Pain Services & Treatment
Epidural Injection
Epidural injections can be performed for neck pain, mid back pain, and low back pain. They can also be used to treat radiating pain down the arms or lower extremities (sciatica). The diagnosis of disc pain requires a good history and physical examination as well as imaging studies such as MRI and x-ray. Occasionally, electrodiagnostic studies such as EMG can also be performed to assist with diagnosis. All of these studies combined with a careful evaluation of the patient, one-on-one with a skilled clinician can make the diagnosis of pain caused by a disc. Epidural injections have been performed safely and effectively for at least the last 40 years.
In this day and age, epidural injections are generally performed using the guidance of an x-ray machine, or fluoroscope, to help assure safety and accuracy of the procedure. While many pain management specialists recommend a “series of 3 epidural injections,” at Comprehensive Pain Management, each procedure is carefully considered and the patient’s response is assessed before we consider additional procedures. In this way, our practice is conservative yet responsive to the patient’s needs. Unnecessary injections are avoided, thereby decreasing the risk and unnecessary cost to the patient. Epidural injections are performed under local anesthesia, with or without conscious sedation, depending on the needs of the patient.
The procedure is generally associated with very little discomfort to the patient, particularly when care is taken to assure good local anesthesia and comfort for the patient. Safety, effectiveness, and comfort of the patient are our highest priorities.
HEADACHE TREATMENT
Headaches are one of the most common chronic pain syndromes and also one of the most complex of all pain problems. Unlike many other types of pain, in most cases there is no diagnostic study that will definitively explain his/her headache syndrome. Headaches, by their nature, are subjective, i.e. without any objective evidence of the cause of the headache. Later exceptions to this rule, but for the most part headaches are rarely diagnosed by findings on MRI, CAT scan, x-ray, EMG, ultrasound or any other imaging studies. Therefore, in most cases, the diagnosis and treatment of a headache condition is based on the history and careful physical examination of a trained professional.
A broad array of healthcare professionals may be involved in the treatment of the headache including, the TMJ Specialist, Pain Management Specialist, Neurologist, Neurosurgeon, Psychologist, Neuropsychologist, Chiropractic Physician, Acupuncturist, Massage Therapist, Osteopathic Physician, to name a few. As you can see by the number of specialists that are involved with this type of treatment, there is often a great deal of complexity in the management of headaches.
In many, if not most cases, the treatment of headaches is a multidisciplinary effort. At Comprehensive Pain Management would work very closely with such specialists to individualize the treatment of your headache. While there may be very serious causes of headache ranging from tumor to cerebral aneurysms to arteriovenous malformations to other various brain anomalies, most headaches that are seen at our clinic are not caused by these more serious conditions. In many of the patients that we evaluate for headache, structural problems contribute significantly to the headache condition. The providers at CPM work closely with our specialists to individualize your headache treatment. These types of problems frequently can be improved or resolved with a variety of interventional pain management techniques.
Injections for Low Back Pain
Low back pain is the most common pain complaint in adults in the United States. Nearly every adult in the United States will, at some point in their life, experience low back pain. Low back pain is frequently related to a spinal condition such as a herniated disc or an arthritic joint (facet joint), but may also be caused by a number of other conditions including sacroiliac dysfunction, muscular pain, trigger points, fibromyalgia, deconditioning, and neuromuscular diseases.
Beyond this, a number of other medical conditions may cause low back pain including diseases of the aorta, pancreas, malignancies, and even heart disease. Therefore, the evaluation and treatment of low back pain is a complex matter that requires careful medical evaluation including a medical history, musculoskeletal history, evaluation of social conditions that may impact upon the pain, and diagnostics including imaging. Critical to the evaluation of low back pain is a skilled musculoskeletal examination and neurological evaluation. Once the diagnosis is made then certain types of injections may be offered to the patient depending on the specific problem. Further, certain injections performed by the pain management specialist may provide additional diagnostic information. Therefore, the injection may have both therapeutic and/or diagnostic benefit.
Examples of injections for the low back include: Lumbar epidural steroid injections Caudal epidural steroid injections Lumbar and sacral selective nerve root blocks Facet joint injections Diagnostic medial branch blocks (to diagnoses lumbar facet pain) Sacroiliac joint injections Trigger point injections Many other treatment modalities are available for low back pain including chiropractic care, physical therapy, acupuncture, spinal decompression, and medication management, to name a few. Ask your pain management professional at Comprehensive Pain Management about the many alternatives available for treating low back pain.
Radiofrequency Ablation
In the field of interventional pain management, over the last 2 decades, radiofrequency ablation has become standard-of-care for treatment of a variety of common painful conditions. Radiofrequency treatments are administered by way of a specially equipped cannula capable of delivering a high temperature lesion that destroys or disables nerves that cause neck pain, back pain, thoracic pain, and headaches.
