Our spine is a complex structure with numerous interconnected bones, nerves, ligaments, and muscles innervated by nerves that work together to provide us with support, strength, and flexibility. Accurate diagnosis as to the root cause of back pain remains critical to the success of a treatment. We specialize in treating patients who are experiencing back pain. As specialized providers in interventional pain,  we conduct a detailed evaluation to arrive at the most accurate diagnosis for your back pain and develop a treatment plan best suited to achieve your functional goals.

Our providers conduct a thorough history and physical examination. This physical assessment helps to determine the root cause of the pain.  If additional tests are needed, an X-ray, CT scan or MRI, blood tests, bone scan, or additional nerve studies may be ordered.  Depending on the diagnosis, our providers may recommend the following:

• Over-the-counter (OTC) pain relievers

• Muscle relaxants

• Topical pain relievers

• Prescription pain medications

• Epidural steroid injection 

• Facet injections or medial branch nerve blocks

• Spinal cord stimulator

• Pain pump

• Regenerative solutions

Physical therapy, psychological counseling, and additional procedures may be required to treat back pain such as implanted nerve stimulators, TENS (transcutaneous electrical nerve stimulation), or implantable pain pumps.  Our team will work together with the patient’s referring doctors to diagnose, treat, and relieve back pain.   

We all experience occasional aches and pains. However, chronic pain is different from usual pain. Chronic pain is defined by some as pain lasting beyond 3 months but it is any pain that outlasts reasonable or expected duration of healing. Initially, pain serves a protective function but when pain becomes chronic, it may simply become a hindrance to the full enjoyment of life. Chronic pain can have a debilitating impact on your day-to-day activities and this type of pain is also called high-impact pain. Our providers help our patients with chronic pain using whole health strategies, medication, and interventional treatments.

Making the correct diagnosis is a critical step in the treatment of chronic pain. Oftentimes, there may be more than one pain generator, and identifying all contributing factors is important to have the best possible outcome. Our team will first try to identify the cause and then develop a comprehensive multidisciplinary treatment plan. We provide a multimodal approach to medication, lifestyle changes, rehabilitation, and interventional therapies. Chronic pain therapies may include steroid injections of the painful body part including the spine, advanced therapies such as spinal cord, dorsal root ganglion or nerve stimulation, and regenerative medicine therapies. We know that chronic pain interferes with daily activities and we’re here to help you achieve your goals.

Degenerative disc disease is a natural occurrence that comes with aging. As we age, one or more of the discs between the vertebrae of the spinal column deteriorate, which may sometimes lead to pain. The discs between the vertebrae allow room for flexing and bending of the back, however, with time, or sometimes due to an injury, they become worn out which may lead to chronic pain.

Disc-related pain may subside with time but can sometimes take years. Disc degeneration when accompanied by specific MRI changes called Modic changes is an independent predictor of back pain. This condition can be challenging to treat without utilizing interventional treatments. Surgery, when it is done for discogenic back pain has a high chance of failure.  We diagnose this condition based on history, examination, and advanced imaging of the spine and provide a broad spectrum of individualized treatment options which include physical therapy, medication management, and therapeutic injections. These injections could include epidural steroid injections, nerve blocks, ablations, and regenerative therapies. 

Facial pain may be a result of several conditions. The temporomandibular joint disorder is not an uncommon cause of facial pain. Disorders of nerve plexuses in our skull such as the trigeminal ganglion may also result in facial pain while some headache disorders may also manifest with facial pain. These conditions, although rare, can wreak havoc in a person’s life when they do occur. 

Treatments for facial pain or trigeminal neuralgia start with a medical review. Our patient treatment options include interventional treatments and medication management. Trigeminal nerve blocks can be performed.

Our spinal disc has a soft, jellylike center that is surrounded by a cartilaginous exterior. A herniated disk refers to a problem where the gelatinous material extends beyond the cartilaginous ring due to a disruption in the material of this ring. This protruding material pinches on a nerve root and causes extremity pain.

