Interventional Pain Management or Pain Medicine is a subspecialty of anesthesia and is certified by the American Society of Interventional Pain Physicians (ASIPP).
Interventional Pain Management at Southern Indiana Surgery Center (SISC)
Interventional pain management encompasses a wide range of procedures that provide significant relief to chronic pain patients while minimizing the need for long-term opioid use. Interventional pain management often incorporates several therapies to help patients achieve optimal results and return to everyday activities. Treatments such as physical therapy and chiropractic care can be combined with cutting-edge outpatient treatment options which are offered at Bayou Region Surgery Center to provide long-lasting relief for patients suffering from chronic pain.
Pain Management
Common Interventional Pain Management Treatments Performed at SISC
Caudal Steroid Injection
A caudal steroid injection is used to reduce leg or lower back pain due to sciatica, bone spurs, herniated discs, and other back problems. During the procedure, your doctor will numb the lower back with a local anesthetic. A thin needle is used to administer a mixture of anesthetic and steroids which spreads into the caudal and epidural spaces to reduce nerve pain and inflammation. A caudal steroid injection procedure typically takes just a few minutes, and long-term pain relief usually begins within two to three days of the injection and can last several months. The procedure may be repeated periodically as the steroid wears off.
Sacroiliac (SI) Joint Injection
An SI joint injection can be used to identify the source of a patient’s discomfort as well as treat the lower back or sciatica pain. Your doctor will numb the sacroiliac joint with a lidocaine injection performed with x-ray guidance. Often while the area is numb, your doctor will ask you to move the joint to diagnose or confirm the SI joint dysfunction. If the diagnosis is confirmed, the steroid is then injected to provide long-lasting relief. The therapeutic injection can be repeated up to three times per year.
Trigger Point Injection (TPI)
Typically used to treat persistent painful knots (trigger points) in the muscles of the arms, legs, neck or lower back, a trigger point injection involves injecting a mixture of an anesthetic and a steroid into the affected area. Several trigger points can be treated in one session which takes only a few minutes.
Trigger point injections can also be used to treat:
- Fibromyalgia
- Tension headaches
- Myofascial pain syndrome
Epidural Steroid Injection (ESI)
This injection is used to treat spinal stenosis and/or spinal disc herniation. Your doctor will numb the area and administer the injection combination of an anesthetic and a steroid into the epidural space of the spine. While the disc doesn’t heal from the ESI, the steroid flushes away the proteins that cause the swelling (pain). By alleviating symptoms, an ESI also enables the patient to participate in rehabilitative therapy.
Facet Joint Injection
This straightforward spine procedure is used to treat facet syndrome, a condition in which the facet joints (located in the spine and neck) that allow the spine to bend become damaged. After applying a local anesthetic, your doctor, using fluoroscopy (x-ray guidance), administers an injection of anesthetic and a steroid into the affected facet joint. The procedure typically takes a few minutes with a short recovery time. Long-lasting pain relief usually begins within a few days and can last several months.
Nerve Block for Migraines
Used to alleviate an ongoing painful migraine episode, a small amount of anesthetic is injected into the base of the skull which blocks pain signals and provides fast relief. The effects of a nerve block can last weeks or months.
Pain Pump Implant (Intrathecal Drug Pump)
A small pump is placed under the skin of the abdomen which slowly delivers pain medication directly to the spinal cord through a catheter. Much less medication is needed with this distribution method than with oral pain medicine, so side effects can be reduced. The pump can be programmed to dispense specific amounts of medication at different times of day and can be refilled through a port.
Kyphoplasty
Compression fractures in the vertebrae (often caused by osteoporosis) are treated by this minimally invasive procedure during which a small balloon is inserted through a thin catheter tube placed in the back. The balloon is then inflated to make space around the damaged vertebra and bring it back to its normal height. Next, the balloon is deflated and removed, and a special cement mixture is injected (vertebroplasty). This corrects the bone deformity and alleviates pain caused by the fractures. The cement hardens in approximately ten minutes, and the procedure usually lasts about an hour.
Rhizotomy
Rhizotomy surgery can be performed endoscopically or using a radiofrequency ablation technique. During the procedure, the roots of the spinal nerves are cut or cauterized with an electric current to relieve back and neck pain. A rhizotomy can effectively treat muscle spasms, facet joint pain, and chronic back pain with little downtime and low risk.
Stellate Ganglion Block
A ganglion block involves injecting anesthetic into the nerves on the side of the voice box to treat pain in the neck, head, chest, or upper arms. This injection can also be used to diagnose and treat nerve injuries and circulation problems including:
- Phantom limb pain
- Shingles/herpes zoster infection
- Causalgia
- Reflex sympathetic dystrophy
- Complex regional pain syndromes
The procedure typically takes less than 30 minutes however, a series of injections may be required for optimal pain relief.
Transforaminal Nerve Root Block
To treat inflamed nerve roots in the spine, an anesthetic and steroid injection are administered where the nerve root exits the spinal cord. Nerve roots can swell due to:
- Arthritis
- Spinal stenosis
- Ruptured or herniated disc
A nerve root block can help diagnose back and/or neck pain and give long-lasting relief for several months.
Spinal Cord Stimulator
A device is implanted which sends electrical impulses into the spinal cord to relieve and manage chronic pain. Two procedures are required to implant a spinal cord stimulator (the trial and the implantation). Electrodes are placed in the epidural space between the vertebrae and the spinal cord, and a small generator (battery pack) is implanted under the skin, typically near the buttocks or abdomen. The patient uses a remote control to send low levels of electricity into the spinal cord when needed to control pain.
Spinal cord stimulators can effectively treat and manage chronic pain such as:
- Post-surgical pain
- Back pain
- Arachnoiditis
- Spinal cord injuries
- Angina
- Pain after amputation
- Peripheral vascular disease
- Nerve pain /diabetic neuropathy/ cancer-related neuropathy
- Complex regional pain syndrome
- Perineal pain/visceral abdominal pain