The specialties of Pain Medicine and Physical Medicine and Rehabilitation are sometimes viewed as revolving solely around medication management. While it is true that medications of all types–non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, antidepressants, anticonvulsants, and low-dose opioids–can play a key role in certain treatment plans, it’s a grave mistake to assume that prescriptions are all that an interventional pain physician has to offer. These providers are expertly trained in a variety of non- and minimally-invasive techniques that can help you control or eliminate pain and get you back to living the life that you want to live.
Please read on for a brief description of the six most common treatments offered by interventional pain medicine specialists that go above and beyond medication management.
Spine Injections & Therapies
Epidurals
Epidural injections are used to treat pain that originates in the spine and radiates out to the arm and legs. It can also be used to treat disc-based pathologies like herniations or bulging. An epidural injection is generally comprised of an anesthetic and a low-dose steroid, similar to a facet injection, and should always be performed with the aid of imaging guidance. During the injection, the needle will be placed in the epidural space, which is just outside the protective membrane that encases and protects the spinal cord. They can be used both as a treatment for pain and as a diagnostic test before undergoing spinal surgery to ensure the surgeon can isolate the nerve root causing a patient’s pain.
Facet injections
The facet joint is a small joint between the vertebrae of the spine. Facet injections are generally performed when there is a more degenerative source of a patient’s pain. They are performed using a combination of an anesthetic agent, to provide immediate relief, and a low-dose steroid to provide longer-lasting benefits. They generally are used more frequently in patients with axial pain presentation, but they can also be used for some cases of referred (radiating) pain.
Medial Branch Blocks & Radiofrequency Ablation
A medial branch block is an interventional pain procedure that requires a pain management physician to inject anesthetic medication into a group of nerves, known as the medial branch, that service the facet joints of the spine. These injections are performed under imaging guidance to ensure that the anesthetic payload is delivered precisely where it is needed to provide relief. It is important to note that medial branch blocks are a diagnostic procedure meant to presage the efficacy of a more complete deadening of the medial branch nerves. Therefore, any relief you experience will only last a few days. However, if the medial branch block brings you relief, that means you could be a candidate for a longer-lasting procedure known as radiofrequency ablation (RFA).
Radiofrequency ablation (RFA) is a micro-invasive procedure that uses radiofrequency waves to heat up a targeted nerve, deadening it while leaving surrounding tissue unharmed. The procedure prevents the targeted nerves from relaying pain signals to the brain, bringing long-lasting relief without the need for surgery. However, you should first undergo a nerve block before committing to RFA so as to ensure the nerve being targeted is actually responsible for your pain and the more permanent RFA procedure will not be done in vain.
Joint and Bursae Injections
A joint is a point in the body where two bones meet. They are comprised of the aforementioned bones, muscles, ligaments, and tendons that stabilize the joint and provide movement and mobility to the musculoskeletal system. These structures can break down as a result of trauma, disease, or the natural process of aging, ultimately leading to pain that can severely affect your quality of life. Fortunately, there are a variety of injections that can be performed to reduce this pain and help patients regain control of their lives without the need for surgery! Similarly, bursae are fluid-filled sacs that lubricate a number of structural components of the body. They can be found on or in the knees, shoulders, elbows, and hips, and can become swollen and inflamed, causing pain and irritation. Like joint pain, most bursae-related pain can be treated with injections performed by a qualified provider.
Choosing the Right Therapy for You
In addition to injections, pain management physicians have access to a variety of treatment modalities that can be leveraged to relieve pain and increase mobility.
Physical therapy
Physical therapy is a very popular treatment modality that includes a variety of strengthening, stretching, and cardiovascular exercises that work together to help strengthen and stabilize the body. Some common physical therapy modalities include water therapy or aerobics, ultrasound, TENS units, and total body strengthening. Physical therapy has a proven track record of helping patients reduce pain and promote recovery; it also has the added benefit of promoting overall health by improving cardiovascular function and increasing total body strength.
Chiropractic care
Chiropractors use manual adjustments to the musculature and skeletal structure of a patient to bring the body back into proper alignment, thereby reducing pain and improving function. Manual manipulation can be used to restore mobility, increase flexibility, reduce pain, and improve overall function. You should only undergo chiropractic care with a trained professional, so it is very important to make sure any provider you chose is a “DC” (Doctor of Chiropractic) and actively licensed by the state in which they are practicing.
Spinal Cord Stimulation
Neuromodulation
Neuromodulation, or spinal cord stimulation, is one of Dr. Iwan’s primary areas of clinical focus. This procedure requires the implantation of leads or paddles in the epidural space at the “sweet spot,” generally found around the T8 vertebrae, that are then connected to an implantable pulse generator (IPG). This device stimulates the dorsal columns of the spinal cord, preventing pain signals from freely traveling up the spinal cord and into the brain. The ultimate goal of spinal cord stimulation is to bring about at least a 50% or greater reduction in reported pain.
Dorsal Root Ganglion Stimulation
Dorsal root ganglion stimulation is an exciting emergent technology in the field of neuromodulation. The dorsal root ganglion is a bundle of sensory nerves located in the epidural space, with each component nerve having its own unique interaction with a defined area of the body. This unique structure allows a pain medicine physician, using the proper equipment and techniques, to apply focused stimulation with the goal of bringing about pain relief in areas of the body that were previously difficult to impact with nerve stimulation. These include the knees, feet, chest, abdomen, and groin, among many others. These devices, which are very similar to more traditional neuromodulation packs, have flexible programming that allow the user to create different sensations in lieu of the pain, including paresthesia and numbness.
If you suffer from back pain, neuralgia, headaches, joint pain, or any other debilitating condition of the musculoskeletal system, call RestorePDX today and see what our team can do for you. Dr. Iwan and her staff welcome the opportunity to review your case and see what we have to offer.