Pain Management Treatments
- Facet joint injections including all levels of the spine.
- Medial branch blocks including all areas of the spine.
- Denotations of medial branches all levels of spine.
- Dorsal Root ganglion blocks both diagnostic and with pulsed radio-frequency , all levels of the spine including occipital blocks.
- Epidurals, all levels of the spine.
- Peripheral nerve blocks both diagnostic and with pulsed RF e.g ilio-inguinal, gentio-femeral and intercostal.
- Sympathetic blocks e.g. stellate ganglion, lumbar and coeliac plexus.
- Joint injections including hips and shoulders.
- Nerve blocks for joint pains i.e. supra-scapular blocks.
- Trigger point injections for example for plantar fasciitis.
- Radio frequency treatments.
- Provocative discography.
- Racz catherisation (Post spinal surgery syndrome).
A bit more explanation:
Facet Joint Injection
A facet joint injection can help to relieve and treat neck and back pain originating from the facet joints. Research suggests it may help to treat pain that comes from inflamed facet joints of the cervical region (neck), the thoracic region (upper back) or the lumbar region (lower back). It may be that an injection can resolve the pain you are experiencing from your facet joints or possibly additional treatment such as radiofrequency denervation will be required. Facet joint injections can lessen pain and allow rehabilitation to progress, which may keep long-term symptoms at bay.
Through a series of ultrasound scans, your surgeon will guide the needle to the right spot in the facet joint. They will then inject a local anaesthetic and steroid into the joint to alleviate pain.
Radiofrequency denervation (rhizolysis or radiofrequency ablation) is a procedure to help treat back or neck pain from facet joints. It is similar to a facet joint injection, except it uses heat to alter the function and structure of the nerve in terms of the way they transmit pain signals to the brain. Special needles are placed alongside the nerves with an electrical current passed through, which creates heat. Effects from this procedure can last 8-24 months and when pain relief is experienced, you can gradually increase your activities, potentially with the support of rehabilitation methods.
The sacroiliac joint is not designed to move much but is essential for bearing weight. They are found in the lower back on the left and right hand sides of the hips, just inside the buttock muscles. Pain may be experienced due to natural wear and tear or other causes. Through the guidance of x-rays/ultrasounds, a mixture of local anaesthetic and a steroid is injected into the joint to relieve pain symptoms and help to identify the cause of the pain.
Trigger Point Injection
Trigger point injections are used to relieve pain associated with muscles. It may feel like an irritable knot or spasm that can be felt under the skin and which can irritate the surrounding nerves. Trigger point injections are a combination of local anaesthetic, with or without a small dose of locally acting steroid and can be used to treat fibromyalgia, chronic headaches or acute myofascial pain.
The injection site will be cleaned and then the needle is inserted into the trigger point where the medication is injected. Following this, an adhesive bandage may be applied to protect the site and aid the healing process.
As a side effect of the trigger point injection you may feel some pain at the site of the injection, however this usually resolves itself within a few days. You may take anti-inflammatory medication such as ibuprofen to relieve any discomfort.
Dorsal root ganglion block
Also known as a nerve root block, the medication in the injection contains a local anaesthetic with or without a locally acting steroid. The solution is designed to alleviate pain resulting from compression or irritation of nerves in the spine.
Our consultants will make your experience as comfortable as possible. For injections in the lower back or the neck, you will be asked to lie on your front so that an X Ray machine can be used to guide the injections. X Ray pictures are taken throughout the procedure to ensure the needle is in the correct area at all times.
Following the procedure, you may feel some tenderness around the area of the injection site but this shouldn’t be any worse than other injections you have been given.
Peripheral nerve block
Peripheral nerve blocks are a type of regional anaesthetic. These are injected near the nerves around the area of a specific part of the body in order to block symptoms of pain experienced by the patient. These injections are most often used for post-operative pain relief. When the procedure can be identified to a specific area of the body, peripheral nerve blocks are most useful.
Intravenous guanethidine block
This type of injection is used to relieve pain originating in your arms or legs. The substance in the injection, guanethidine, is designed to block pain signals that travel along the sympathetic nerves. These nerves maintain a pain condition affecting the arms or legs, making them unresponsive to over-the-counter pain killers. The pain experienced has been described as a shooting, stabbing or sharp sensation, varying in its intensity. Guanethidine reduces pain signals from the sympathetic nerves and is often used as a last option when other treatments have failed.
Stellate ganglion block
A stellate ganglion block is a local anaesthetic injected into the sympathetic nerve tissue of the front, right or left side of the neck. This injection is designed to diagnose whether the pain is stemming from the sympathetic nervous system. If the injection is successful in blocking the pain then other medications may be used to prolong the pain relief.
A lumbar sympathectomy is an injection of local anaesthetic and steroid anti-inflammatory around the nerves supplying feeling to the veins in the legs. It is used to treat pain felt in the leg or foot, originating from the lumber (lower) back region by blocking the sympathetic nerves. The consultant will use an X-ray to guide the injection to ensure the needle is in the correct position. You may feel a pressure or tightness but this is completely normal. After the procedure you may experience an aching at the site of the injection but this should subside. You should be able to slowly resume activities as your pain decreases.
Your Pain Management Consultant may feel acupuncture is an effective treatment for your pain.
Acupuncture has been used for more than 2,000 to treat many medical problems and is particularly useful for pain. It can help with joint pains, muscular pains, migraine and even period pains. It can also be used to treat problems such as sinusitis, hay fever, irritable bowel and nausea.
Acupuncture stimulates the release of natural pain-relieving chemicals within several areas of your body – around the site where the needles are placed, in your spinal cord where the nerves run and in your brain. Acupuncture releases other natural substances in your body which promote healing and aid recovery.
Most people receive some benefit from Acupuncture – you may lose your pain completely or find it is much improved. However, about a quarter of patients do not respond to Acupuncture.
Acupuncture is a very safe treatment with fewer side effects than many drug treatments.
Acupuncture involves placing a number of very fine needles into various points in your body for a short time (15 – 30 minutes). The needles may either be left in, they may be manipulated, or they may have a small painless electrical simulation applied to them.
Most people need between three to eight treatments, with some people returning for regular top up treatments.
TENS – Transcutaneous Electrical Nerve Stimulation
Transcutaneous means ‘through the skin’ – TENS machines deliver small electrical pulses to the body via electrodes placed on the skin. TENS machines are thought to affect the way pain signals are sent to the brain. Pain signals reach the brain via nerves and the spinal cord. If pain signals are blocked then the brain will receive fewer signals from the source of the pain.
TENS machines are thought to work in two ways.
1. When the machine is set on a high pulse rate (90-130 Hz), it triggers the ‘pain gateway’ to close, which is thought to block pain nerve pathways to the brain.
- When the machine is set on a low pulse rate (2-5 Hz), it stimulates the body to make its own pain relieving chemicals called endorphins, which block pain signals.
Your Pain Management Consultant will show you how to use the TENS machine, which will come with full instructions.
If you have a pace maker you should inform your consultant.