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Pain Management

Pain management, also known as pain medicine, is a branch of medicine that employs an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain. This medical specialty involves the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain.

  1. Acute Pain: This is temporary pain that acts as a warning of disease or a threat to the body. It usually resolves when the underlying cause is treated or heals.
  2. Chronic Pain: Chronic pain lasts for a longer period, typically over 12 weeks, and can be resistant to many medical treatments. It’s often associated with a long-term illness, such as osteoarthritis.
  3. Neuropathic Pain: Caused by nerve damage, it’s often described as a shooting or burning pain.
  4. Nociceptive Pain: This type of pain is caused by damage to body tissue and is usually described as a sharp, aching, or throbbing pain. It’s often the result of an injury or inflammation.

Epidural steroid injections (ESIs) are a common treatment option for various types of chronic pain, especially pain that radiates from the spine. These injections deliver steroids directly into the epidural space in the spine. Steroids are a potent anti-inflammatory medication used to reduce inflammation and swelling which can decrease pain. The frequency of these injections can vary depending on the patient’s response and the underlying condition. Patients are usually limited to three injections per year. The procedure is performed under Fluoroscopy, a real-time form of X-ray, used to guide the needle accurately into the facet joint.

Indications for this procedure include:

  • Sciatica: pain that radiates along the sciatic nerve which runs down the low back into the legs
  • Spinal stenosis: a narrowing of the spaces within the spine that can put pressure on the nerves and spinal cord.
  • Degenerative disc disease: Pain resulting from damaged vertebral discs.
  • Herniated discs: When the disc protrudes and puts pressure on the nerve roots.

Sacroiliac (SI) joint injections are a treatment used primarily for diagnosing and relieving pain associated with sacroiliac joint dysfunction. The SI joints are located at the bottom of the spine, connecting the sacrum (the bony structure above the tailbone) with the pelvis. These joints are small and don’t move much, but they are critical for effectively transferring the load of the upper body to the lower body. The procedure is performed under Fluoroscopy, a real-time form of X-ray, used to guide the needle accurately into the facet joint.

What is the purpose of SI joint injections?

  • As a diagnostic tool a local anesthetic is injected into the SI joint so the doctor can determine if the SI joint is the source of the patient’s pain.
  • As a therapeutic treatment, along with the local anesthetic, a corticosteroid is often injected to reduce inflammation and provide longer-term pain relief.
  • The local anesthetic provides immediate pain relief, and the steroid takes a few days to start reducing pain and inflammation.
  • SI joint injections are often part of a comprehensive treatment plan, which may include physical therapy and other pain management strategies.
  • The procedure is typically recommended only after other conservative treatments, like physical therapy or medication, have not provided adequate relief.

Intra-articular facet injections are a medical procedure used in the management of pain associated with facet joint disorders. Facet joints are small stabilizing joints located between and behind adjacent vertebrae in the spine. These joints provide stability and facilitate motion in the spine but can become a source of pain due to arthritis, injury, or degeneration.

The procedure is performed under Fluoroscopy, a real-time form of X-ray, used to guide the needle accurately into the facet joint. The number of injections one can safely receive is generally limited to reduce potential side effects, particularly those associated with steroids.

What is the purpose of intra-articular facet joint injections?

  • Diagnostic Tool: These injections can help determine if the facet joints are the source of a patient’s back pain. If pain relief is experienced following the injection, it suggests that the targeted facet joint is at least one source of the pain.
  • Therapeutic Treatment: Besides helping in diagnosis, these injections can also provide pain relief. They typically include a combination of a local anesthetic and a corticosteroid to reduce inflammation and alleviate pain.

Trigger point injections are a treatment used to relieve pain caused by trigger points, which are painful “knots” in muscle tissue. These knots can form when muscles do not relax, often as a result of overuse, muscle strain, or injury. Trigger points can be tender to the touch and can cause referred pain, meaning pain felt in another part of the body. Trigger point injections can provide prompt relief of muscle pain and stiffness and may help break the cycle of pain and muscle spasms.

What are the indications for trigger point injections?

