Antidepressants are one of the most commonly prescribed classes of medication world-wide. They are primarily used to treat depression, but can be used to treat other psychiatric disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), anorexia, and bulimia. Although not specifically intended to treat pain, antidepressants have become a mainstay in the treatment of chronic pain. Many people with chronic pain suffer from depression, but antidepressants can ease chronic pain whether or not there is underlying depression. The pain relieving properties of antidepressants are not very well understood. They may increase neurotransmitters, or chemical messengers, in the brain and spinal cord that decrease pain signals. Antidepressant pain-relieving effects are not immediate and may take several weeks to provide maximum benefit. Many people report moderate pain relief from antidepressants. Anti-seizure medications can be added to antidepressants if pain relief is incomplete.
Caudal steroid injections are a form of low back treatment that typically involve medications and steroids to reduce or relieve inflammatory pain. Chronic back pain, especially in the lower spine and sacrum region, is a commonly reported complaint. The occurrence of lower back pain in adults is estimated to be between 40% and 70%. Caudal steroid injections have been shown to be especially effective at treating chronic lower back pain.
Celiac plexus blocks are an effective treatment method that is often recommended for patients suffering from chronic abdominal pain. This technique is also an effective treatment approach for pancreatic cancer patients who are suffering from nerve pain.
Cervical facet radiofrequency neurotomy is a non-surgical, simple treatment used for relieving nerve pain. Studies have shown that more than 75% of people will encounter some type of acute neck or back pain during their life. When patients experience pain originating from the neck or back, it can be triggered by numerous health conditions such as a pinched nerve, a herniated disc, injury, or severe trauma. There are numerous treatment options to relieve pain caused by these ailments, with cervical facet radiofrequency neurotomy being one of the best for patients who experience pain deriving from the facet joints.
In cases of chronic neck pain and cervical radiculitis, one of the most popular types of treatment is cervical epidural steroid injections. Studies have shown that this treatment option is very effective for reducing, and in some cases eliminating, cervical nerve pain. The exact mechanisms of action are still being researched, but it is primarily found that steroid injections serve to reduce nerve pain through their anti-inflammatory properties. Steroids have other benefits beyond the anti-inflammatory characteristics that also play a role in their effectiveness, such as the ability of steroids to stabilize nerve membranes and obstruct the conductance of ions, both of which are viable explanations for the relief of pain symptoms.
A coccygeal nerve block refers to a minimally invasive treatment for chronic lower back and tailbone pain. Several conditions such as herniated discs, compression fractures, spinal stenosis, and sciatica may cause pain in these regions as well as prolonged poor posture or trauma to the coccyx. A rare condition that causes tailbone pain is called coccydynia, but it is not diagnosed very often.
Disc denervation is a procedure designed to treat certain types of chronic back pain, more specifically, conditions caused by defects in the intervertebral disc located between pairs of vertebrae (spinal bones). Chronic pain associated with disc anomalies is also termed discogenic pain. Disc denervation is the disruption of spinal nerves that transmit discogenic pain signals with electrothermal probes. This renders these nerves unable to conduct signals and, therefore, brings relief from chronic pain.
Facet joint injections are a minimally invasive non-surgical treatment that is used as treatment for many different causes of neck and back pain. It works by reducing the inflammation and irritation in the facet joints of the spine that cause pain. Facet joint injections and medial branch blocks have been regarded as being a key feature in the conservative pain management treatment plan for treating lower back and neck pain. In general, patients who are referred for facet joint injections have exhibited symptoms of a degeneration of the facet joint. This degeneration can be linked with a number of conditions, such as lumbar facet syndrome. It has been estimated that approximately two-thirds of all adults will experience difficulties associated with back or neck pain at some point in their lives. Indeed, the most common form of pain for people in the U.S. has been reported to be chronic spine pain. The primary goal of both facet joint injections and medial branch blocks is to provide patients with relief from these forms of pain.
Ganglion impar blocks are intended to inhibit pain associated with the tail bone (coccyx) of the body. This is felt in the region of the perineum and may be associated with nerve, organ, or tissue damage. It is often experienced as a vague or widely-distributed burning or discomfort in this area, which is controlled by the ganglion impar.
A hardware block is a minimally invasive procedure that can treat chronic pain that arises as a consequence of a fusion surgery. Many post-fusion patients find chronic pain is a reaction to the hardware implanted in the course of their surgeries. A hardware block can also act as a diagnostic tool in eliminating this possibility while locating the source of pain. If hardware-related pain is detected, blocks or other treatment options can then be used to manage this condition.