We will first treat our patients with conservative treatment options such as medications, physical therapy, and injections to decrease pain and improve function. A treatment plan is formulated to meet the patient’s goals. If there is progressive numbness or weakness, a surgical consultation may be needed. 

As one of the strongest and most complex joints in your body, your knees can handle a considerable amount of stress, strain, and everyday wear and tear. Not only do they bear your full body weight every time you take a step, but they also support a much greater load every time you run or jump. It’s no coincidence, then, that knee pain is a relatively common problem.  

After a comprehensive exam and diagnosis, the team will come up with a treatment plan designed to address the underlying cause of your knee pain. Chiropractic care, massage therapy, and rehabilitative exercises are often helpful in decreasing inflammation, preventing instability around the joint, and restoring strength and range of motion. If you have osteoarthritis in your knees, viscosupplementation or gel-based injections may be a good option. This quick, easy treatment involves an injection of hyaluronic acid, a natural joint replacement fluid that acts as a lubricant and shock absorber, to help the joint function properly. It can also help provide pain relief for up to 6 months, so you don’t have to resort to surgery or prescription medications.

Another treatment option is a genicular nerve block. This procedure targets the sensory nerve endings of the knee and if a nerve block provides greater than 50% pain relief then these nerve endings can be targeted by a procedure called Radiofrequency ablation (RFA) which can provide sustained pain relief for up to a year. This procedure can even be performed for those who continue to have knee pain after already having a total knee arthroplasty or for whom more surgery is not an option. 

If opening jars or other items becomes more difficult because of painful hands, or if climbing stairs produces pain in your knees, arthritis is often the first thing that comes to mind.

Osteoarthritis treatment:  Treatment varies from one person to the next. Osteoarthritis is not reversible, but the symptoms can be managed. Our providers will work with you to determine the best treatment for you which may include physical therapy, pain medication, application of heat/ice, weight loss and/or surgery, and when necessary, consider injections. 

Rheumatoid arthritis treatment:  treatment includes medicine, exercise, and lifestyle changes, which must continue throughout life. Finding treatment early can control the condition and prevent it from worsening. Our providers will work with your rheumatologist to help mitigate this.

Ligaments are small bands of tough, flexible tissue, made up of lots of individual fibers, which connect the bones of the body. bones. They give your joints support and limit their movement. Ligaments lengthen during tension and return to their original structure when the tension is gone. You have ligaments around your ankles, elbows, knees, shoulders, and other joints.

We work with our patients suffering from torn ligaments to the elbow, foot, shoulder, or knee.  There are various treatment options available for torn ligaments including physical therapy, anti-inflammatory medication, bracing, and surgical options (for more severe injuries). Regardless of the type or severity of your torn ligament, the first step toward healing is to receive an examination.  Our providers will not only assess your injury but also recommend the most effective and personalized treatment plan including regenerative therapies.

Fibromyalgia is chronic (ongoing) and is characterized by widespread pain and fatigue. The condition can affect the way your spinal cord and brain process pain signals. Fibromyalgia symptoms can appear after surgery, other kinds of trauma like an injury, infections, or psychological stress. While there’s no cure for fibromyalgia, pain-management treatments can ease the pain, helping you feel better.

We will recommend one or more of the following to treat your fibromyalgia:

Lifestyle changes

Lifestyle habits can reduce the ongoing pain of fibromyalgia. Habits that can ease your pain include managing stress, getting a better night’s sleep, exercising regularly, and eating healthy foods. Not smoking, limiting your caffeine intake, and receiving counseling to manage depression, anxiety, and other mental health struggles can also help.

Therapies

Several noninvasive therapies can reduce fibromyalgia pain. These include physical therapy, massage therapy, occupational therapy, and counseling to help you develop ways to better cope with fibromyalgia pain.

Ketamine infusions

Ketamine is a pain-relieving medicine that our providers can inject directly into your bloodstream to help you feel comfortable. This medication interacts with targeted receptors in your brain.

