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  • SPINAL CORD STIMULATION TRIAL
  • SYMPATHETIC NERVE BLOCK
  • TRIGGER POINT INJECTION
  • JOINT INJECTIONS
  • PLATELET-RICH PLASMA THERAPY
  • FACET JOINT INJECTIONS AND RADIOFREQUENCY ABLATIONS
  • EPIDURAL STEROID INJECTIONS
  • BURSA INJECTIONS
  • MYOFASCIAL RELEASE
  • SACROILIAC JOINT INJECTION
  • PIRIFORMIS INJECTIONS
  • GENICULAR NERVE BLOCKS
  • OTHER TREATMENTS/PROCEDURES
SPINAL CORD STIMULATION TRIAL

Spinal Cord Stimulation Treatment Overview

Spinal cord stimulation (SCS) is an advanced procedure that has evolved in clinical use since the late 1960’s. It involves the placement of programmable electrodes into the epidural space where they emit signals to the spinal cord to mask pain signals.

If your physician recommends spinal cord stimulation, you will first undergo a trial placement in an outpatient clinic setting. Electrodes will be placed with x-ray guidance and custom programmed to provide relief of your pain condition. Over the next 3-5 days you will be able to test the spinal cord stimulation system to see how much it relieves your pain and improves your function.

If the trial is successful, then you will be scheduled to undergo surgical implantation at an area hospital. The implantation is like that required for placement of a pace-maker and does not require an overnight stay in-hospital.

Conditions Treated with Spinal Cord Stimulation

  • Failed Back Surgery Syndrome (FBSS), post-laminectomy pain
  • Neuropathic pain from diabetes or peripheral vascular disease
  • Neuralgia/Neuritis
  • Radicular pain syndrome or radiculopathies resulting in pain secondary to FBSS or herniated disk
  • Degenerative Disk Disease (DDD) / herniated disk pain refractory to conservative and surgical interventions
  • Epidural fibrosis
  • Arachnoiditis or lumbar adhesive arachnoiditis
  • Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD), or causalgia

Benefits of Spinal Cord Stimulation Treatment

Published studies on spinal cord stimulation have shown that when used in properly selected patients it can offer the following benefits:

  • Effective: Spinal cord stimulation may provide significant and sustained reduction in spine and limb pain and hope for a better quality of life.
  • Safe: When used as directed, safety has been demonstrated in clinical trials over the last 35 years.
  • Predictable Success: A screening test allows the patient to experience spinal cord stimulation on a temporary basis to assess response before implantation.
  • Reduced Medication: Patients may be able to reduce oral pain medication doses and their associated side effects.
  • Reversible: Unlike some surgeries, spinal cord stimulation is reversible. The system can be turned off or surgically removed.
  • Programmable: Neurostimulators can be programmed to meet the specific needs of each individual patient. As pain patterns change, parameters can be adjusted to increase the effectiveness of the therapy

FAQs about Spinal Cord Stimulation Treatment

  1. How long does a spinal cord stimulation trial placement take?
    A spinal cord stimulation trial typically takes roughly 60 minutes’ total to include programming.
  2. How does spinal cord stimulation work?
    The spinal cord stimulator provides a signal to the spinal cord that competes with pain signals. In this way, it blocks or masks the pain signals from being sent to your brain.
  3. How long will the trial be?
    Spinal cord stimulator trials usually last between 3 to 5 days. At the end of your trial you will be seen in clinic and the stimulator wires will be easily removed in an exam room – removal takes no more than a minute or two.
  4. How will I feel during my trial?
    Most patients describe a pleasant tingling in place of their usual pain. You may notice you require less pain medication or that you can walk further or sleep better.
  5. My trial went well, what is my next step?
    If your trial was a success, your physician will begin the process of scheduling you for outpatient surgery to have a system implanted.
  6. Do I have to stop taking my pain medications for this procedure?
    You are encouraged to continue taking your pain medications as prescribed.
SYMPATHETIC NERVE BLOCK

Sympathetic Nerve Blocks Overview

The sympathetic nervous system helps control many functions in your body (blood pressure, sweating, peripheral blood flow) and is usually not involved in pain sensation. However, in some pain conditions, such as Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD), the sympathetic nerves become activated in an abnormal way and begin to transmit pain.

