Common Pain Management Procedures

Interventional pain management uses minimally invasive procedures to diagnose and treat specific sources of pain. Depending on the condition, a procedure may:

• ✦Reduce inflammation around an irritated nerve or joint
• ✦Temporarily numb a painful nerve
• ✦Deliver medication directly to a painful structure
• ✦Determine whether a particular nerve or joint is contributing to pain
• ✦Reduce pain from selected spinal or joint conditions
• ✦Treat certain sources of chronic headache and facial pain
• ✦Help you participate more effectively in physical therapy

Many procedures are performed on an outpatient basis and require little or no recovery time.

Epidural steroid injections are commonly used for spine-related nerve pain, particularly when inflammation or irritation around a spinal nerve contributes to symptoms. They may be considered for sciatica, lumbar or cervical radiculopathy, herniated disc-related nerve pain, and spinal stenosis with radicular symptoms.

Medication is delivered into the epidural space around the spinal nerves to reduce inflammation and irritation. An epidural does not correct the underlying structural problem, such as a herniated disc — instead it may reduce symptoms and help facilitate activity and rehabilitation.

The procedure is usually performed using fluoroscopic or other image guidance, with local anesthetic to numb the skin. It is generally brief, though the full appointment takes longer because of preparation and recovery. Some patients experience temporary improvement, others relief lasting weeks or months, and some little or no benefit.

A selective nerve root block targets a specific spinal nerve. It can be diagnostic — temporary numbing medication helps determine whether a particular nerve is contributing to your symptoms — and therapeutic, when a corticosteroid is used to reduce inflammation around the nerve.

Facet joints are small joints at the back of the spine that provide stability and allow movement. Arthritis or irritation of these joints can contribute to neck or back pain, and facet injections may be considered when they are suspected to be a significant source. They can provide relief and also inform a diagnostic evaluation before considering radiofrequency ablation.

Medial branch nerves carry pain signals from the facet joints. A medial branch block injects a small amount of local anesthetic near these nerves, often primarily for diagnosis. If you experience significant but temporary relief after appropriately performed blocks, your physician may consider whether radiofrequency ablation is a reasonable next step.

Radiofrequency ablation uses radiofrequency energy to interrupt pain signaling from selected nerves. It is commonly considered for carefully selected patients with chronic facet-mediated neck or back pain who have responded appropriately to diagnostic medial branch blocks.

The procedure does not remove arthritis or repair the underlying joint — it reduces pain transmission from the targeted sensory nerves. Depending on the diagnosis, radiofrequency techniques may also be considered for selected peripheral joint pain and other nerve-mediated pain conditions.

Relief varies among patients. Because the targeted nerves can eventually recover or regenerate, relief is not necessarily permanent; some appropriately selected patients experience meaningful improvement for several months or longer. Your physician will determine whether and when repeat treatment is appropriate.

The sacroiliac (SI) joints connect the lower spine to the pelvis. SI joint dysfunction or inflammation can cause pain in the lower back, buttock, hip region, or occasionally the leg. An SI injection can serve both diagnostic and therapeutic purposes, with local anesthetic and, when appropriate, anti-inflammatory medication delivered under image guidance.

Injections can also treat pain arising from peripheral joints — knee, hip, shoulder, elbow, ankle, wrist, and smaller joints. Different injectable treatments may be appropriate for different conditions, including corticosteroids, hyaluronic acid, PRP, or other orthobiologic treatments in appropriately selected patients.

Trigger points are painful areas within muscles that may contribute to localized or referred pain. Trigger point injections may be considered for selected patients with myofascial pain involving the neck, upper back, lower back, shoulders, or other areas.

A small needle is inserted into the painful muscle or trigger point, and depending on the plan, local anesthetic or another medication may be used. The procedure is generally quick and can often be performed in the office.

Trigger point injections are usually most effective when combined with appropriate stretching, strengthening, posture correction, and physical therapy.

