Intralaminar epidural injection

Intralaminar epidural injections use X-ray guidance technology and are often used to treat wide areas of the spine. After the skin is anesthetized, the needle enters the mid-line of the individual’s back between the most prominent bones in the mid-line of the spine. The combination of steroid and anesthetic is delivered into the epidural space in the midline and spreads to the nerve roots on both sides of the spine. Interlaminar epidural steroid injections provide short-term relief.

Medial branch block

A medial branch block is a minimally invasive non-surgical treatment used for arthritis related neck and back pain. After a local skin anesthetic is applied, the physician uses X-ray guidance to place a needle along the nerves that supply the inflamed joint. Medial branch blocks are performed on an outpatient basis and can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or are on blood thinners.

Rhizotomy

The purpose of a rhizotomy injection is to provide lasting low back pain relief by disabling the sensory nerve that goes to the facet joint. Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain.

The physician uses a local anesthetic and X-ray guidance to insert a needle with an electrode at the tip along the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

A rhizotomy provides pain relief by "shutting off" the pain signals that the joints send to the brain, and provides long-term pain relief.

Sacroilliac joint injection

A sacroiliac joint injection is primarily used to diagnose the source of a patient's pain and/or sciatica symptoms pain, and to provide therapeutic pain relief. Sacroiliac pain can occur in the lower back, buttocks, groin, and legs.

The injection is performed on an outpatient basis. The physician uses guided X-ray imaging to inject a local anesthetic and a corticosteroid medication into the affected joint. This strong, long-acting medicine reduces inflammation and provides pain relief over an extended period of time.

Short-term pain relief (lasting a few hours) may occur from the local anesthetic. The benefit from the corticosteroid medicine will typically occur two to four days following the procedure and last for several months.

Transforaminal epidural injection

Transforaminal epidural injections use X-ray guidance technology to deliver the steroid near the nerve where it exits the spine. The medication travels up the nerve sleeve and into the epidural space. This method allows the physician to target a specific area with a concentrated amount of medication, even to the level of single nerves.

This method is often preferred for patients who have undergone previous spine surgery and have foreign bodies (surgical pins, surgical rods, screws) as well as previous scarring since the pain management physicians are able to avoid these structures. Transforaminal epidural injections are effective for short-term and moderate to long-term improvement in managing lumbar back pain.

Trigger point injections

Trigger points are specific areas of muscle spasm and inflammation and can occur in the upper back and shoulder areas, as well in the low back or arms and legs.

Trigger point areas are tender, and frequently when pushed, pain radiates from the trigger point itself to an area around the trigger point. Trigger points commonly accompany chronic musculoskeletal disorders such as fibromyalgia, myofascial pain syndrome, neck pain, and low back pain. They can also occur with tension headaches and temporomandibular pain.

With trigger point injection therapy, a small needle is inserted into the trigger point and a local anesthetic, with or without a corticosteroid, is injected. Injection of medication deactivates the trigger point and alleviates pain. The pain relief should be experienced not only in the affected muscle, but in the area of referred pain as well.