Hip injections are an effective pain management technique that can be used in patients suffering from hip pain due to osteoarthritis, disease, and injury. This procedure has both diagnostic and treatment benefits and can provide physicians with accurate information about the origin of a patients’ pain.
Intra-articular peripheral joint injections are non-invasive procedures used to treat joint pain and swelling when mild analgesics and non-steroidal anti-inflammatory drugs provide insufficient relief. This procedure is commonly used to provide relief from rheumatoid arthritis and can also be used to treat degenerative musculoskeletal diseases and joint injuries. When effective, these injections can be used as part of an ongoing treatment regimen to manage chronic pain and inflammation.
Intra-articular steroid injections are considered a safe and effective treatment option for patients suffering from painful and inflamed joints associated with a variety of conditions including osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis, and tendonitis. There are relatively few side effects associated with this procedure and for most patients the benefits of the medication outweigh the potential risks. Patients suffering from joint pain and inflammation should discuss their symptoms with a physician at Colorado Pain Care to determine whether an intra-articular steroid injection would provide pain relief for their condition.
Interscalene blocks are a local anesthetic is delivered to the brachial plexus, the network of nerves that travel from the spine into the neck and arm area. This procedure temporarily disables feeling in and movement of the shoulder and upper arm. This type of nerve block is usually administered to provide pain relief during or immediately after upper extremity surgery on the shoulder or arm.
Intercostal nerve blocks are popular with physicians treating chronic pain and inflammation in the abdomen or chest for a prolonged period of time. Patients with pain that is resistant to opioid treatments, or who wish to avoid using them, often find intercostal nerve blocks are a viable and less risky pain management option. Surgeons may also use intercostal nerve blocks as part of analgesia during major thoracic or abdominal procedures.
A joint injection is a common treatment method that is performed to manage stiffness and pain that arises in the joints due to inflammation. Chronic joint pain and even acute pain that is intense may cause mobility problems that can disrupt an individual’s daily routine and decrease that person’s quality of life. If the symptoms are not properly treated, they can eventually start to have detrimental effects on emotional and mental health as well. Joints are where two bones come together in the skeleton allowing the body to be mobile and flexible. Osteoarthritis is the most common form of degenerative joint disease impacting millions of Americans. The joints that are most commonly impacted include the knees, hips, shoulders, and spine joints (also known as facet joints).
Knee joint injections are commonly administered in order to manage both stiffness and knee pain that develops as a result of inflammation. Acute and chronic knee pain typically causes mobility problems that hinder daily activities and leads to a decrease in the quality of life. These types of symptoms can eventually begin to affect an individual’s health and emotional well-being.
The treatment of chronic pain should take advantage of various modalities, which may include consultations with pain specialists, medications, procedures, and imaging studies. Medications, the most efficacious avenue, are the cornerstone of any chronic pain management program. Medications target mediators of inflammation, as well as blockade pain receptors in the nervous system. The most effective class of drugs targeting the mechanisms mentioned are opioid analgesics. Opioid analgesics are strong blockers of painful stimuli, whether acute or chronic. They are not used without peril or adverse effects, however. Opioid medications are subject to rampant abuse and risks of death. Although these are concerns, correct and responsible use of opioid agents can provide extraordinary analgesia (pain relief) and may improve bodily function. The remainder of this discussion focuses on the management of chronic pain with long-term prescription of opioids, including methods, benefits, and hazards.
A lumbar epidural steroid injection is a non-surgical treatment method for the management of lower back and radicular pain. The technique was initially utilized in the 1950s as an alternate approach for sciatica and lumbar pain.The purpose of this procedure is to inject a steroid medication into affected nerves as a means of reducing inflammation. If the injection is successful, pain relief may be experienced in the lower back and additional symptoms such as pain in the legs, numbness, and tingling may also decrease.
Lumbar medial branch blocks are a common treatment approach that is used to treat and diagnose back pain as well as discomfort in the buttocks, hips, and groin. Several studies have reported that the degeneration and inflammation of facet joints causes between 10% and 15% of chronic back pain cases. It has also been reported, however, that a medial branch block effectively reduces inflammation in facet joints that is the result of irritated nerves.
A lumbar sympathetic block is an injection that is administered to patients in order to reduce pain that is caused by lumbar nerves. A sympathetic chain is an essential nerve bundle that is the length of the spine and runs parallel to the spinal cord. The roots of the nerves are located in the spine, and they extend to various regions of the body in order to regulate important biological functions. A bundle or a cluster is also referred to as a ganglion and this structure is comprised of numerous nerve endings. The clusters form a chain that runs from the upper region of the body to the lower region, which controls movement, sensations, and blood flow to the lower extremities.
