009-9

    21. Anderson MW. Lumbar discography: an update. Seminars in roentgenology. 2004;39(1):52-67. doi:10.1016/J.RO.2003.10.011

    22. Tobin J, Flitman S. Occipital nerve blocks: when and what to inject? Headache. 2009;49(10):1521-1533. doi:10.1111/J.1526-4610.2009.01493.X

    23. Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. Journal of Exercise Rehabilitation. 2014;10(4):241. doi:10.12965/JER.140137

    24. Baxter CS, Singh A, Ajib FA, Fitzgerald BM. Intercostal Nerve Block. Pain Medicine: An Essential Review. Published online October 21, 2021:319-320. doi:10.1007/978-3-319-43133-8_85


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