Our Physicians

Dr Frey
Dr. Frey
Dr Schmidt
Dr. Schmidt
 
Contact Us for Appointment

/ APPOINTMENTS

Making an Appointment
Phone, Forms, Directions

Locations

spacer
spacer
 
colorado spine logo
 
Telephone: (303) 762-0808
Fax: (303) 762-9292
TollFree: 1-866-971-7940
colorado spine logo
Telephone: (303) 762-0808
Fax: (303) 762-9292
TollFree: 1-866-971-7940
Contact Us for Appointment

/ APPOINTMENTS

Making an Appointment
Phone, Forms, Directions

Denver/Englewood Office

/ ENGLEWOOD

3277 S Lincoln St.
Englewood CO 80113

green slash

Interventional Pain Management

CCSI Nerve Block

Effective control of acute and chronic pain is an essential task for CCSI's medical team. Severe, un-controlled pain can obviously destroy a patient's quality of life, and thus CCSI makes pain management a very high priority. One type of treatment that we offer is interventional pain management. Under the expert direction of Kevin Schmidt, M.D., MBA this type of treatment has brought relief from pain to numerous CCSI patients. The following article provides an overview of interventional pain management techniques.

Nerve blocks, epidural steroid injections and radiofrequency nerve ablation are non-operative forms of pain management. Therapeutic injections may be considered an adjunct to medication and physical therapy. Injection therapy may help control pain from degenerative disc disease, injury, osteoarthritis and other disorders of the spine. Pain management strives to relieve and control acute and chronic pain.

Facet and Medial Blocks

Sacroiliac Joint Injection

Selective Nerve Root Block

Diagnostic Spinal Injections

Table 1: Types of Pain

Types of PainSymptom Description
Acute Pain
Severe, short-term pain, self-limiting
Chronic Pain
Consistent, not self-limiting
Neuropathic Pain Burning, electric, shooting, tingling
Nociceptive Pain Sharp, aching, throbbing, localized

The following is a brief overview of different types of nerve blocks and epidural injections used to treat pain and discomfort caused by spinal disorders.

Nerve Blocks

A nerve block is an injection of medication onto or near nerves. The injected medication may include a local anesthetic, steroid and narcotic.

  • Facet Joint Block and Medial Blocks
    Joint inflammation between the spinal bones can cause back pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint. A medial block uses similar medication injected outside the joint space near the nerve that feeds that joint.

  • Peripheral Nerve Block
    Paresthesias are sensations described as numbness, tingling, or a ’pins and needles’ feeling. These sensations may be caused by a disturbance in the peripheral nervous system. The nerves outside of the brain and spinal cord are the peripheral nerves. Sensory peripheral nerves transmit information to the central nervous system. Motor peripheral nerves transmit information from the brain.

  • Selective Nerve Root Block (SNRB)
    Pain and discomfort from cervical or lumbar radiculopathy may be relieved by a SNRB. A radiculopathy is irritation and inflammation of a nerve root that serves a particular body part (eg arm, leg).

  • Sympathetic Nerve Block
    Sympathetic nerves regulate part of the autonomic (involuntary) nervous system. This includes such bodily functions as sweating and blood flow. Conditions causing chronic pain often involve the sympathetic nerves.

Epidural Steroid Injections

The epidural space is the space surrounding the membrane that covers the spinal cord and nerve roots. Disorders such as spinal stenosis and herniated disc can cause nerve irritation, inflammation and pain. An epidural injection places anti-inflammatory medication (eg steroids) into the epidural space. Epidural injections are performed in the cervical, thoracic and lumbar spine.

Sacroiliac Joint Injection

The sacroiliac joint is the largest joint. It is located in the lower spine above the tailbone. Inflammation of the sacroiliac joint can cause low back and buttock pain. An injection of an anesthetic and steroid may help relieve joint pain.

Radiofrequency Nerve Ablation

Facet joints are one source of back pain. Radiofrequency nerve ablation uses radio waves to produce heat directed at a specific facet joint nerve. The heat destroys the nerve and relieves pain.

The ablation procedure is similar to a nerve block or spinal joint injection except two needles are inserted; each facet joint has two nerves. Fluoroscopic guidance is used to correctly position each needle. Then radiofrequency "radio waves" are directed through each needle. The ablation process takes about two minutes. The entire procedure takes about 2 hours.

Patient Restrictions

For safety, some patients are not allowed to undergo a spinal injection for the following reasons:

  • Allergy to the drugs to be injected
  • Anemia
  • Asthma
  • Bleeding problems
  • Infection
  • Kidney disease
  • Pregnancy/breast-feeding
  • Severe spinal abnormality

Patient Preparation: At Home

It is important to follow all pre-test instructions. These instructions generally include:

  • Stop blood thinning medication 2 days prior to the test
  • Do not take any aspirin product 5 days prior to the test
  • Stop anti-inflammatory medication 5 days prior to the test (Vioxxâ„¢ or Celebrexâ„¢ is an exception)
  • Stop pain medication 8 hours prior to the test
  • Do not eat or drink 6 hours prior to the test
  • Arrange for someone to provide transportation home

Patient Preparation: At the Medical Facility

  • The medical staff will review the patient’s history, condition, medications taken on a daily basis, food and/or drug allergies, and other information.

  • The patient changes into a gown and lies down in a hospital bed. The facility provides a secure place for the patient’s personal items.

  • An EKG monitor (heart function), automatic blood pressure cuff (blood pressure), and oximeter (measures blood-oxygen levels) are attached to the patient. This equipment enables the medical staff to consistently monitor the patient’s vital signs before, during and after the procedure.

  • Medication to relax the patient is administered by injection. In some cases, light intravenous sedation may be given.

What to Expect During the Procedure

  • The procedure is performed in a sterile setting similar to an operating room.

  • The injection site is cleaned and draped. Skin numbing medication is injected into and around the procedure site.

  • Before proceeding, the fluoroscopy C-arm is positioned over the patient. Fluoroscopic guidance is used during the procedure to guide the needle into the proper position.

  • After the needle is placed, an anesthetic and steroid are injected. An antibiotic may be included in the injection to prevent infection.

After the Procedure

  • The patient is wheeled to the recovery area where the medical staff continues to monitor vital signs.

  • Patients are usually discharged home when stable with written instructions.

  • The area around the injection site will feel numb.

  • Steroids may cause side effects that include blurred vision, frequent urination, increased thirst and change in blood sugar levels. If these side effects become bothersome or worsen, seek medical attention.

  • If fever, chills, increased pain, weakness or loss of bowel/bladder function occurs, seek immediate medical attention. " Follow-up with the treating physician.

Possible Complications

Spinal injections, like other medical procedures, have risks. Complications include risk of infection, low blood pressure, headache, and injury to nerve tissue.

Conclusion

At CCSI we perform the full -range of therapies outlined above. Our medical team will carefully discuss the options with you, and give you detailed instructions for before and after the procedure.

 
 

By using this site, you acknowledge that you have read and agreed to the terms of our User Agreement . The information provided is not intended to replace the medical advice of your doctor or health care provider.
© 2004-2017 Colorado Comprehensive Spine Institute

LastUpdate: 2016-11-30 17:18:32

  • top