Back pain is a very common problem. There are many different causes of back pain and sometimes there is no cause at all. Here at Western Rockies Interventional Pain Specialists we focus on treating back pain based on a combination of symptoms and diagnostic imaging results. Dr. Lewis uses diagnostic imaging for reference, however; he bases most of his clinical decision making on the patient’s description of the pain. We offer a variety of procedures for the treatment of back pain which are explained in detail below.
An epidural steroid injection is a simple, high-volume injection of steroid in the epidural space. This treatment is not aimed to diagnose or treat a specific structure in the spine. It is designed to reduce inflammation, swelling, and pain around the structures of the spine. An epidural steroid injection can effectively treat a large region of the spine with just one injection. These injections can be done in the cervical, thoracic, or lumbar spine.
Sacroiliac joint injections can be helpful for those experiencing low back and buttock pain that has been identified as not originating from the spine. The injections are done by flooding the joints with local anesthetic and steroid. The steroid injected into the joint works to decrease inflammation, swelling, and pain. This injection can also serve to diagnose the sacroiliac joints as primary pain generators. Once these joints have been identified as pain generators, there are several treatment options for the long-term treatment of the joints.
Medial branch block testing is how we diagnose which nerves to treat with radiofrequency ablation neurotomy. This treatment is designed to treat the nerves that innervate the facet joints of the spine. It can be performed on the cervical, thoracic, lumbar spine, and nerves to the sacroiliac joints. Medial branch block testing is performed by placing a small about of numbing medication directly on the nerves as they exit the facet joints. A successful diagnosis is made when the pain is gone after the numbing medication has been applied. Once the nerves have been successfully identified with medial branch block testing, the same nerves are then treated with radiofrequency ablation neurotomy. The radiofrequency ablation neurotomy is done with a small needle that is placed on the nerve. That needle then heats up just enough to remove the very delicate nerve tissue in the targeted area.
A selective nerve root block is a diagnostic and therapeutic injection used primarily for the treatment of pain radiating down the leg. The injection is designed to diagnose and treat specific nerve roots where they exit the spine. Nerve roots may be irritated from a bulging disc or from other structural abnormalities around the nerve. A small amount of numbing medication and steroid are placed directly on the targeted nerve root. The numbing medication provides a diagnostic phase that indicates whether the targeted root is the primary pain generator and the steroid provides for decreased inflammation, swelling, and pain.
Sympathetic blocks are designed to treat a component of the central nervous system, the sympathetic nervous system. These injections are intended for the treatment of neuropathic pain that originates from the nervous system rather than from a physical structure. The injections target the sympathetic nervous system chains located on the front of the spine. The goal of the injections is to interrupt and reset the neuropathic pain cycle that is causing pain. Sympathetic blocks are performed on the cervical spine, lumbar spine, and pelvis. Injections are typically done in a series of a least two injections separated by 10 to 14 days.
Spinal cord stimulators are implanted to treat a specific area of pain by treating specific pain fibers within the spinal cord. The stimulator interrupts the pain signals before they reach the brain and are perceived as pain. This treatment is appropriate for patients with neck pain, back pain, leg pain, or arm pain that either cannot be identified or cannot be treated directly. Some examples of conditions typically treated with spinal cord stimulation include, but are not limited to: phantom limb pain, failed-back surgery syndrome, and complex regional pain syndrome. A four-day trial with a temporary system precedes all implants. Permanent implantation is only performed if the four-day trial was successful. The trial placement is done in our office and the permanent implant is placed at the hospital in the operating room.