Radiofrequency ablation for spinal pain is performed only after diagnostic injections are performed to demonstrate that a radiofrequency ablation is likely to relief the pain. Therefore, prior to radiofrequency ablation a diagnostic procedure such as a medial branch block is necessary. Therefore, the process of treating back pain by way of radiofrequency ablation is really a two-step process, first the diagnostic and then, if indicated, the ablation. A great deal of sophistication and care is required to perform such procedures.
Trigger Point Injections
Many times, the pain that one feels in the neck or back is really related to muscle pain or muscle spasm, also known as myofascial pain. In the early 1960s, Janet Travell M.D., personal physician to President John F. Kennedy, began to develop a comprehensive approach to managing myofascial pain, “the Trigger Point Manual.”
Some 5 decade later and through a number of revisions, “the Trigger Point Manual” continues to be one of the definitive texts on myofascial pain. Trigger point injections can be administered easily in an office setting using a variety of medications, most commonly local anesthetic with or without Traumeel, a proprietary homeopathic medication. Trigger point injections are often used in conjunction with other types of therapies such as manual therapy, chiropractic therapy, and physical therapy to improve therapeutic outcomes of treatment.
Rehabilitation Services
Physical rehabilitation and optimization of function go hand in hand with pain management at Comprehensive Pain Management. In fact, many pain problems are actually caused by issues of physical deconditioning. Therefore, as part of our multidisciplinary pain program, we emphasize rehabilitation and recovery of function.
In many cases, various types of rehabilitation are combined with interventional pain therapies to expedite the recovery process. However, many patients with pain issues actually require only rehabilitative services such as physical therapy, occupational therapy, and treatment for the emotional aspects of pain. As with all patients, the treatment plan is specific to the needs of the individual patient. A holistic approach is of the utmost importance in development of the treatment plan, reduction of pain, and optimization of function. Please consult with your health care professional at Comprehensive Pain Management regarding our rehabilitative services, call us now at (602) 971-8200 .
Fibromyalgia & Neuritis
Fibromyalgia is a syndrome of diffuse pain, above and below the waist, on both sides of the body. The syndrome is characterized by hyperirritability of the nervous system to painful stimuli. Therefore, medical treatments now focus on down-regulation of the signals to and from the central nervous system. The results of the newer treatments have been extremely encouraging.
We also encourage nutritional changes and certain supplements that decrease the inflammatory response and tend to reduce muscle spasm. Treatment of sleep and mood disorders is also central to our approach. Finally, non-traumatic aerobic exercise and weight control are emphasized. As you can see, there is a lot we can do to improve the lives of patients suffering from Fybromyalgia but only your active participation in your treatment. Many times, the pain we perceive as muscle pain in our back, neck, and extremities is just that, pain from a muscle. Call us at (602) 971-8200 for prompt scheduling.
EMG and Electrodiagnostics
Electromyography, otherwise known as EMG, discussed the study of electrical impulses as they are transmitted from the central nervous system to the extremities. Nerve conduction velocities (NCV Studies) also measure the function of nerves as they passed along the extremities. EMG and NCV studies are performed to determine the causes of painful syndromes of the neck, back, and the extremities. The studies are helpful and explaining the pain syndromes and directing treatment. These studies can be helpful in defining such conditions as radiculopathy (compressed or irritated nerve to an extremity), and nerve compressions of the arm or leg, or neuropathies due to medical conditions.
Sciatica
Although commonly used as a diagnosis, the term sciatica actually describes a number of symptoms, including pain and/or numbness, tingling, and at times weakness, which can be present in the lower back and buttocks, often radiating into the legs and feet. This condition may be quite painful and debilitating. Sciatica has many causes, including bulging or herniated lumbar (lower back) discs, which can impinge on nerves. Another cause of sciatica is from inflamed/irritated or arthritic lumbar facets (joints which connect the vertebra).
The sacroiliac joints, which are found in the buttocks region, (joints connecting the pelvis and tailbone), can also become inflamed/irritated or arthritic and cause sciatica. Referred pain from trigger points, spasms or injuries to muscles can also produce sciatic type symptoms. Just as there are many causes of sciatica, there are also a number of potential treatment options available.
Only after the doctor has obtained a careful history and examination (often including diagnostic studies), can the potential underlying cause be identified and the appropriate treatment recommendations be selected, including: Lumbar epidural steroid injections Caudal epidural steroid injections Lumbar and sacral selective nerve root blocks Facet joint injections Diagnostic medial branch blocks (to diagnoses lumbar facet pain) Radiofrequency ablation Sacroiliac joint injections Trigger point injections Many other treatment modalities are available for sciatica including chiropractic care, physical therapy, acupuncture, spinal decompression, and medication management.