How is it done?
A local skin anesthetic is given near the base of the neck on the affected side. A needle is inserted by the anesthesiologist near the transverse process of the cervical spine (usually at the cervical-6 level). A sterile tubing is attached to the needle and anesthetic medication is slowly injected through the tubing.

Expected Results
The patient may note increased warmth and redness of the painful arm during and after the injection. The patient can expect hoarseness of their voice, redness of the eye, drooping of the eyelid and pupillary constriction for four to eight hours after the injection. Pain relief may be noted immediately. Duration of relief is variable. The patient must assess their pain relief over the first three to four hours after the injection and report this to the anesthesiologist.

How is it done?
The patient is given a local skin anesthetic – a needle is then inserted into the facet joint or facet capsule and an anesthetic and steroid are injected by the physician. This is done under fluoroscopy.

Expected Results
Decrease in or relief of back pain.

How long does it take?
Thirty minutes.

Blocks are done in conjunction with physical therapy.

Glossary

Facet Joints - Joints located on the back of the spine on each side where one vertebrae slightly overlaps the adjacent vertebrae. They guide and restrict movement of the spine.

Fluoroscopy - X-ray imaging of a part of the body that is displayed on a screen or monitor in the block suite – this facilitates and assures proper placement of the needle and medication.

A discogram is a diagnostic test performed to view and assess the internal structure of a disc and determine if it is a source of pain.

How is it done?
The patient is given intravenous medication as a relaxant and pain reliever. A local anesthetic is injected into the patient’s skin in the area that is being examined.

A needle is inserted through a previously placed needle in the skin and into the disc under fIuoroscopy. A saline solution and radiopaque dye are injected into the disc or discs if more than one disc is being examined. A CT scan is usually performed on the painful disc after the dye is injected to obtain images of the dye distribution. This will demonstrate anular tears, scarring, disc bulges and changes in the nucleus of the disc.

Expected Results

• Recreation of painful symptoms if the disc/discs is abnormal.
• Confirmation of a diagnosis and/or determination of which disc/discs is the source of pain.

How long does it last?
Thirty minutes plus an additional thirty minutes if a CT is indicated plus recovery time of several hours.

How is it done?
With the patient in a prone position and under local anesthesia and fluoroscopic guidance, a radio-frequency needle is advanced to the base of the transverse processes. The needle is placed along the course of the medial branch. The needle is heated to 80

How long does it take?
The neurotomy takes 10 to 45 minutes, depending on the number of levels be done. The patients is then recovered in the observation area for 30 minutes to 1 hour.

Potential Risk
Increased localized back pain and/or leg pain can be expected from several days to several weeks and rarely several months. Destabilization of the facet joint is a risk and post injection training to strengthen the extensor muscles can prevent this possibility.

Expected Outcome
Following the neurotomy, there is a 60% chance of pain relief. This typically last for 3 months to 1 1/2 years. The nerve eventually grows back and the procedure can be repeated. While the patient is experiencing pain relief, vigorous physical therapy is necessary to try and strengthen the involved facet joint(s).

How is it done?
A local skin anesthetic is given in the lumbar area of the back. A needle is then inserted into the back under fluoroscopy next to the vertebral body.  The block may be performed on both sides of the spine.  An anesthetic medication will be injected into the area.

Expected Results
The patient may note redness of the lower extremity and a feeling of warmth.

How long does it take?
It takes thirty minutes for the procedure followed by evaluation and recovery for several hours.

Sympathetic Nerves- A network of nerves extending the length of the spine that control some of the involuntary functions of the body such as opening and narrowing blood vessels.

How is it done?
The patient is placed in a prone position and given a local skin anesthetic. Under fluoroscopy the specific costovertebral joint(s) is identified. A needle is placed in that area(s) and an anesthetic and steroid are injected.

How long does it take?
Fifteen to thirty minutes.

Expected Results
Initially, when a needle is inserted in the costovertebral area(s), there will be a reproduction of pain. Following injection of the medications, there may be relief of pain and increased mobility. Duration of relief varies with the individual.

Information provided by International Spine Intervention Society

How is it done?
A local skin anesthetic is given. A spinal needle is then inserted into the epidural space of the lumbar or caudal spine. An anesthetic and steroid are injected into the epidural space.

Expected Results
Relief of pain if the medication reaches the inflamed area or source of pain.

How long does it take?
Thirty minutes plus approximately forty-five minutes recovery time.

Epidural - Space outside the dura or covering of the spinal cord. This space runs the length of the spine.

How is it done?
The patient is given a local anesthetic.  The physician then locates, under fluoroscopy, a specific spinal nerve root. A needle is introduced through the skin into the area adjacent to the nerve root. Medication is then injected into the area bathing the nerve root. The medications include an anesthetic and steroid.

Expected Results
Relief of back and leg pain.

How long does it take?
Thirty minutes to one hour.

Information provided by International Spine Intervention Society

 Pacific Pain Physicians Inc.

The Pacific Pain Center provides consultation and management services to patients suffering from acute and chronic pain syndromes.  Our board certified specialists in interventional pain management combine superior clinical care with the latest interventional treatments to help patients alleviate and control their pain.

At the Pacific Pain Center, we see patients by physician referral or by patient self-referral.  During the initial visit, our specialists perform a comprehensive evaluation, which includes a history, physical, and review of the referring physician’s medical records to identify factors contributing to the pain.  After discussion with the patient, a diagnostic and therapeutic treatment plan is then determined.

If you have any questions, feel free to contact us:

3045 De La Vina Street, Second Floor

Santa Barbara, CA 93105

Phone : (805) 563-0363

FAX : (805) 563-0364

Email : info@pacificpainphysicians.com

Website : www.pacificpainphysicians.com

Emergencies: Call 911 or go to the closest emergency room

Pacific Pain Physicians specializes in the treatment of:

> Back and Lower Extremity Pain

> Sciatica

> Failed back Injury Syndrome

> Cancer Pain

> Head, Neck, and Upper Extremity Pain

> Neuralgia and Neuropathy – Pain from Nerve Injury and/or Dysfunction

> Post Surgical Pain

> Ischemic and Vascular Pain

> Post Herpetic Neuralgia and Shingles

> Complex Regional Pain Syndrome

> Reflex Sympathetic Dystrophy

> Causalgia

> Spasticity (Intrathecal Baclofen)

> Musculoskeletal Pain