| By
Marc H. Sencer, MD
Trigger-point
injections are the most basic type of interventional
pain management. Complicated or persistent back pain
may require more advanced procedures. An anesthesiologist
or physiatrist can perform the following interventions:
•
Facet joint injections. Also known
as facet blocks, these injections often provide long-term
relief of previously intractable pain.
The procedure consists of local anesthetic and steroid
injected directly into the facet joints. The physiatrist
injects dye to identify the exact site of inflammation
and guides the actual injections by fluoroscopic placement
of the needle.
This
type of procedure requires a 30-minute recovery in
the office.
•
Epidural steroid injections. These
injections are administered in a similar manner to
facet joint injections. Cortisone is the steroid most
often used and up to 70 percent of patients who have
not had any back surgeries experience relief of diminished
or absent pain that lasts from weeks to years.
•
Nerve block therapy. This therapy
is helpful for pain and dysfunction when nerves are
trapped in scar tissue. This therapy can also be used
diagnostically in place of more dangerous exploratory
surgeries. Nerve blocks can actually reset the pain
thermostat of the nervous system and are a powerful
tool to combat many types of chronic spinal pain syndromes.
•
Intradiscal electrotherapy (IDET).
IDET is a relatively new procedure used for disc-related
problems in the lumbar spine. Using fluoroscopic guidance,
the physiatrist introduces a small catheter and then
heats the catheter. The heating causes shrinkage of
the disc and ablation of inflamed nerve endings affected
by the herniated disc.
In
the most successful cases, patients are spared back
surgery and after recovery and rehabilitation are
able to lead pain-free lives. And patients can leave
the office the day of the procedure.
•
RF rhizotomy. In this procedure
radio frequency waves are used to deactivate inflamed
pain-causing nerves around the facet joints. When
a patient has a successful result, the effects usually
last longer than those of facet injection —
often months to years.
•
Nucleopasty. This exciting new technique
is used to treat certain herniated discs. The doctor
creates channels in the disc and uses a special RF
apparatus to send thermal energy through the channels
and cause dissolution and shrinkage of part of the
disc. The procedure leads to retraction of the herniation.
•
Epidural neuroplasty. This is actually
a group of procedures in which various medications
are introduced around the epidural space to reduce
scarring, fibrosis and adhesions that increase nerve
root tension and inflammation. These procedures are
done under radiological guidance, usually on an outpatient
basis.
•
Discography. When other diagnostic
methods have failed or the patient has had back surgery
with poor results, the physiatrist may opt to use
this older procedure. Discography requires injecting
a saline solution into suspect discs in an effort
to reproduce the patient’s pain. The discogram
helps pinpoint areas to be treated.
Marc
H. Sencer, MD, owns and manages a multi-specialty
Pain Management Group practice in Florida. He can
be contacted at 800-916-1462 or through www.mdsfordcs.com.
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