The Comprehensive Center for Pain Management’s goal is to utilize the most minimally invasive pain management remedy necessary for each patient. Although we cannot guarantee that every patient will be rid of all pain after treatment, the vast majority improve significantly through our intervention. We offer a wide variety of treatment options, and sometimes a combination of these may be used to fit the patient’s requirements. Options are listed below. For more information click on the Patient Education & Media tab to the left:
Trigger Point Injection/ Nerve Blocks: The cause of your muscle pain or spasms may be one or more trigger points. Trigger points are specific sites on the muscles that cause pain (both locally and throughout the back) when pressure is applied to them. Trigger points are believed to occur due to excessive physical activity, fatigue or trauma. This injection is done in the comfort of the physician’s office. The physician will feel and stretch the muscle to find the trigger point. The physician will then do a series of injections with various medications to best relieve the pain. This type of injection may help you increase movement and may help the muscle heal.
Sympathetic Nerve Block: The sympathetic nerves run on the front surface of the spinal column. When regulation of the sympathetic nervous system is altered, usually as a result of injury, pain can occur resulting in Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD). A sympathetic nerve block involves injecting numbing medicine around these nerves in the neck or the back, reducing or eliminating the pain.
Facet Joint Injection: If your doctor suspects the source of your pain is in the facet joints, where the vertebrae connect to one another, he may recommend a procedure called a facet joint block. Under fluoroscopy (x-ray), a steroid and/or anesthetic medication is injected directly into the joint capsule or injected in such a manner to block the nerve(s) to the facet joint to relieve pain.
Epidural Injections/Blocks: When inflammation within the spinal column causes nerve root irritation and swelling, doctors sometimes administer a potent anti-inflammatory medication to reduce inflammation and ease pain. Steroids typically are injected directly into the epidural space – the area between the dura mater (the outer membrane of the spinal cord) and the vertebrae – to deliver medication directly to the site of inflammation. These injections are given under fluoroscopy (X-ray) and can be done in a series, if necessary, to provide pain relief. At CC4PM we perform many of these injections using the transforaminal technique (see animation on PATIENT EDUCATION and MEDIA PAGE), which provides in most cases a better response than traditional approaches.
Qutenza® Patch treatment for Shingles: Shingles (herpes zoster) is caused by the varicella-zoster virus (VZV)—the same virus that causes chickenpox. After recovery from chickenpox, the virus becomes dormant in some nerve cells. If the virus reactivates and becomes active again in adults, it is called shingles. When VZV surfaces again, it travels along the nerves in the skin, causing a rash, blisters, and pain. In some people, the pain continues after the shingles rash has healed. This is called postherpetic neuralgia (PHN). PHN pain results from nerve damage caused by the virus. Qutenza®, is a unique, FDA-approved patch that can provide 3 months of pain relief from a single, with a 1-hour application. Qutenza® targets the nerves in the skin, and is a non-narcotic. It has no contraindications and can be used alone or with other pain medications. For more information, see www.qutenza.com.
Discogram: This is a test in which contrast fluid is injected into a disc in your spine. The test helps pinpoint what is causing your back or leg pain. It is often done when certain treatments for your pain are being considered. As part of the test, an image of the disc is taken. This image shows where and how the disc is damaged.
Functional Anesthetic Discogram (F.A.D.):This is the most comprehensive test available for axial, or low, back pain. F.A.D. is performed by inserting a thin flexible catheter into the nucleus of each suspected disc. The patient is able to stand with the catheters in place and perform the activities that typically generate their axial back pain. Your CCPM physician is then able to isolate the source of your low back pain by selectively anesthetizing the discs in sequence. Patients are monitored for improvements in pain score as well as range and fluidity of motion. This permits an accurate determination of whether the pain is discogenic vs. non-discogenic as well as an evaluation of the pain contribution by each disc.
IDET(“Intradiscal Electrothermal Therapy”): This is a significant medical advancement in the treatment of contained herniated discs. Because of its new technology, IDET is a minimally invasive procedure. It is a fast treatment that requires only local anesthesia and a mild sedative. Recovery is rapid with no bracing necessary. The procedure is much like having an epidural steroid injection. First, you will be given a local anesthetic. Then, your doctor will insert a needle into the center of the herniated disc. The needle emits radio waves that dissolve excess tissue, reducing the size of the bulge. This relieves the pressure in the disc and also against the nerves. When the pressure is relieved, the symptoms are minimized. Disc Nucleoplasty new technology allows for a quick recovery. For more information see www.smith-nephew.com.
enSpire™ Interventional Discectomy System: Another new technique for the surgical removal of herniated disc material that is pressing on the surrounding nerves or spinal cord is the enSpire™ Interventional Discectomy System. A small needle-based tool is used to cut, grind and aspirate disc tissue for lumbar discectomy procedures. A unique, expandable (up to 7 mm) spiral cutting wire is deployed through the small needle to mechanically remove selected disc tissue. The quantity of tissue can be easily confirmed visually and may be sampled for pathologic study. With this needle-based procedure, CCPM’s physicians may achieve results similar to those achieved with surgical discectomy in contained herniated discs, but with minimal tissue disruption or scarring. For more information see www.spineview.com.