Oral medications

Taking oral medications can also relieve fibromyalgia pain, helping you to sleep better. Don’t live with the severe, ongoing pain of fibromyalgia when simple treatments are within reach. Call the office to book an appointment or request one online today.

Joint pain is a common problem, especially if you have arthritis. Our team will help diagnose the cause of joint pain. We will treat it, improving joint function, and restoring your quality of life.

Common joint pain treatments include:

Home remedies

Things you can do at home to ease joint pain include using ice or heat packs, resting the affected joints, wearing a brace, and losing weight if necessary. Getting regular exercise is a must.

Medications

Taking medications can reduce the pain and inflammation in your joints, offering you relief and a better quality of life.

Injections

Joint injections can reduce the pain and inflammation that come with injuries and arthritic degeneration.

Regenerative medicine

Regenerative medicine can generate new cells and boost your body’s natural healing ability to ease joint pain. Regenerative medicine treatments include platelet-rich plasma (PRP) and stem cell injections.

Physical therapy

Physical therapy strengthens and stretches joints and the surrounding tissues to reduce your pain and risk of further joint damage.

Surgery

In the case of severe joint deterioration or injuries, our team could recommend that you undergo surgery to replace, remove, or repair the affected joint tissues.

Don’t let joint pain get the best of you when simple treatments are available. Call the office to schedule an appointment or book one online today.

Facet Injections Q&A

Facet joints are small joints which connect each segment of the spine’s vertebrae that provide stability and help to guide motion. Although small, the facet joints can become painful due to arthritis of the spine, a back injury or strain of the back. Depending on which part of the spine, these joints are referred to as cervical, thoracic, and lumbar. Facet injections can help localize the pain, improve flexibility, enhance function, and in general help patients return to their normal life.

What is it?

Pain from facet joints can be targeted either by directly targeting the joints or by targeting the nerve innervation of the joint. The facet joint may be treated with a steroid injection for acute to subacute pain but for chronic pain, regenerative modalities such as PRP injection may be a better alternative. 

A medial branch block is a diagnostic tool which helps us determine which facet joints are painful. The purpose of this procedure is not to provide long lasting pain relief, but to identify the source of a patient’s pain. Once identified, this can be more treated with a procedure called radiofrequency ablation which provides more sustained pain relief.

How does it work?

Pain from facet joints is perceived by us when nerve endings called the medial branch nerves relay this pain to our nervous system. A medial branch nerve block will block these impulses, thus reducing pain. If indeed, the facet joints targeting are the primary source of pain, we expect to see greater than 80% pain reduction. This injection only consists of a local anesthetic. These drugs and this procedure have a long record of safety and effectiveness. Injections are performed under live X ray guidance to enhance precision and safety.

What are the advantages?

Facet joint injection and medial branch nerve blocks act as a minimally-invasive tool to confirm the facet joint is, in fact, the source behind a patient’s spine pain. Combined with physical therapy and medication, this treatment option can reduce inflammation, which in turn, can improve an individual’s function and overall quality of life. In fact, when the pain is truly facet mediated, surgery is not a good option to treat it. Studies have found facet-joint injections to have immediate, long-lasting low-back pain relief.

Facet injections may be used to treat the following conditions:

• Lumbar facet syndrome

• Spondylolysis

• Spondylolisthesis

• Ankylosing Spondylitis

• Trauma such as car accidents or sports/work involving repetitive forceful extension of the spine

Sacroiliac Joint Injection Q&A

The Sacroiliac (SI) joint pain is a commonly overlooked source of pain in the low back and buttocks area. Joint pain is an inflammation of one or both of your sacroiliac joints located where the lowest part of the spine called sacrum and pelvis connect. The SI joint is a complex joint that allows for a small amount of movement for flexibility of the pelvis while walking. This joint expands during childbirth and may sustain injury from falls. SI joint involvement is common in patients with Ankylosing spondylitis. Treatment might involve physical therapy, medications and injections. This condition is diagnosed by the patient’s history, physical findings, radiological investigations and sacroiliac joint injection findings. Surgery to fuse the joint and stop painful motion may be recommended based on medical diagnosis. Another treatment called radiofrequency ablation may sometimes be used to target the nerve supply of this joint to block pain.

