In this section of the FAQ, I’ll answer questions about some of the most common interventional procedures I perform.
Q: What is an epidural steroid injection (ESI)?
A: An epidural steroid injection involves injecting a corticosteroid and anesthetic into the epidural space around the spinal nerves, reducing inflammation and pain. These spinal nerves emerge from the spinal cord, through openings in the vertebral column, and control sensation and function throughout different areas of the body.
Q: What conditions are treated with an ESI?
A: Nerve irritation, inflammation or compression due to bulging or herniated discs, spinal arthritis, osteophytes (bone spurs) and spinal stenosis. Any of these conditions can result in pain, numbness, tingling, burning, weakness and loss of function in a specific limb or area(s) of the body. This pain is clinically known as radiculopathy.
Q: How do you know where to inject the medication?
A: I perform the procedure using live x-ray (fluoroscopy) and contrast agent to pinpoint the exact location of the nerve root I want to target. I also consult MR scan images.
Q: What is a nerve block?
A: A nerve block involves injecting medication (which can be only anesthetic or can have a steroid included) directly around a nerve or group of nerves to interrupt pain signals sent to the brain. This can be used diagnostically to help me prove or disprove a diagnosis and can provide significant pain and inflammation relief. There are different anesthetic medications used for different types of nerve blocks, some of which provide short, medium or long-acting pain relief.
Q: What conditions are treated with a nerve block?
A: There are a multitude of nerve blocks that can be used for different reasons, including for surgery, diagnostic reasons, and therapeutic needs. Typically, I administer nerve blocks to treat pain that originates in the facet joints of the spine, certain knee pain, leg pain, and abdominal pain. Nerve blocks are often done as a precursor to radiofrequency ablation.
Q: What is radiofrequency ablation (RFA)?
A: Radiofrequency ablation uses heat generated by radio waves to destroy the outer sheath that covers specific, pain-causing nerves. The outer myelin sheath of the nerve facilitates getting pain signals to the brain. This can provide long-lasting relief for conditions like arthritis and chronic neck or back pain. The myelin sheath will grow back after about six-twelve months, but the pain is typically eliminated or greatly reduced.
Q: What conditions are treated with radiofrequency ablation?
A: Pain from arthritis, chronic neck or back pain, joint pain, complex regional pain syndrome (CRPS), sacroiliac (SI) joint pain, peripheral nerve pain
Q: What is Electronic Spinal Cord Stimulation (ESCS) Aka Spinal Cord Neuromodulation?
A: Used to treat intractable, chronic pain that fails to respond to other treatments, an electronic impulse generator is implanted in the buttocks connected to electrodes which are implanted into the spinal space between the spinal cord and vertebral column. The generator emits electrical impulses that can be adjusted in intensity, frequency and type to override/compete with pain signals that are being sent to the brain, providing effective pain relief.
Q: What conditions are treated with is Electronic Spinal Cord Stimulation (ESCS)?
A:
- Failed back surgery syndrome
- Post-surgical pain
- Arachnoiditis (painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord)
- Nerve-related pain (such as severe neuropathy from diabetes, radiation, surgery or chemotherapy)
- Complex regional pain syndrome (CRPS)
- Phantom limb pain
- Visceral abdominal pain and perineal pain