Epidural Steroid Injection
The epidural steroid injection (ESI) may bring relief to those who suffer from low back pain or sciatica. While it also may be used to treat neck and mid-back pain, ESI on the neck and cervical spine may be complicated, and Dr. Grubbs at SIR is one of the few physicians in the Sarasota-Bradenton area who performs ESI in those areas.
ESI is a 20- to 30-minute outpatient procedure that is performed with conscious sedation. While the patient is lying flat on the stomach, a local anesthetic is administered to numb the lower back. Then state-of-the-art CT imaging is used to safely guide the needle into the epidural space. Saline and contrast are injected first to ensure that the needle is accurately placed within the epidural space, and injection of the steroid follows. The patient may feel pressure as the steroid is injected, but this should not be painful. After the procedure, the patient spends 30 minutes to an hour in the post-op recovery area and then may go 内蒙古快3 with a driver.
Selective Nerve Root Block
A selective nerve root block may be beneficial when severe leg or arm pain impacts one’s quality of life. Like the epidural steroid injection, the procedure is performed with conscious sedation and a local anesthetic to numb the area. CT imaging is used to guide the needle to the nerve root where a contrast is injected to confirm the needle’s location, and the steroid is then injected.
The procedure takes about 20 to 30 minutes, followed by about 30 minutes in post-op recovery. Immediate pain relief should occur in the days following the procedure, but the nerve root block may need to be repeated in several months.
Trigger Point Injection
A trigger point is an area of spasm and inflammation in skeletal muscle. Common sites of trigger points include the upper and lower back, shoulders and, less commonly, the extremities. A palpable nodule may be present in the muscle where the trigger point is located. There is much tenderness in the area of the trigger point, and pain may radiate from the trigger point to an area around it. An injection that includes an anesthetic, corticosteroid, or mixture is administered directly into the trigger point site to relieve the pain.
Facet Joint Injection
The facet joints are small stabilizing joints located between and behind adjacent vertebrae. They can become painful due to arthritis, injury or stress, and also from being in almost constant motion. Facet joint disorders are among the most common problems of recurring neck and low back pain. The cervical, thoracic and lumbar facet joints can be injected with a small amount of local anesthetic and/or steroid to anesthetize them and block the pain. This procedure is known as a facet joint injection. The injection helps diagnose the cause and location of pain and provides longer term pain relief by reducing inflammation.
Sacroiliac (SI) Joint Injection
The sacroiliac (SI) joints are located next to the spine and connect the sacrum with the hip on both the left and right sides. Inflammation or dysfunction of these joints is responsible for an estimated 15-20% of chronic low back pain. SI joint pain has been one of the most challenging conditions to treat, but the SI joint injection has proven to be effective in reducing this type of pain.
The SI joint injection is performed for either diagnostic or therapeutic purposes. Using fluoroscopy for guidance, contrast is injected into the joint to ensure proper needle placement and insertion of a numbing medication. Following the injection, the patient is asked to perform some normal activities to determine if the pain persists. If the pain is significantly diminished, the diagnosis is confirmed that the SI joint is the source of the problem. The patient may undergo additional injections and/or be referred to physical therapy to promote further pain reduction.
Ketamine is a medicinal therapy, administered by infusion, that is used to manage chronic pain. It functions as a strong NMDA receptor antagonist that eliminates pain hypersensitivity in patients with neuropathic pain and several other types of chronic pain. Neuropathic pain is pain that results from damaged nerve fibers and presents as shooting and burning pain, with tingling and numbness. Ketamine works by blocking the nerve channels that cause intense pain, while allowing the nerves themselves to function normally.
In addition to neuropathic pain, ketamine treats other pain conditions:
• Centralized or intense widespread pain
• Complex regional pain syndrome, or CRPS—chronic or excessive pain that most frequently affects one of the limbs (arms, legs, hands, or feet) and usually occurs after an injury or trauma to that limb)
• Hypersensitivity or hyperalgesia—an extreme reaction to a stimulus that is normally only slightly painful, such as a pinch
• Allodynia—pain from a stimulus that normally does not cause pain, such as touch or temperature
Ketamine may be a viable option for pain management if conventional approaches such as medications, physical therapy, and standard clinical interventions are not successful in alleviating the pain.