Subacute and Chronic Pain Management
We offer a multidisciplinary approach to treat the whole patient in order to most effectively manage ongoing musculoskeletal pain. Our toolbox is loaded with non-surgical interventional pain procedures, medication management, pain psychology, massage therapy, K-Laser therapy and outside resources which include physical therapy, acupuncture and chiropractic treatment.
Interventional Procedures for Pain Treatment
Epidural Steroid Injections
Epidural steroid injections are used to help relieve neck, arm, back and leg pain associated with inflamed spinal nerves resulting from conditions such as stenosis or disc herniation.
During the epidural steroid injections (ESI), a local anesthetic is used to numb the treatment area, this helps to alleviate any discomfort associated with the procedure. Under the guidance of x-ray fluoroscope, our physicians will inject medicines comprised of a corticosteroid and an anesthetic numbing agent into the epidural space. The cord and epidural space is the area between the vertebra and the protective dura sac which surrounds the spinal nerves. Contrast dye is then injected into the area so that our doctors are able to confirm where the medication will flow.
Depending on the location of your pain, additional injections may be performed for several spine levels on the right or left side.
Most patients are able to walk right after the procedure. Our team will monitor the patient for a short time and provide discharge instructions. Rarely temporary numbness may occur, so patients should plan to have someone else drive them home.
Pain relief varies from patient to patient, lasting anywhere from weeks to years. If pain relief is mild, follow up injections may be recommended in order to achieve full effect. Pain relief can help patients to have more tolerance in performing a physical therapy session designed to help strengthen the back.
Sacroiliac Joint Injections
Sacroiliac joints are located next to the spine on both the right and left side, they connect the sacrum to the hip on their respective sides.
Sacroiliac joint injections are used to treat low back pain or pelvis pain related to sacroiliac joint arthritis or dysfunction.
During the Sacroiliac Injection a local anesthetic is used to numb the treatment area. The injection is performed using X-ray guided fluoroscopy. Once the needle is inserted into the joint a contrast is injected to ensure that the needle is placed properly and that the numbing and corticosteroid medication spreads correctly.
The corticosteroid helps to provide pain relief by reducing inflammation in the joint. Corticosteroid should take effect in one to two days, with peak effects felt after a couple of weeks. Relief usually lasts several weeks to months.
Medial Branch Block of the Facet Joint
At each segment of the spine are small joints called facet joints. They provide support and assist in motion. Due to injury of the back, mechanical stress to the back, or arthritis of the spine, pain can be experienced at the facet joint. A medial branch block involves injection of a local anesthetic medication into the small medial nerves connected to a facet joint. The anesthesia numbs the joint or blocks the pain. The pain relief is usually temporary and, depending on the medication, can last for several weeks or months. The pain relief can help a person have more tolerance in performing a physical therapy session designed to improve the back condition or injury. There are usually two objectives for using facet blocks. The first is to assist in diagnosing the location and cause of pain and the second is to give pain relief.
Minimally invasive Radio Frequency Ablation can be used to treat chronic pain in the facet joints. Facet joint pain is often associated with previous surgeries, auto accidents, and pain resulting from degenerative diseases such as spinal arthritis. Patients typically tolerate RFA treatment well and the majority experience pain relief. During this outpatient procedure, a local anesthetic and a mild sedative is administered to the patient. Dr. Lewis uses fluoroscopy to guide a small needle which is positioned over the nerve associated with the patient’s pain. A microelectrode is then placed through the needle and an electrical current heats up surrounding nerve tissue creating a lesion, which interrupts pain signals stemming from the area. The procedure usually lasts between 30 and 90 minutes and can help alleviate pain for 6 to 24 months.
Peripheral Nerve Blocks
Peripheral nerves run from the spinal cords to your arms, hands, legs and feet.
We use peripheral nerve blocks to treat neuralgia or nerve pain caused by inflammation or entrapment.
Prior to administering a Peripheral Nerve Block, patients will receive an IV in the hand or arm. If requested this IV will be used to dispense a sedative which will help the body to relax as it prepares for the injection. During the Peripheral Nerve Block a local anesthetic is used to numb the treatment area. Typically, patients will lay horizontally in a supine position. The injection is performed with a spinal or epidural needle which is placed using X-ray guided fluoroscopy. Once the needle is placed appropriately next to the nerve roots a local anesthetic and steroid is injected into the area.