Medial branch blocks are a nerve blocks that are targeted at treating joint pain in the spine, also known as the facet joints. The Medial branch nerves are nerves that transmits pain from the joints in the spine to the spinal cord. These joints are classified as cervical, thoracic and lumbar facet joints. At Colorado Pain Care, we utilize these blocks to determine how much pain is associated with the joint itself. This is important to determine given that pain could also come from the muscle, tendon/ligaments, disc, or nerve root. In other words, these blocks help determine the exact etiology of pain so as to best target therapy. It has been shown that these blocks can be highly successful with a greater than 70% patients reporting significant improvement in pain.
Muscle relaxants, which are also known as skeletal muscle relaxants or muscle relaxers, are a type of medication that can be used to effectively treat symptoms of pain and discomfort associated with musculoskeletal conditions. Muscle relaxants do not actually act on the muscles themselves. Instead, these drugs affect change through their impact on the central and peripheral nervous system.
Non-Steroidal Anti-Inflammatory Drugs – All drugs are classified in terms of either their active ingredients or how they are used to treat a particular condition. Moreover, a specific drug may fall into one or more of these specific drug classes. Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that all have similar analgesic, antipyretic, and anti-inflammatory properties. Though the individual drugs that fall within this class of medications differ in chemical structure, they are grouped together in this class due to their action of blocking the enzyme cyclo-oxygenase (COX). By blocking this enzyme, NSAIDs act to inhibit the production of thromboxanes and prostaglandins, which are both products of the inflammatory response.
Occipital nerve blocks are a non-invasive form of treatment for chronic headaches. People who suffer from headaches generally report experiencing throbbing pain in the skull that radiates from the head to the neck. Blocking the occipital nerve disrupts the transmission of pain signals and, in doing so, decreases the occurrence of headaches. This procedure provides significant pain relief for several months by treating inflamed nerves in the occipital region.
Opioid medications are also referred to as narcotics. These class of drugs are often used to treat moderate to severe pain. They are often effective in both acute pain and cancer pain but not non-malignant chronic pain. Unfortunately, these prescription drugs have unintended consequences that can lead to side effects, dependency, addiction, and even death if not managed safely and appropriately.
The Radio Frequency Ablation procedure uses radio waves to produce electricity, creating heat targeted to nerve regions for chronic pain treatment. This nonsurgical procedure uses targeted heat that, when applied to pain causing nervous tissues, disrupts the pains signals that are sent from the spinal cord and relayed to the brain. In this manner the pain pathway is blocked and the pain is relieved.
A sacroiliac joint injection is a treatment approach for patients who are suffering from sacroiliac joint pain. Reports indicate that approximately 15-30% of individuals tend to suffer from persistent and nonspecific back pain that is due to irritation of the sacroiliac joint. Clinical trials have shown that injecting steroids into the tissue surrounding the joint or directly into the sacroiliac joint provides patients with more pain relief than placebo injections. Furthermore, the effects of the injections were reported to last for at least one month.
Spinal cord stimulation is a minimally invasive pain management application that involves placing a thin, flexible implant within the spinal column of a patient. The implant emits a low-amplitude electrical signal (which is the basis of neural signaling, or the method by which nervous tissue conducts information to and from the brain). The implant targets the spinal nerve in the immediate vicinity of its location, in the epidural space of the spine. This nerve may be either damaged or over-active, which results in protracted pain signaling. This is often the source of chronic pain. The implants are normally accompanied with a remote control that the patient can activate in response to painful sensations. Spinal cord stimulation has been demonstrated as effective in treating intractable chronic pain, and is particularly effective in the treatment of pain associated with nerve damage (i.e. neuropathic pain). Neuropathic pain may also be linked to dysfunction in nerves travelling either to or from the brain.
A superior hypogastric plexus block is a common treatment for people who suffer from tailbone, lower abdominal, or pelvic pain. The sympathetic nervous system includes the heart muscles, but it starts at the spinal column and extends to all smooth muscles and glands within the body. These nerves respond to any unexpected changes in the body that might be physical or environmental by transmitting signals that regulate essential biological processes. Even involuntary movements are regulated by nerves in this system. Patients who have persistent pelvic pain are typically treated with pain relievers and injections. If this form of treatment is not effective or causes harmful side effects, a physician may recommend a superior hypogastric plexus block.
A sphenopalatine ganglion block is a commonly utilized treatment for atypical face pain, headaches, neuralgia, and additional painful conditions. The sphenopalatine ganglion is a nerve bundle that is located in the pterygopalatine fossa bone cavity directly under the nose and is a part of the parasympathetic, sympathetic, and sensory nervous systems. Patients who have not responded to typical medical management or those who have experienced side effects from typical medical management of their condition may also benefit from this treatment.
