Commonly Asked Questions About Pain Management

Q: What is an epidural steroid injection and how can it help me?
A: An epidural steroid injection is an injection of a long lasting steroid into the epidural space - the area which surrounds the spinal cord and nerves exiting out of it. The steroid helps reduce inflammation and/or swelling of nerves in this area. The procedure takes a few minutes and you are able to go home right after. You will be advised to take it easy for a day or two. The steroid starts working in 3-5 days and can last several days to a few months.

Q: What is a Stellate Ganglion Block and what is it for?
A: A stellate ganglion block is an injection of local anesthetic into sympathetic nerve tissue. The nerves for this particular block are located on either side of the voice box in the neck. It is done as a part of the treatment for RSD and herpes zoster involving the upper extremities or head and face.

Q: What exactly is RSD and how does it differ from CRPS?
A: The term RSD was changed in 1993 to Complex Regional Pain Syndrome, (CRPS). CRPS type one is formerly known, as RSD and CRPS type two was causalgia. CRPS, type one is a debilitating disease, which involves the skin, nerves, blood vessels, and bone. The sympathetic nervous system reacts to a stimulus, i.e., an injury and become overactive and cause a variety of symptoms. The most common symptom is burning pain. Others include: swelling, temperature changes, decreased motor function, and severe sweating. These usually occur in a limb, but can occur in other body parts. Common causes are trauma, cerebral lesions, infections, and surgery. CRPS type two is defined by burning pain, allodynia, ( increased sensitivity to an area by non-painful stimulus), and onset usually occurs after nerve injury. The burning pain is constant and worsens by light touch, stress, temperature, or movement of the limb. Changes may also occur in the skin, nails, or hair. The main dice from type one is this is caused by a nerve injury.

Q: My doctor tells me I have myofascial pain and need trigger points? What is he talking about?
A: Trigger points are over irritated bundles of fibers within a muscle, which become "knotted" and inelastic due to injury or stress. On exam, there is marked muscle tenderness. In a trigger point injection, the doctor injects a form of lidocaine; sometimes mixed with a steroid, and by deep needling and deep muscle massage followed by TENS and heat therapy, this aims to "break up" the tight muscle band and help with relaxation of the muscle group.

Q: What is Radiofrequency Rhizotomy?
A: Radiofrequency rhizotomy is a procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. This is accomplished by the application of heat when an electronic current is passed. This can be as short as 3 months and as long as 18 months. You must have responded well to local anesthetic blocks to be a candidate for radiofrequency. The procedure can take from a few minutes to a few hours.

Q: What is a Discogram?
A: A discogram is a diagnostic procedure in which x-ray dye is injected into the discs of the spine. After injected, an x-ray is taken of the discs. It will either show that the disc is normal or that there are tears in the lining of the disc. It will help answer the question as to whether or not a patient's back pain is from a degenerated disc and which ones are causing the pain.

Q: What will I feel during a discogram?
A: When a normal disc is injected, you will feel a sense of pressure, but no pain. When an abnormal disc is injected, you will feel pain. It will be important to tell whether the pain you feel is your usual pain or different.

Q: Everyone it talking about a new procedure called IDET ? What is it?
A: IDET stands for IntraDiscal ElectroThermal Therapy. It is a recently developed technique for treating pain coming from a spinal disc. A special probe is inserted into the disc and heated. This will cause the material in the disc wall to shrink, thicken, and may numb the nerves in the wall of the disc. Disc pain is usually felt as a deep, aching pain in the back and sometimes in the buttocks and thigh. Painful discs in the neck cannot be treated with IDET, only those in the low back. The procedure for two discs takes approximately 2-2½ hours. It is performed as an outpatient procedure in an operating room. Local anesthetic and mild sedation are used. Under fluoroscopy, a needle is inserted into the disc, and through the needle a flexible catheter is positioned in the disc. Once in place, it is heated for about 17 minutes. After the procedure, you will need to wear a special brace that will support your back and limit motion for a few months.

Q: How does a Spinal Cord Stimulator work?
A: A Spinal Cord Stimulator is done in a two step process. In the first stage, a tiny wire is guided to the correct location in the epidermal space between the bony spine and the spinal cord and it is connected to a temporary power source. The goal is to position the lead so the patient feels a tingling sensation rather than the pain. This trial lasts a few days allowing the patient to become familiar with the electrical stimulation and evaluate the results. If the patient's pain improves at least 50%, the trial is considered successful and the next stage is to secure the wire permanently and add a permanent power source.