Interventional Pain Management

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When pain limits daily life, despite dedication to the various medicines, topical products, exercise, modalities and other non-invasive treatments, careful, minimally-invasive Interventional Pain Management procedures might be indicated.

These procedures can induce an immediate and dramatic resolution of pain and rapid return to activity, as long as they are performed accurately, by a well-trained and careful physician, and for the right reasons. In order to insure the best possible outcome, we:

Perform these procedures either in the office or in the Same-Day Surgicenter, depending on patient safety and comfort

Use the highest quality image-guided technology (for example ultrasound or fluoroscopy) to insure quick, accurate and safe placement of the injection

Limit the number of injections/procedures to as few as possible to get the desired result

Always perform these procedures in the context of a multidisciplinary treatment program, that includes exercise and other strategies so that there is a long-lasting result

Our practice performs a wide variety of medically-indicated interventional pain management procedures including:

Spinal Injections

Injections work to provide temporary and powerful reduction or elimination of pain. Epidural steroid injections, targeted to the pain generating spinal segment or nerve, are among the most common and effective pain management procedures. Other common injections are facet joint injections, single nerve root blocks, and sacroiliac joint injections. To insure accuracy, we always perform spinal injections using surgical sterility and careful image-guidance (fluoroscopy or ultrasound).

Medial Branch Blocks / Radiofrequency Rhizotomy (also called RF Ablation)

Medial branch blocks and radiofrequency ablation are performed to reduce pain from the painful “hinge joints” (facet joints) of the spine. This procedure involves a trial very temporary block (“medial branch block”) to determine whether the more long-lasting procedure, the radiofrequency rhizotomy) will be effective. This procedure, performed in the same-day surgicenter under fluoroscopic guidance, involves using heat to temporarily shut down the conduction of the small pain nerves that feed the facet joints of the spine. Many patients get pain relief for 6 to 12 months.

Peripheral Nerve Ablations, IOVERA procedures

Peripheral nerve ablation involves using various techniques to temporarily inhibit the pain signals sent from sensory nerves to the brain. This can be done by heating nerves directly (Heated RF ablation) or indirectly (RF ablation using water-cooled systems), under fluoroscopy and using nerve stimulation to insure accuracy. These RF ablations are performed in same day surgery, and require minor sedation. A recent novel approach (FDA-approved) uses IOVERA, an office based cryo-neurolysis procedure using a hand held device that delivers cold directly to the nerve and does not require sedation. Our office is one of the first in the country to perform this safe and effective procedure.

Our physicians perform office - based IOVERA procedure for several conditions including:

Osteoarthritis of the hip, knee & shoulder; Sacroiliac pain; Painful knee replacement; Morton’s neuroma; Nerve entrapment syndromes.; Occipital Neuralgia/ Headaches.

Neuromodulation (Electrical Stimulation and Intrathecal Pump Implants)

Intrathecal pump implants, also known as pain pumps, provide potent medications straight to the source of your pain. Pain pumps are commonly used for cancer pain and failed back or neck surgery. With this procedure, a small device—called a pump—gets implanted under your skin and your doctor programs the pump to deliver a specific amount of medication. The pump needs to be refilled every few months. This is an invasive procedure with a mixed success rate and is reserved for severe, disabling pain that has not responded to other treatments.

Implantable electrical stimulation involves the placement of a small electrical stimulation device (similar to a pacemaker) under the skin that is attached to an electrical lead which is placed against the spinal nerves, sending electrical pulses directly to the area that’s causing pain. The impulses block pain signal transmission, substituting instead a sensation of benign numbness. First, a trial is performed with a temporary device. If there is significant improvement in pain, the permanent device is later placed.

As with a pain pump, electrical stimulation is usually one of the last interventional pain management treatments tried.