A sciatic nerve block is a treatment approach for individuals who are experiencing debilitating and intense sciatic nerve pain that has not been resolved by traditional methods of pain management. The purpose of this type of nerve block is to hinder the transmission of pain signals from the spinal cord to the buttocks and lower limbs, which leads to the elimination or dramatic reduction of sciatic pain
Splanchnic nerve block is a minimally invasive procedure that targets the nerves that innervate the deep abdomen (or gut area). This includes pain associated with the internal organs such as the pancreas, gallbladder, stomach, kidneys, liver and intestines. This procedure is not considered surgery. It involves precision delivery of medication to the target sight under image guidance. It has been shown to be an effective option for those suffering from deep abdominal pain.
Corticosteroids are used to treat a wide variety of inflammatory, allergic, and autoimmune conditions related to the skin, respiratory system, endocrine system, digestive system, eye, immune system, and musculoskeletal system. Specific conditions that can require corticosteroid treatment are asthma, chronic obstructive pulmonary disease, skin rashes, food and drug allergies, colitis, Crohn’s disease, anemia, tendinitis, arthritis, and migraine headaches.
A stellate ganglion block is a treatment approach for upper body pain that is caused by damaged ganglion nerves. The sympathetic chain consists of ganglion nerve bundles that run along the spinal cord and extend down the trunk of the body. The nerves extend to various parts of the body and control numerous unconscious functions such as heart rate as well as conscious biological processes. Ganglia are clusters of nerve endings called nexuses and essential ganglia are located throughout the sympathetic nervous system. A single network of these nerve endings has the ability to control sensations and movement.
Topical creams can be applied to the muscle, tendon, and joints by applying the medication across the affected area. Since oral drugs (taken by mouth) can cause side effects due to its systemic spread throughout the body, topical creams have limited systemic involvement. This allows for safe delivery of medications with little chance of side effects associated with oral medication administration. Talk to a specialist today at Colorado Pain Care to determine if topical creams are the right avenue for your healthcare treatment!
A trigger point injection is a minimally invasive procedure that involves an injection of medication directly into the trigger point that helps to provide pain relief. The trigger point injection may be a single local anesthetic, a combination of local anesthetics, a corticosteroid, or a combination of an anesthetic and corticosteroid. The goal of the treatment is to inactivate the trigger point, thereby reducing pain in the affected area.
Kyphoplasty is a type of treatment for compression fractures of the lumbar and thoracic spine column. Compression fractures occur when the bone is weakened because of loss of calcium (osteoporosis) or because of trauma (for example, after a hard landing while snowboarding). Compression fractures are like any other broken bone in that they can hurt. By placing a cement like material into the vertebral body, we can stabilize the broken bone and take away the pain. Kyphoplasty is done via a special needle placement through the skin in the back. The cement is injected into the vertebral body after augmentation of the fractured bone via a balloon or another type of flexible device. This is an outpatient procedure performed at a surgery center, where patient’s pain is generally alleviated shortly after the procedure is done.
Intravenous (IV) Ketamine is an exciting therapy. It is being used for Complex Regional Pain Syndrome (CRPS, also known as Reflex Sympathetic Dystrophy, or RSD) and Major Depressive Disorder (MDD). It has also been used for radiculopathy, phantom limb pain, post herpetic neuralgia migraine, central neuropathic pain, chemotherapy induced neuropathy, fibromyalgia, painful limb ischemia, traumatic peripheral nerve injury, spinal cord injury, temporomandibular joint pain, trigeminal neuropathic pain and whiplash. Ketamine is used when first-line treatments, such as tricyclic antidepressants (such as amitriptyline or Elavil) or reuptake inhibitors (such as duloxetine or Cymbalta) or “membrane stablizers,”(such as gabapentin or Neurontin or pregabalin or Lyrica) don’t work for CRPS or MDD. Up to 60% of patients with neuropathic pain can be unresponsive to standard treatment. We will perform up to 4 infusions separated by a week. If necessary, we can perform daily infusions for up to 10 days. Our infusions last 2 hours. Patients will be monitored by an RN for the entire procedure. Greater than 50% relief has been seen after a 10-day infusion with benefit up to 3 months, with “booster infusions“ of three infusions as needed. Please check with your insurance provider to see if this treatment is covered.
There are four different epidural steroid injections the Pain Institute of Charleston offer’s patients looking for relief from low back pain:
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