Pain Management

 

Different regions of the back
Back Pain can be generated in different places

Back pain affects 80% of people in our country during some time of their lives. Back pain can generate from many different areas along your back, from lower back, middle back, or upper back to low back pain with sciatica. Common causes include nerve and muscular problems, degenerative disc disease, and arthritis. Many people try to find relief from symptoms by using pain medication or pain killers.

Typically we suggest using conservative therapy first such as exercise. Excercise will tend to help mild to moderate back pain, but if you are experiencing severe pain too much exercise can be harmful. Usually non weight-bearing excersies are best such as biking or cross-training at the gym. Any exercise in the water in usually beneficial. Yoga or Pilates can also be very helpful. Both of these types of exercise help to increase your core strength.

However if conservative treatment is working for you or you want to find alternative treatments than long term medication. Memphis Vascular Center offers several outpatient procedures to help with acute or chronic back pain.

Most of these interventional procedures require only a very small incision, no stitches are needed, so there is generally less scarring compared to surgery.  These minimally invasive procedures usually cost less than equivalent surgical procedures.

Common Interventional Pain Management Procedures

There are several procedures that interventional radiologists can perform.  Some of the more common procedures such as: facet blocks and nerve blocks, treatments for disc disease, vertrebral body fractures, and nerve stimulation are list below.

**These procedures require a referral from your primary care doctor or your pain management doctor.**

Facet Blocks and Nerve Blocks

 

Rhizotomy injection

In some patients with low back pain, three facet block injections provide good but temporary relief of the patient’s pain, a facet rhizotomy injection may be recommended. The purpose is to provide lasting low back pain relief by disabling nerve that goes to the facet joint.

Facet joint injections

Facet joint injections are performed for facet joint pain. Facet joints can be injected with long acting local anaesthetic and anti-inflammatory steroids,which can alleviate facet joint pain for long periods.

Facet joint denervation

This is a straightforward procedure that is normally carried out if you have had a successful result from facet joint injections. Special needles are carefully placed under continuous fluoroscopy so that their tips lie exactly on the nerves that carry pain signals from the facet joints. Radiofrequency energy is then passed through the needles so that that tissue at the tip is heated to about 80 degrees C for about a minute. This coagulates and inactivates the nerves.

 Sacrolliac joint steroid injection

In the first instance a solution of long-acting local anaesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into one or both joints. If this is successful the joint can then be denervated in a similar way to facet joint denervation.

Selective nerve root block (SNRB) for diagnosis or pain management

Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain.

 Lumbar sympathetic block

Injection needles will be positioned and then there are three main ways to produce the block: injection of a long acting local anaesthetic to produce a diagnostic block to safely see if your pain can be treated this way; injection of a neurolytic substance such as phenol or alcohol to destroy the lumbar sympathetic nerves; and the use of radiofrequency energy to similarly destroy the nerves in a highly controlled way.

Stellate ganglion block

The stellate ganglion is a collection of autonomic sympathetic nerves, which lies in front of the spine at the level of your larynx. It can be a site where pain signals from the face, heart, or arm are processed. It can therefore sometimes be useful to block it.

 

Discography and treatment for disc disease

 

Discography

Discography involves the insertion of a thin needle into one or more discs. Then either saline is injected into the disc to see if it is painful, or radio-opaque contrast dye is injected and x-rays will be taken to show the internal structure of the disc.

 Dekompressor discectomy

The Stryker Dekompressor is a relatively new technique for the decompression of contained lumbar herniated discs. A special device the size of a needle is inserted into the affected disc. This then rotates like a drill removing some of the nucleus of the damaged disc, thus decompressing it and allowing the bulge to reduce. This in turn reduces the pain from both the disc and the nerve root.

Percutaneous disc nucleoplasty

This is a relatively new technique for the decompression of contained lumbar herniated discs. A special device the size of a needle is inserted into the affected disc. This probe has radiofrequency electrodes at its tip and is slightly angled. It is moved around inside the disc vapourising a very controlled amount of disc nucleus, typically 1 – 2 ml.

 

Epidural Injections

 

Epidural steroid injection

 The word ‘epidural’ simply refers to a layer of supporting tissue outside the spinal cord. In an epidural a solution of long acting local anaesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into the epidural space in the spine.

 Transforaminal epidural injection

This is an important adjunct to epidural steroid injection and the two are normally done together. If you have lumbar radiculopathy or cervical radiculopathy, you will probably also have one or more transforaminal epidural injections.

 

Vertebral Body Fractures

 

Vertebroplasty

 It involves the injection of bone cement into the crushed vertebral body, which stabilises it and reduces pain by reducing movement at the fracture site. It is well established and straightforward to perform, usually as a day-case procedure. A newer alternative treatment is Kyphoplasty.

Kyphoplasty

It involves the insertion of needles into the damaged vertebral body, through which balloons are passed. These are inflated under high pressure, which expands the VCF and corrects the deformity. Once corrected, liquid bone cement is injected into the vertebra to permanently fix the restored shape.

 

Nerve Stimulation

 

Spinal cord stimulation

Spinal cord stimulation can be very effective at treating nerve pain(neuropathic pain) and dysfunction from a number of different conditions. It has been shown to be particularly effective at relieving resistant nerve pain such as lumbar radiculopathy following spinal surgery. It involves the implantation of a wire and a device the size of a matchbox.

 Sacral nerve root stimulation

 This is a new and effective treatment for a number of loosely related bladder and bowel control problems. The other main treatment alternative is spinal cord stimulation. The main risk is infection, which can occur in up to 5% of patients.

 Intrathecal pump implant

Intrathecal drug delivery devices are advanced pain management systems for patients whose pain cannot be adequately be controlled by conventional oral or systemic analgesics. Delivery of strong painkillers such as morphine directly into the cerebrospinal fluid can avoid many of the unpleasant side effects of conventional drug delivery.