What is it?

The sacroiliac joints link your pelvis and lowest part of the spine called sacrum. There are two SI joints, one on each side. Strong ligaments hold these joints in place. The sacroiliac joints support the weight of your upper body when you stand. For some, SI joint pain could be dull and achy, for others it can be sharp and stabbing. You’re most likely to feel SI joint pain in your lower back and buttocks, but it can be referred to to your thighs, groin, and even your feet. You may also experience pain on only one side of your lower back or both sides, pain with prolonged standing and pain that worsens with walking, running, or taking large strides. Conditions that lead to SI pain include trauma, pregnancy, inflammatory arthritis, osteoarthritis, abnormal walking patterns, spine surgery, and infection.

How is it treated?

Depending on the cause of your SI joint pain, we may recommend:

• Pain relievers, muscle relaxants or anti-inflammatory meds

• Physical therapy to help range-of-motion, strengthening and stretching exercises

• Steroid shots to reduce inflammation and pain

• Radiofrequency ablation to eliminate the nerve fibers that carry pain signals in the joint

• Minimally invasive fusion of the SI joint to prevent abnormal movement which causes pain.

What are the advantages?

When conservative and minimally invasive treatments fail to provide lower back pain relief due to SI joint pain, minimally invasive implants help to stabilize the joint facilitating fusion of the joint and providing long term pain relief. 

The SI joint fusion devices are minimally invasive implants done in the operating room under monitored anesthesia care and local anesthetics. It requires a half inch incision with minimal soft tissue damage and minimal tendon irritation. Patients leave the surgical center the same day after surgery and can usually resume daily living activities within four to six weeks, depending on how well they are healing. The procedure offers several benefits compared to traditional SI joint surgery which includes minimal incision size, minimal soft tissue striping and quicker recovery.

Epidural Steroid Injections Q&A

Epidural steroid injections (ESIs) are a common treatment option for many forms of lower back pain and leg pain. An ESI is safe, fast and effective. The medicine is injected into the epidural space or the area that covers the spinal cord where the inflamed nerves are located. If you have intense and difficult to treat pain in your leg or arm from an inflamed spinal nerve, then an ESI may reduce the inflammation and provide pain relief. ESI treatments have been used for decades and are considered an integral part of the treatment of sciatica, arm pain from a pinched nerve and lower back pain.

What is it?

ESIs are minimally-invasive procedures to relieve leg, back, arm, and neck pain caused by inflamed spinal nerves. Nerves become inflamed when the passages narrow as the nerves traverse the spinal canal and foramina. This narrowing can occur as a result of several causes, such as spondylolisthesis (or slipped vertebrae), stenosis, joint cysts, disc herniation, or bone spurs. ESIs have been used for decades and are an effective and safe option for people experiencing pain.

How does it work?

Steroids in epidural injections are believed to have an anti-inflammatory effect that suppresses pain signals from inflamed spinal nerves thereby improving function in the lower back and/or legs. ESI procedures are an outpatient procedure which may be done under moderate sedation or just with local anesthetic. A fluoroscope is a special X-ray machine which allows the doctor to see in real time, the exact placement of the needle and to verify its correct position. 

The procedure usually takes no more than five to ten minutes, followed by a brief 15–20-minute recovery before being discharged to your home.

What are the advantages?

Unlike painkillers and oral steroid medications, ESIs deliver medication near the pain source which relieves pain faster than other methods. This form of medication controls chemical inflammation and reduces severe pain. When properly administered, ESIs can be an alternative to surgery, provide quick and substantial relief, and improve mobility.

Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique of treating pain. This technique employs radiofrequency waves to produce heat and the heat produced damages the nerves transmitting pain signals to the brain. This procedure is performed to treat painful facet joints in the spine that usually cause chronic low back pain and neck pain.

Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints and this is confirmed by performing a diagnostic facet joint injection. Facet joint injection relieves pain for a short duration whereas radiofrequency ablation can keep you pain-free for a longer period of time.

Radiofrequency ablation is a minimally invasive technique and therefore administration of general anesthetic is not required. You will be conscious throughout the procedure and lying on your stomach. Only a small area over your back which requires treatment is cleansed and numbed. This procedure is performed under the guidance of fluoroscopy. The fluoroscope is a special kind of X-ray machine that helps doctors to visualize the placement of the needle electrode in invasive procedures.

During the procedure, your provider will direct a special radiofrequency needle electrode close to the facet joint in such a manner that the needle tip lies almost near to the medial branch nerve. The needle tip is then heated so that the nerve gets cauterized and destroyed thereby reducing the pain. This procedure may last for about 30 min.

Nerve Root Injection (NRI): This is a diagnostic and therapeutic injection. Both a strong anesthetic and steroid are used and injected around the nerve and into the epidural space.

Overview of the nerve root injection procedure

Here’s what to expect during a lumbar nerve root injection procedure:

• You will lie face down, with a pillow underneath your abdomen.

• The injection area is cleaned and numbed before the injection.

• Using fluoroscopic (X-ray) guidance, your physician will determine the appropriate path for the needle.

• Your provider will insert a thin needle to a point immediately behind the nerve root.

• Next, your provider will inject a small amount of contrast dye to make sure that the medication will flow exactly where intended.

• Then, your provider will inject a small amount of anesthetic, steroid, or a combination of both, depending on the procedure’s purpose.

• During the injection, you may feel a sensation of pressure in the neck or arm. This typically disappears in a few moments.

• After the procedure, you’ll spend 20 to 30 minutes in the recovery area.

Joint injections are common treatments used to reduce stiffness and pain in joints caused by inflammation and arthritis.  The most common joints that can benefit from an injection include knees, shoulders,hips and sacro-iliac joints.

Conditions Treated With Joint Injections

• Knee or shoulder osteoarthritis and tendon tears.

• Frozen shoulder or Adhesive capsulitis.

• Sacro-iliac (SI) joint pain.

• Hip osteoarthritis.

• Ankle pain.

• Wrist pain.

Typical Benefits of Joint Injections

Joint injections are simple and safe procedures that can potentially help you avoid surgery. Some of the benefits include:

• Near immediate pain relief and return to normal activities.

• Anti-inflammatory properties decrease swelling in the joint.

• No need to take oral medication which can have side effects.

• A great diagnostic tool for identifying the underlying source of pain.

• Restore range of motion.

• Restore function and allow for more effective Physical Therapy course.

• Avoidance of surgery.

A Medial Branch Block (aka Facet Joint Injection) is a simple office based procedure where a small dose of local anesthetic is placed next to the facet joint. This helps identify which facet joints are causing symptoms, and result in:

• Reduction in pain

• Increase in function and mobility

• Improved quality of life

Medial branch blocks and facet injections are common treatment options for patients who experience back pain, neck pain and headaches. These simple injections are administered around facet joints to reduce inflammation and irritation from arthritis pain. The facet joints are located along the spine and connect each vertebra to the next. These joints help support the spine by providing stability and range of motion. They can become painful due to arthritis of the spine, a mechanical injury, or poor posture.

What is an Occipital Nerve Block?

• The occipital nerves run from the top of the spinal column up to the back of the scalp.

• An occipital nerve block involves an injection of local anaesthetic and steroid onto the area of the occipital nerves.

• This is performed in order to treat headaches arising from the following causes: Occipital neuralgia (pain is typically located in the back of the head / neck); Whiplash injuries; Tension headaches.

Prior to the Procedure

• All blood thinning products (except aspirin) must be stopped prior to your procedure. You will be advised by letter when to stop taking these medications at the time your admission date is arranged.

• You will need to organize someone to drive you home after the procedure as you will not be able to drive for a minimum of 4 hours after your procedure.