At CVMC’s Pain Clinic, our team of anesthesiologists provide a variety of outpatient pain block procedures, as well as medical consultations, for alleviating and managing chronic pain.
Our anesthesiologists provide pain consultations for patients referred by their primary care physicians, orthopedic specialists and Spine Medicine. The anesthesiologist will meet with the patient and make recommendations about pain medication and other options for dealing with chronic pain.
While anesthesiologists do not prescribe pain medication, their specialized knowledge about the types of pain medication available and how different pain medications work together can help your provider in prescribing a new or modified course of treatment.
Epidural Pain Block Procedures
Epidural injections are outpatient procedures conducted in the Ambulatory Care/Day Surgery unit at CVMC. These procedures involve the injection of long-lasting pain medication directly into the epidural space and are commonly used for non-surgical relief of arm, back, neck and lower leg pain (sciatica), as well as other chronic conditions.
- What is the Epidural?
The epidural is a sleeve-like space that surrounds the dura, which covers the nerve roots in the spine. Nerves must travel through this epidural space to reach the arms, chest and legs. In order to avoid injecting pain medication directly into the spine or nerves, medication is injected into the epidural space, where it will travel to the nerves, helping to reduce swelling and inflammation and block pain.
- Benefits of Epidural Injections
Epidural procedures can benefit patients who have experienced a recent injury by providing pain relief and reducing swelling, therefore allowing the patient to heal and participate in physical therapy. For patients with chronic pain that has not responded to physical therapy, epidurals can be used over time for long-term pain relief. Some epidurals are also used for diagnostic purposes, in order to locate the source of the pain.
- Number and Frequency of Injections
The number of initial injections and the long-term frequency of epidural injections vary from patient to patient. Initial relief is usually achieved with one or two injections. If this initial course of treatment provides permanent relief, no additional injections will be required. For those with chronic pain, injections will be repeated as needed, every few months, as the effects wear off. No more than three injections are administered over a 6 month period.
Types of Epidural Procedures
The following types of Epidural Injections are performed at CVMC:
- Cervical Epidural Steroid Injection
This injection of a long-lasting steroid into the epidural space in the neck is a common form of pain management of neck pain to decrease neck or upper extremity pain caused by one or more compressed or inflamed spinal nerves in the neck (cervical spine).
- Thoracic Epidural Steroid Injection
This injection of a long-lasting steroid into the epidural space in the upper or mid back to decrease pain in the upper or mid back.
- Lumbar Epidural Steroid Injection
This injection of a long-lasting steroid (cortisone) into the epidural space is a common form of pain management for sciatica and lower back pain.
- Lumbar Facet Joint Injections
Facet joints are small joints at each segment of the spine that provide stability and help guide motion. Arthritis, back injuries or other types of stress can cause inflammation and pain in these joints. Lumbar facet joint injections are utilized for both diagnostic and therapeutic purposes. If a patient receives immediate relief from the local anesthetic used in the injection, this will confirm that the facet joint is the source of the pain. The injections also include time-released anti-inflammatory medicines, such as cortisone, that can provide long-term relief of several months to a year. For patients who experience long-term relief, this procedure can be repeated over time as necessary.
Radiofrequency Ablation (RFA)
Radiofrequency ablation is an alternate interventional treatment that uses heat to reduce or stop pain transmission through a nerve. By blocking the nerve from sending along a pain signal, RFA can provide extended relief for chronic pain.
Anesthesiologists specially trained in this outpatient procedure provide treatment through the Pain Clinic at CVMC.
- When is radiofrequency ablation used for treatment?
RFA is most often used to treat chronic pain in the neck and spine when a patient does not respond to other treatments or procedures, such as physical therapy or medication.
- How long does the pain relief last?
Most patients experience pain relief that lasts six to 12 months.
(Learn more about RHA under the Resources tab at top of this page.)
Peripheral Nerve Blocks
- Peripheral nerve blocks are generally done to control pain arising from a nerve, also known as a neuralgia. Nerve injury can be caused by trauma, compression, ischemia, or toxic exposure to a nerve. The block involves the injection of a local anesthetic with a steroid in proximity to the injured nerve to decrease the conduction of pain signals along the nerve. Procedures for Sciatic or femoral nerve blocks are offered for leg or knee pain.
Trigger Point Injections
- Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
We do not recommend that you receive any vaccinations 2 weeks before or after a pain clinic procedure or pain clinic injection that involves a steroid injection.