Patients will typically feel relief for several days to several months.
Occipital Nerve Blocks
Occipital nerves run from the top of the spine to the back of the head and around the ears.
Occipital nerve blocks are used to treat headaches, neck pain and head pain caused by swollen or injured occipital nerves.
Prior to administering an Occipital Nerve Block, patients will receive an IV in the hand or arm. If requested this IV will be used to dispense pain medication which allows the body to relax in preparation for the injection. During the Occipital Nerve Block the skin area of the injection site will be numbed. Using a very fine needle one of our physicians will inject pain-relieving medication consisting of a local anesthetic and steroids into the scalp just above the neck, where the bottom of the occipital nerve is located. Shortly after the injections, the scalp may begin to feel numb on the side of the head that was treated.
Pain relief can often be felt within minutes, the local anesthetic will wear off in a few hours, but the full effect of the steroid usually continues to increase over several days. Relief often lasts for months. However, if no relief is felt in a week or two, it may be necessary to perform a second injection or a different type of injection.
Stellate Ganglion Blocks
The stellate ganglion is part of the sympathetic nervous system, it is located in the neck on either side of the voice box.
Sometimes sympathetic activity can cause pain in nerves that are affected by trauma or infection. Stellate ganglion blocks are used to help relieve pain in the head, neck, upper chest and upper arm. Recently SGBs have been used successfully to treat PTSD and severe panic disorder.
Prior to administering a Stellate Ganglion Block, patients will receive an IV in the hand or arm. If requested this IV will be used to dispense pain medication which allows the body to relax in preparation for the injection. During the stellate ganglion block a fine needle is inserted near the stellate ganglion using fluoroscopy (X-ray guidance) and an anesthetic is injected. This block may help to reduce the release of norepinephrine – a chemical responsible for activating the pain sensitive nerves.
Repeated injections will often cause lessening of symptoms. A blockade of the sympathetic nerves can sometimes result in permanent pain relief, especially if implemented early after the injury.
Spinal Cord Stimulation
A type of electrical stimulation for chronic pain, spinal cord stimulation is an innovative technology that is frequently used to alleviate chronic neuropathic pain. The technique involves placing soft, thin wires near the spinal column. These wires connect to a programmable generator in the abdomen or upper buttocks area and administer electrical currents to the spinal column. Only low-voltage stimulation is used in spinal cord stimulation treatment. The electrical charges allow the body to better manage pain by interfering with the pain signal as it travels to the brain. Although the pain is not entirely removed, most patients see between a 50 and 70 percent reduction in pain, and many find themselves able to perform daily activities with greater ease or take less pain medication. Due to the simplicity of spinal cord stimulation, it makes it easy for doctors to test patients ahead of time for any negative reactions. It also allows for a quick procedure. Spinal cord stimulation is associated with very few side effects and is easily removed if it does not work. The procedure is also minimally invasive and does not limit patients in terms of recreational activity.
Bursae (plural for bursa) are gel- filled sacs that help muscles to glide over bones and reduce friction between body tissues. Bursae are located in areas such as the hips, knees, elbows, shoulders, they are adjacent to tendons near large joints.
Bursa injections can help to relieve conditions such as arthritis and bursitis. The injections help to reduce inflammation which may help alleviate long term pain.
Bursa injections typically quick procedures. First we will numb your skin with a local anesthetic. The provider will then insert a thin needle into your bursa and inject an anesthetic and corticosteroid. The anesthetic will often help to provide temporary relief within thirty minutes. Long term relief is typically felt with in a few days – the time it takes for the steroid to reduce inflammation.
Alternative Options for Chronic & Acute Pain Treatment
Physical rehabilitation is an important part of helping to combat pain. Our physical therapist will personalize your treatment plan to match your personal needs. He will assess your pain, the effect it has on your life, and provide one-on-one skilled care to help optimize your function. Depending on your home, work and recreational levels, individual treatment typically includes manual therapy, core stabilization, flexibility and postural training. Making improvements is possible! Physical therapy is an important part of reducing the day-to-day impact that pain causes in your life.
