Medical Pain Management

On occasion we may recommend that you get injections or management of your medications.

Trigger Point Injections are injections of local anesthetics (sometimes combined with corticosteroids) directly into painful soft tissue or muscles along the spine or over the back of the pelvis. While generally useful for localized pain, trigger point injections do not help heal a herniated lumbar disc.

Epidural Injections or "blocks" may be recommended if you have severe leg pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves), performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date, and should be done as part of a comprehensive rehabilitation and treatment program.

Selective Nerve Root Sleeve Block is an injection like an epidural, but it is injected around the nerve root sheath. This is used for leg and arm pain and for determining which nerve root is responsible for your pain. It can be therapeutic and diagnostic. You will need a driver to take you home and no pain medications should be taken after midnight the night before your injection.

Facet Injections are injections of corticosteroids and local anesthetics directly into the painful facet joints of your low back. This helps reduce pain and inflammation. If helpful, they can be followed by a Facet Rhizotomy, in which the sensory nerve in this joint is disabled giving long-term relief.

Sacroiliac Joint Blocks are injections that are primarily used for diagnosing and treating the low back pain associated with sacroiliac (SI) joint dysfunction. The SI joint lies next to the spine and connects the sacrum (bottom of the spine) with the pelvis (hip). In an SI joint block approach, a physician uses fluoroscopic guidance (live x-ray) and inserts a needle into the sacroiliac joint to inject Lidocaine (a numbing agent) and a steroid (an anti-inflammatory medication). It takes a highly skilled and experienced physician to be able to insert a needle into the sacroiliac joint. An SI joint block may be repeated up to three times per year. For the treatment to be successful, the injection should be followed by physical therapy and/or chiropractic manipulations to provide mobilization and range of motion exercises.

If you continue to have back pain despite surgical intervention, your doctor may recommend you for consideration of a Dorsal Column Stimulator (DCS). This stimulates the cord for symptomatic pain. This procedure is performed by a surgeon in conjunction with a pain management specialist.

Oral Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications such as aspirin, ibuprofen, naproxen, or acetaminophen. If you have severe persistent pain, your doctor might prescribe narcotics for a short time. Sometimes, but not often, a doctor will prescribe muscle relaxants. All medication should be taken only as directed.

Nonsteroidal anti-inflammatory medications (NSAIDS) are analgesics and are used to reduce swelling and inflammation. These include aspirin, ibuprofen, naproxen, and a variety of prescription drugs. If your doctor gives you anti-inflammatory medications, you should watch for side effects such as stomach upset or bleeding. Chronic use of prescription or over-the-counter NSAIDS should be monitored by your physician for the development of any potential problems.

Corticosteroid medications - taken orally or by injection - are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDS, can have side effects. Risks and benefits of this medication should be discussed with your physician.

Antidepressants - These drugs may be effective treatments for specific types of pain, or pain with specific causes. For example, antidepressants will be prescribed to help relieve certain types of neuropathic pain -- it doesn't necessarily mean your doctor thinks you are depressed. There are risks, side effects and drug interactions with any medication, so a medical professional should always be consulted prior to taking medications.

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