Pain Clinic Procedures and Injections
You will receive a call from our scheduler when your appointment has been scheduled. Some procedures and insurances require prior authorization before scheduling your appointment.
Once your appointment is scheduled, you will receive a call from a nurse that will review your appointment date and time in addition to any instructions on how to prepare for your procedure. You may be required to stop some of your medications or supplements before the procedure which will be reviewed during your phone call. You must have a driver to take you to and from your appointment, we do not allow a taxi or bus as transportation for your appointment.
Radiofrequency Ablation Patient Education
An important part of helping you manage your pain is for you to have a clear understanding about your treatment. This literature contains important information on Radiofrequency Lesioning/Ablation.
What is the purpose of Radiofrequency Ablation (RFA)?
Radiofrequency Ablation is a procedure that sends radio waves (heat or pulsed) through a needle to damage small sensory nerve endings and interrupt pain signals. Radiofrequency is considered quite effective. Some patients report pain relief for 6 months to two years after the procedure. Since nerves endings have a tendency to grow back, the pain will probably return at some time in the future. Fortunately the procedure can be repeated if necessary.
What does the procedure involve?
Radiofrequency lesioning is an outpatient procedure performed in our CVMC Pain Clinic. This procedure is performed in a procedure room with fluoroscopy, which is a specialized x-ray machine.
Depending on the nerves being treated, you will be positioned on your stomach to be able to treat the nerves in the back or neck. The area will be cleansed with an antiseptic solution and the doctor will inject some numbing medicine into the skin that may cause a burning sensation for a few seconds. After the numbing medicine takes effect and with the assistance of the fluoroscopy machine (specialized xray), the doctor will insert a special radiofrequency needle. You will feel dull pressure but minimal pain. After confirming that the needle tip is in position, an electrode is inserted into the needle. Again, the proper location of the needle is confirmed by fluoroscopy. Using electrical stimulation, the doctor will then verify the correct nerve, you will feel a tingling, buzzing or pressure sensation but not pain. You may also experience some minimal muscle twitching.
The tissues surrounding the needle tip are then heated or pulsed when electric current is passed using the radiofrequency machine for 60-120 seconds. This will numb the nerves.
After the procedure, you will be assisted to a seated position, we will review discharge instructions and you will be able to leave the pain clinic as long as you are accompanied by a driver.
Can I go to sleep for the procedure?
Since it is important for you to talk to your doctor and describe what you are feeling, you will not be put to sleep.
How long will the procedure take?
Depending upon the situation, radiofrequency lesioning will take 30 -60 minutes to complete the procedure.
What should I do before the procedure?
- Be sure that you have a driver to take you home from the appointment.
- You may need to stop taking certain medications several days before the procedure, the nurse will review which medications to stop and when. If your primary care or cardiologist has you taking any Aspirin or blood thinners, be sure to check with them prior to discontinuing the medication.
- If this is a cervical or thoracic procedure, you may not have any solid food after midnight. You may have clear liquids (water, black coffee, tea, apple juice) until 4 hours prior to the procedure and then nothing by mouth until after your procedure. If this is a lumbar/sacral procedure, you are not restricted from eating or drinking.
- If you are diabetic, be sure to discuss your medication schedule and eating/drinking with your doctor.
- Tell the doctor if you have developed a cold, fever, flu symptoms or any skin issues before your scheduled appointment. If you have an infection and require antibiotics, you must complete the antibiotics and be symptom free for 10 days before you can have an injection.
Is there anything special that I need to do after the procedure?
- After the procedure, you may experience some muscle soreness for a few days. You may want to apply ice or a cold compress to the affected area if needed for soreness. Do not apply heat to the area.
- Do not drive for the remainder of the day. Please have an adult drive you home, or the GMTA taxi (pre-arranged) for door to door service, you may not take a bus or regular taxi service.
- Depending on how you feel, you may resume normal activities and return to work the following day.
- If the doctor prescribes physical therapy, it is very important that you continue with the physical therapy program.
What are the risks of Radiofrequency ablation?
The risks, although infrequent include:
- Allergic reaction to the medication
- Bruising at the injection site
- Infection at the injection site
- Damage to the nerves or blood vessels near the lesioned nerve.
- Results will vary with each person, there is a 50% chance that the results are not effective from this procedure.