  • Myofascial pain syndrome
  • Fibromyalgia
  • Tension headaches
  • Chronic pain conditions involving the musculoskeletal system

The procedure involves identification of trigger points and injection of a local anesthetic and sometimes a corticosteroid injection. Substances use may include local anesthetic, corticosteroids, saline, and Botulinum toxin may be used to inactivate the trigger point.

Neuro-ablative procedures, also known as neurolytic procedures, are a set of medical interventions designed to deliberately damage or destroy nerve tissue in order to relieve pain. These procedures are typically reserved for severe, chronic pain conditions, especially when other, less invasive treatments have failed to provide adequate relief. Neuro-ablation is often considered for patients with cancer pain, severe neuropathic pain, or pain due to a degenerative disease.

Medial branch blocks:

A medial branch block is a diagnostic and sometimes therapeutic procedure used in pain management, specifically to identify the source of back pain and provide temporary pain relief. This procedure targets the medial branch nerves, which are small nerves that feed out from the facet joints in the spine and carry pain signals to the brain.

As a diagnostic, it is used to determine if the facet joints are the source of the patient’s back pain. Sometimes they may provide temporary pain relief. Fluoroscopy, a real-time form of X-ray, is used to guide the needle accurately to the targeted medial branch nerves.

If a medial branch block successfully identifies the source of pain, it may be followed by a more long-term treatment called radiofrequency ablation (RFA), where the medial branch nerves are heated with radio waves to disrupt their ability to transmit pain signals.

This procedure is often recommended for patients who have not responded to conservative treatments such as physical therapy or medications and for whom imaging tests (like MRI) do not clearly indicate the source of pain.

Radiofrequency Nerve Ablation

Radiofrequency nerve ablation, also known as radiofrequency ablation (RFA) or radiofrequency neurotomy, is a minimally invasive procedure used to treat chronic pain. In this procedure, radiofrequency waves are used to produce heat, which is then applied to specific nerves to interrupt their ability to transmit pain signals to the brain.

What are the indications for RFA?

  • Spine: Especially for chronic low back pain and neck pain due to degenerative conditions like arthritis.
  • Facet Joints: For treating pain arising from these joints in the spine.
  • Sacroiliac Joint: Sometimes used to treat pain in this joint.
  • Peripheral Nerves: For conditions like trigeminal neuralgia or knee osteoarthritis.

Fluoroscopy or ultrasound is used to precisely guide the needle to the target nerve. Radiofrequency energy is then transmitted through the electrode, heating and ablating (destroying) the nerve tissue.

RFA is a minimally invasive, nonsurgical procedure with quick recovery, and longer lasting pain relief when compared to steroid injections. It is often considered when other treatments, like medications or injections, haven’t provided sufficient relief. It is especially useful for chronic pain conditions when the source of the pain is localized.

Genicular nerves radiofrequency

Genicular nerve radiofrequency ablation, also known as genicular nerve neurotomy, is a minimally invasive procedure specifically targeted at treating knee pain by disrupting the nerves that transmit pain signals from the knee joint. The genicular nerves are branches of nerves around the knee that relay sensation, including pain, from the knee joint to the brain.

This is a nonsurgical option for patients with chronic knee pain. Fluoroscopy or ultrasound is used to precisely guide the needle to the target nerve. It offers a sustained pain relief that can last for months or even years for patients who have not found relief with other interventions and as an alternative to surgery. It helps reduce the need for pain medications and offers quick recovery time with minimal downtime.

What are the indications for this procedure?

  • Chronic knee pain due to osteoarthritis.
  • Persistent knee pain after knee surgery (like total knee replacement).
  • Patients who are not candidates for knee surgery due to medical comorbidities or those who wish to avoid surgery.

Schedule a consultation

At Silicon Valley Orthopedics, we treat athletes and non-athletes alike with cutting edge techniques and procedures as well as nonsurgical options that will help healing when time and patience are in order. Contact us to schedule a consultation at one of our offices in Fremont, Los Gatos or Menlo Park. We strive to provide all of our patients with world-class compassionate and personalized orthopedic care aimed at your specific needs.

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