Treatment options for acute and chronic pain can vary. Your treatment plan might include pain medications, various pain management procedures (with or without sedation) and lifestyle changes.
The Pain Medications range from over the counter drugs, such as NSAIDs and muscle relaxants to powerful opioids. Opioid usage carries a high risk of addiction and adverse effects if abused.
Pain Management Procedures:
Epidural Steroid Injection
The Epidural Steroid Injection is a procedure where a numbing medicine (anesthetic) and an anti- inflammatory medicine (steroid) is injected into the epidural space to treat pain caused by irritation of the spinal nerves. A protective covering called the dural sac surrounds the spinal cord. This sac contains spinal fluid that bathes and nourishes the spinal cord. The space between the outer surface of the dural sac and the bones of the spinal column is the epidural space. Nerves that go from the spinal cord, through the spinal column and to the body pass through the epidural space. Depending on the location of your pain, the epidural steroid injection can be given in the neck (cervical), middle back (thoracic) or lower back (lumbar).
Sacroiliac Joint Block
A Sacroiliac Joint Block is an injection procedure used to diagnose and treat low back pain associated with injury or disease to the sacroiliac joint. The sacroiliac joints are located in the area of the low back and buttocks where the pelvis joins with the spine. Injury and disease to these joints will cause pain in the low back, buttocks, abdomen, groin, and legs. The medicine injected reduces inflammation and swelling inside the joint space, which may in turn reduce the pain.
Lumbar Facet Injection
The Lumbar Facet Joint Injection is a procedure used to block or decrease pain caused by problems in the lumbar (low back) spine. Lumbar facet joints, which are not much larger than your thumbnail, are located on either side of each vertebrae. They provide stability and guide motion in the low back. If the joints become inflamed you may experience not only lower back pain, but also pain in the abdomen, buttocks, groin and legs.
Radio-Frequency Ablation or Rhizotomy
Radio-frequency Ablation or Rhizotomy is a procedure used to selectively disconnect problematic nerves surrounding the facet joints. The nerves to be ablated are identified by performing diagnostic facet joint injections with local anesthetic (sometimes combined with steroid for additional therapeutic effect). If diagnostic blocks provide even short-lasting pain relief, there is an indication for RF Ablation. The relief achieved by Rhizotomy may last for up to 6 – 24 months. Because nerves regenerate over time, the procedure may be repeated when the pain is back
Joint Injections of the extremities, such as in the knees, shoulders, hips, etc. are used to treat the pain that is most commonly caused by arthritis. The joints of the extremities can undergo degeneration from constant wear-and-tear (osteoarthritis), as well as from injury (chronic sprains) or from disease (rheumatoid arthritis), thus leading to chronic inflammation and pain. If the inflammation is severe and left untreated, the joint can become permanently damaged from erosion and destruction of the cartilage lining that lubricates the moving parts of the joint.
The biggest joints of the extremities (such as the shoulders, hips and knees) are the ones most commonly afflicted with arthritis. Arthritis can also involve the smaller joints, such as the ankles, wrist and finger joints. The medicine injected (corticosteroid) reduces the inflammation and swelling inside the joint space. This in turn treats the pain long term.
Trigger Points Injections
Trigger point injections (TPI) are used to treat extremely painful areas of muscle. A normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when a muscle fails to relax. The knot can often be felt under the skin and may twitch involuntarily when touched (called a jump sign).
The trigger point can trap or irritate surrounding nerves and cause referred pain — pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time.
TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment, although there is some debate over its effectiveness. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. TPI also can be used to treat Fibromyalgia and tension headaches.
Moderate sedation / analgesia (conscious sedation) for pain procedures
Conscious sedation is a type of sedation in which you can respond to verbal directions, but feel no pain, and have a drug-induced depression of consciousness. This level of sedation is used for minor medical procedures in which it is necessary for the patient to be responsive, and also for procedures which do not merit the use of general anesthesia.
Sedation analgesia usually is administered through an intravenous catheter (IV), to relax you and minimize any discomfort you might experience. It is also combined with an injection of a local anesthetic, or “numbing medicine,” at the site of procedure.
When receiving conscious sedation, you will feel drowsy and may even sleep through the entire procedure, but will be easily awakened when spoken to or touched. You may or may not remember the procedure afterwards.
Like any form of anesthesia and sedation, there are some risks to moderate sedation, but it is significantly less dangerous than general anesthesia.
Preparation for the sedation: no food or drinks (water is permitted) 4 hours prior to the procedure with sedation.