Psychological Evaluation and Treatment
Pain is more than a physical sensation. Pain involves biological, psychological and emotional factors. Exploring and understanding how their history is inherently associated with long term pain can help patients better manage their pain. Our psychologists are skilled at working with patients to help them understand how their history influences their biology and thus contributes to their personal pain experience. When patients understand why they hurt, they hurt less. Our psychology team assists patients in developing personalized strategies to address the challenges of chronic pain so patients can recover functioning, improve their quality of life, and return to living a rich, full, and meaningful life.
Pain Neuroscience Education (PNE) is a structured approach to teaching patients the neurobiology and neurophysiology of pain. PNE stresses the impact of cognitions on pain and how chronic pain can adversely affect cognitions, beliefs, emotions, and behaviors. Changing the underlying unhelpful thoughts and beliefs patients have about pain is crucial for improving outcomes. We believe when our patients understand why they hurt, they hurt less.
Our pain psychology team at Northwest Spine and Pain Medicine has developed a five- lesson plan curriculum for utilizing PNE with our patients.
Traditional education on pain has focused on the biomedical education model. However, this education, from a patient’s perspective, is often incomplete and iatrogenic. Increased pain related fear, locks patients into a “fear of pain” cycle that can lead to disuse, disability, and ultimately increased pain over time. By contrast, patients who participate in PNE before receiving traditional interventions, such as surgery or physical therapy, are shown to have better outcomes when compared to patients who did not receive PNE in combination with these treatments.
At NWSPM we whole-heartedly believe in treating the mind, body and soul. We want everyone to “live their best life”, especially those involved in our program! Our providers offer patients education on nutrition, sleep, social support and anything else that helps you be the best version of yourself.
Pharmacological Pain Management
Certified Suboxone Prescriber
Cold Laser is an FDA-cleared non-invasive treatment which promotes healing in sub acute and chronic pain areas. During treatment the area of pain is targeted with specific wavelengths of light, which have been identified to interact with surrounding cells and enhance the body’s natural regenerative functions. Many patients report positive results in as little as one treatment. Some of the conditions that typically respond well to K-Laser include: Arthritis Pain, Degenerative Discs/Joints, Sciatic Pain, Back and Neck Pain, Carpal Tunnel Syndrome, Sprains, Fibromyalgia, Athletic Injuries, Work Related and Auto Injuries. Please call our office to find out more about treatment options.
Trigger Point Injections
Trigger points are a nodules or knots that form in a taut band of muscles. These knots keep muscles tight and often decrease blood flow to the area causing pain. Trigger points can usually be felt by compressing a finger- tip over the muscle. Trigger points often cause referred pain or discomfort; this pain usually follows patterns which help our providers to locate the actual area in which the trigger point is located.
Trigger point injections help to release tension in the muscle causing pain. Injections are performed by inserting a small needle into the trigger point or painful area. This needle often disrupts the taut band of muscles and helps them to relax. These procedures are sometimes also performed using a numbing agent or anti-inflammatory. Trigger point injections often provide quick relief.
Botox Injections for Chronic Migraine Relief
Botox is injected around the pain fibers that are involved in chronic migraines by using fine needle injections in muscles of the face, back and sides of head as well as the neck. Botox enters the nerve endings and blocks the release of chemicals involved in creating pain before a migraine starts. Patients typically receive four treatments per year with each treatment lasting about twenty minutes. Patients may feel relief within three days of initial injections, with increasing relief upon consecutive treatments.
EMG / NCS
An EMG, or an electromyogram, measures electrical activity of muscles both at rest and in contraction. A nerve conduction study, or NCS, measures how well nerves are able to send electrical signals. Both tests can be done to learn what is causing nerve and muscle issues or pain. An EMG can be done to locate the source of muscle weakness, paralysis, or twitching, which could be inside a muscle, in the nerves supplying a muscle, in the spinal cord, or inside an area of the brain. It tests for things like herniated discs or amyotrophic lateral sclerosis. An NCS is performed in order to locate damage to the peripheral nervous system. This test can discover nerve damage such as carpal tunnel syndrome or Guillain-Barré syndrome.