Peripheral nerve blocks involve injecting medication near a specific nerve or group of nerves. They may be used for focal nerve pain, entrapment neuropathies, extremity pain, certain postoperative pain conditions, selected headache disorders, and diagnostic evaluation of nerve-related pain. Ultrasound guidance may be used to improve accuracy.

Occipital nerve blocks are commonly used in selected patients with headache or pain involving the back of the head — including occipital neuralgia, certain migraine patients, and cervicogenic headache. Some patients experience temporary improvement, while others have little or no response.

Sympathetic nerve blocks may be considered in selected patients with complex regional pain syndrome (CRPS) or certain sympathetically mediated pain conditions. Because these procedures are performed near important nerves and blood vessels, appropriate patient selection and image guidance are important.

OnabotulinumtoxinA (Botox®) is an FDA-approved preventive treatment for adults with chronic migraine. It is administered through a series of small injections in specific areas of the head and neck according to an established protocol, generally repeated approximately every 12 weeks when clinically appropriate.

Botox is different from a nerve block or trigger point injection. It works over time and is used as a preventive treatment, rather than as an immediate rescue treatment for an individual migraine attack.

For carefully selected patients with certain chronic pain conditions, spinal cord stimulation (SCS) may be considered. SCS uses an implanted device to deliver electrical stimulation near the spinal cord with the goal of modifying pain signaling.

It may be considered for persistent spinal pain after surgery, certain neuropathic limb pain, complex regional pain syndrome, and other chronic pain that has not responded adequately to conservative treatment.

SCS is significantly different from an injection because it involves implantation of a medical device. In appropriate candidates, a temporary trial is typically performed before permanent implantation.

A successful pain procedure begins with an accurate diagnosis. Before recommending an intervention, your physician may review your pain history, physical examination, previous treatments, medication history, imaging studies, neurological findings, functional limitations, and relevant medical conditions.

The goal is to determine whether there is a specific pain generator that can reasonably be targeted.

Many procedures use image guidance — fluoroscopy, ultrasound, or CT in selected circumstances — allowing your physician to visualize anatomy and place the needle precisely. This matters most near nerves, blood vessels, and the spinal canal.

Your experience depends on the procedure performed. Some treatments provide relief relatively quickly, particularly when local anesthetic is used. Others — such as corticosteroid injections, radiofrequency procedures, or orthobiologic treatments — may take longer to show their full effect. Temporary soreness at the injection site is common.

Your physician will provide specific instructions regarding activity, exercise, physical therapy, medications, wound care when applicable, when to resume normal activities, and when to contact the office.

Interventional pain procedures are generally considered minimally invasive, but no procedure is completely risk-free. Potential complications depend on the specific treatment and may include:

• ✦Temporary pain or soreness
• ✦Bruising or bleeding
• ✦Infection
• ✦Allergic or medication reactions
• ✦Temporary numbness or weakness
• ✦Nerve irritation or injury
• ✦Injury to surrounding structures
• ✦Changes in blood pressure or blood sugar with certain medications
• ✦Rare procedure-specific complications

Your physician will discuss the risks and benefits of the recommended procedure before treatment.

Not necessarily. Some procedures are intended as a one-time diagnostic intervention. Others may be repeated when the initial treatment provides meaningful but temporary benefit.

The appropriate frequency depends on the procedure performed, your diagnosis, your response, the duration of benefit, your overall health, and the risks of repeating it.

We do not recommend procedures simply according to a fixed schedule.

Interventional procedures work best when incorporated into a comprehensive plan. Depending on your condition, treatment may also include physical therapy, exercise and strengthening, medication management, weight management when appropriate, ergonomic and activity modification, sleep optimization, behavioral strategies for coping with chronic pain, orthobiologic treatments, and surgical consultation when indicated.

The goal is not simply to perform a procedure. The goal is to help you function better and achieve meaningful, sustainable improvement.