M.I.L.D.® (“Minimally Invasive Lumbar Decompression”): Lumbar Spinal Stenosis (LSS) is a narrowing of the lower spinal canal that causes pressure on the nerves and leads to pain and immobility. M.I.L.D. is a groundbreaking new procedure for the treatment of LSS that safely and therapeutically reduces pain and improves mobility while maintaining the spine’s structural stability. During the procedure, the physician uses M.I.L.D. devices to remove small pieces of bone and tissue causing the pressure on the nerves. Performed under image guidance through a 5.1 mm M.I.L.D. Portal (about the diameter of a pencil), M.I.L.D. requires only an adhesive bandage for closure. Many M.I.L.D. patients report immediate relief, and most go home the same day. For more information see www.vertosmed.com.
TruFUSE® Facet Fusion Technique: The wearing down of the facet joints, which are the large joints that connect each vertebrae to another, can be caused by degenerative joint disease such as osteoarthritis as well as other causes of spinal instability. An innovative spinal surgical solution for such conditions is the TruFUSE® procedure. Performed minimally invasively in less than 30 minutes, the technique involves using fluoroscopy to localize the affected facet joint. A self-centering spatula aligns a drill guide into the plane of the joint, and a specialized reamer is then used to create a taper-shaped tunnel at the midpoint of the facet. An oversized TruFUSE® dowel is impacted into the joint. The dowels perform several functions: separate the arthritic joint surfaces to reduce inflammation; stretch the anterior joint and create a fit to enhance stability; and optimize the environment for facet fusion. TruFUSE offers many potential benefits, including rapid recovery time, minimal tissue and blood loss, and lower risk of infection. Additional information can be found at www.trufuse.com.
Vertebroplasty: This is a minimally invasive treatment for patients suffering from a weakness of the vertebral body. This procedure stabilizes the vertebral body by using medical grade cement that is injected into the vertebral space and hardens immediately to provide needed support and decrease the pain.
Balloon Kyphoplasty: Balloon kyphoplasty is a minimally invasive treatment that can repair Vertebral Compression Fractures, which are primarily caused by osteoporosis and certain types of cancer. Orthopaedic balloons are used to lift the fractured bone and return it to the correct position. The balloon is then deflated and removed, creating a cavity within the vertebral body. The cavity is then filled with a special cement to support the surrounding bone and prevent further collapse. The cement forms an internal cast that holds the vertebra in place. Generally, the procedure is done on both sides of the vertebral body. The incision site is small, approximately 1 cm in length. Performed under local or general anesthesia, this procedure usually takes less than an hour and may require an overnight hospital stay as determined by the physician after completion. Balloon kyphoplasty can make it easier for patients to return to everyday activities such as walking, bending or lifting with significantly less pain than they had prior to the procedure. It has been performed world-wide since 2000.
Radio frequency (RF) Lesioning or Ablation (RFA): RF is used to interrupt pain signals by heating up and destroying specific nerve tissue. The RF energy is applied through a small needle the physician places in the area of your pain under the guidance of fluoroscopy (X-Ray). This procedure is done under a light sedation and using local anesthesia in a hospital setting. This technology can provide lasting pain relief and has a wide range of useful applications to control your pain.
Spinal Cord Stimulation: This implantable medical device is very effective in treating chronic pain that is due to nerve damage or neuropathy. Before a stimulator is permanently implanted you must go through a trial period (Stage 1) with a temporary system. Depending on your pain pattern, the physician may insert one or two leads in to your epidural space. These leads conduct electrical current that masks or blocks the pain signals to your brain and replaces it with a tingling or massaging feeling called “parenthesis.” The trial period is usually 1-3 days. If you are pleased with the pain relief you will be scheduled for the permanent implant (Stage 2). Stage 2 involves the same lead placement as the trial but the leads are placed under your skin and connected to an IPG (Implantable Pulse Generator) or Radio Frequency system. For more details, see www.ans-medical.com.
Intrathecal Drug Pump (implantable programmable pain pump): This implantable medical device can be effective at treating chronic nociceptive pain (i.e., neuronstimulation caused by injury, inflammation, or disease). Before a pump is permanently implanted you must go through a trial period (Stage 1) with a temporary system. A small catheter is placed in your intrathecal space of your spine where medication is released to reduce or control your pain. This trial is usually 1-3 days. If successful at providing relief, you will be scheduled for the permanent pump. Similar to your trial, a catheter is placed in your intrathecal space of your spine and then connected to a pump that has a reservoir that holds very concentrated medication. This pump comes in various sizes and dosing technologies. Discuss with your physician what technology would be best for your condition. See www.medtronic.com for more details.