Transcutaneous electrical nerve
stimulation (TENS) has been used with varying
degrees of success in the management of chronic pain.
Electrodes are applied to either side of a pain site.
The TENS machine then administers an electrical stimulus
across the nerves in the area. The electrical stimulation
reduces the capacity of nerves to transmit pain signals.
Treatment can be repeated as required depending upon
how long the relief lasts.
Cryotherapy is destruction
of nerves with an ice ball produced by intense cold
at the end of a probe. The pain relief is temporary
and may last up to two weeks.
Epidural steroid injection
is injection of long lasting steroid medication into
the epidural space surrounding the spinal cord and the
nerve roots. The steroid reduces nerve inflammation,
which in turn reduces pain, numbness, and other symptoms
caused by nerve irritation or swelling. The injection
consists of a mixture of local anesthetic (like lidocaine
or bupivacaine) and a steroid medication (triamcinolone
or methylprednisolone). The immediate effect is usually
from the local anesthetic injected. This wears off in
a few hours. The cortisone starts working in about 3
to 5 days and its effect can last for several days to
a few months. A series of three injections at three
to four week intervals is a common treatment course.
Facet joint injection
is an injection of long lasting steroid into the facet
joints of the vertebrae. The steroid reduces the inflammation
of tissue in the joint space, which in turn reduces
pain and other symptoms caused by irritation of the
joint and surrounding structures. Like epidural steroid
injections, the solution injected is composed of a mixture
of local anesthetic and steroid medication. The procedure
is performed with the patient either lying on the stomach
or sitting (for cervical injections) under x-ray control.
Sacroiliac joint injection
is an injection of long lasting steroid into the sacroiliac
joints located on either side of the low back area.
The steroid reduces the inflammation of the joint space
tissue, which reduces pain due to inflammation of the
joint and surrounding structures. The injection consists
of a mixture of local anesthetic and steroid medication.
It is done with the patient lying on the stomach under
Epidurolysis (RACZ) procedure
is done to dissolve scar tissue from entrapped nerves
in the epidural space of the spine so that medications
can reach inflamed, painful areas. Scarring is most
commonly caused from bleeding into the epidural space
following back surgery and the subsequent healing process.
Sometimes scarring can occur when a disk ruptures and
its contents leak out.
The procedure requires a series of three injections.
First, under fluoroscopic guidance, a catheter is inserted
in the epidural space up to the area of scarring. The
first injection of medications is made via this catheter.
The second injection is done the following day. On the
third day, the catheter is injected and then removed.
The injection consists of a mixture of local anesthetic
and steroid as well as x-ray contrast dye to visualize
the scarred space, and hyaluronidase – and concentrated
sterile salt solution to soften scar tissue.
Radio frequency lesioning
is a procedure using a specialized machine to interrupt
nerve conduction and reduce pain on a semi-permanent
to permanent basis. A needle is placed under x-ray guidance
and a local anesthetic is injected. After confirmation
of the needle tip position, a second needle is inserted.
The tissues surrounding the needle tip are heated when
electric current is passed using the radio frequency
machine for a few seconds. This procedure effectively
"burns" the nerves and destroys the pain pathways.
Dorsal column spinal cord stimulator
therapy employs a specialized device to stimulate nerves
with tiny electrical impulses via small electrical wires
placed on the spinal cord. It is a treatment modality
for patients with chronic severe pain due to nerve tissue
damage who have not responded to conservative treatments.
The procedure is done in two stages. First, temporary
wires are placed and an external generator is used by
the patient to generate electrical current. If this
trial is successful in relieving pain, then the permanent
generator is placed under the skin. Wires are placed
along the spinal cord under x-ray guidance. For the
pain involving lower back and lower extremities, the
wires are inserted in the midline at the lower back.
Spinal myeloscopy is a
relatively new procedure performed to release scar tissue
around spinal nerve roots. A miniature fiberoptic scope
is placed into the epidural space of the spine after
local anesthesia has been applied to the skin. The space
in the lower back is then examined, scar tissue released,
and a combination of local anesthetic and steroid is
injected directly onto inflamed nerves. Spinal myeloscopy
is usually performed after routine epidural steroid
injections have failed to relieve pain.
Occipital nerve stimulation
is a new treatment for patients who suffer from occipital
neuralgia. Using tiny electrodes placed just beneath
the skin, the occipital nerve is stimulated and pain
is replaced with a minor tingling sensation to which
the patient becomes accustomed. The electrodes and battery-operated
generator, which are smaller than a cardiac pacemaker,
are then completely implanted under the skin. The procedure
is reversible and initial results have been positive.
Nerve blocks are injections
of anesthesia sometimes in conjunction with steroid
medication to reduce nerve inflammation and block pain.
Nerve blocks are administered in various sites depending
upon the nature and location of the pain under treatment.
Some of the most common nerve blocks are:
Occipital nerve blocks
are injections of anesthesia into the back of the neck
in order to treat pain going up the back of the head.
By injecting the peripheral nerves in the neck which
relate to damaged structures, impulses to the trigeminal
nerve are blocked and cervicogenic headache is relieved.
Stellate ganglion blocks
are used to relieve upper extremity pain syndromes.
The stellate ganglion is a collection of sympathetic
nerves in the upper neck on either side of the larynx.
It is the nerve center for the hands, arms and shoulders.
A local anesthetic is injected into the ganglion. Epinephrine
may be added to prolong the beneficial effects of the
injection. The injection permits increased blood flow
to the area and can often decrease or stop the pain.
A series of three to six injections is usually performed
over a period of two to three weeks. The number of injections
depends upon the severity and duration of the extremity
Intercostal nerve blocks
are used to relieve severe pain caused by rib fractures,
or chest pain associated with pleurisy, acute herpes
zoster, and post herpetic neuralgia. Intercostal nerve
blocks are injections of long-acting local anesthetic
and sometimes a steroid around the nerves of the ribcage.
The injection interrupts the signals sent along the
intercostal nerves, reduces pain and inflammation, and
promotes healing and function. It may be necessary to
perform intercostal nerve blocks on a weekly basis until
significant improvement occurs.
Lumbar sympathetic blocks
are injections of local anesthetic into the sympathetic
nerve tissue located on the either side of spine. The
injection blocks the sympathetic nerves to reduce pain,
swelling, redness and sweating changes in the lower
extremity. The injection consists of a local anesthetic
(like lidocaine or bupivacaine). Epinephrine or Clonidine
may be added to prolong the effects of the injection.
It is done either with the patient lying on stomach
under fluoroscopic x-ray guidance.
Neurolysis is the destruction
of a nerve by injection of ethanol, phenol, or other
neurolytic agents at sites of chronic intractable pain.