Blocking these sympathetic nerves can improve pain and a positive response is also useful in helping to provide a diagnosis for your pain.

Sympathetic blocks are done with either x-ray or ultrasound guidance, and all involve the injection of local anesthetic around bundles of nerves. The blocks may be done initially in a series of three over 6 weeks, but in some patients, are repeated several times per year.

Spine Levels for Sympathetic Nerve Blocks

Sympathetic blocks can be done at five different levels of the spine, depending on the area and type of pain involved:

  1. Stellate Ganglion Block
    The Stellate Ganglion is a bundle of sympathetic nerves that lies roughly at the C7 level, or at the base of the neck. This block may be suggested if you have nerve pain in one or both arms that is difficult to treat with other methods.
  2. Celiac Plexus Block
    The Celiac Plexus nerve bundle is at the T12-L1 level and receives pain transmission from many organs in the abdomen. If you have abdominal pain from cancer, chronic pancreatitis or other conditions, this block may be recommended by your physician.
  3. Lumbar Sympathetic Block
    The lumbar sympathetic plexus is located at roughly the L3 level. Painful conditions in one or both legs, to include CRPS and some peripheral vascular disease, may respond to blockade of this plexus with local anesthetic.
  4. Superior Hypogastric Plexus Block
    Located at the L5 level, the hypogastric plexus receives pain signals from most pelvic organs. This block may be recommended if you have pelvic or low-abdominal pain.
  5. Ganglion Impar Block
    The lowest collection of sympathetic nerves is found in the Ganglion Impar, which lies near the junction of your sacrum and coccyx. Blocks at this level may be helpful if you have coccydynia, or tail-bone pain.

FAQs about Sympathetic Nerve Blocks Treatment

  1.  How long does a sympathetic block take?
    Sympathetic blocks usually take no more than 30 minutes.
  2.  How will I feel afterwards?
    Relief from sympathetic blocks is usually noticed with 15 minutes of your procedure. You may also note rapid improvement in blood flow to the area, with increase in temperature and decreased sensitivity.
  3.  How long will the relief last?
    Relief is variable and you may require a series of injections over several weeks to provide lasting results.
TRIGGER POINT INJECTION

Trigger Point Injections Overview

This procedure, which does not require x-ray or ultrasound guidance, is for the treatment of painful areas of muscle tension or spasm. Muscle spasms in the neck, low or middle back can be quite painful and may persist for weeks to months.

Trigger point injections involve the placement of a thin needle directly into the worst areas of pain for injection of local anesthetic and sometimes steroid. They can provide pain relief for weeks to months, and can also be useful for treating pain associated with Fibromyalgia or tension-type headaches.

Trigger Point Injections FAQs

  1. How long do Trigger Point Injections take?
    Trigger point injections usually take no more than 5 minutes to perform, and do not need to be done in the procedure suite.
  2. How will I feel afterwards the injections?
    You will probably relief of pain and tension within minutes of your injection.
  3. How long will the relief last?
    Relief is variable but can last from weeks to roughly 1 month or more.
JOINT INJECTIONS

Overview of Joint Injections

If you have joint pain due to osteoarthritis your physician may recommend joint injections as part of your treatment plan. Injections of steroid and local anesthetic can provide good lasting relief of pain arising from essentially any peripheral joint to include the knees, hips, shoulders and elbows.

Some joint injections are best performed with x-ray guidance, while others are performed with ultrasound guidance.

Frequent Asked Questions

  1. How long does a joint injection take?
    Injections of the peripheral joints usually take 10 to 15 minutes.
  2. How will I feel afterwards?
    The use of local anesthetic in the joint will likely improve your usual pain within minutes, but you may have a temporary pressure sensation.
  3.  What is viscosupplementation?
    Viscosupplementation is the injection of artificial joint fluid into your affected joint. Your physician may recommend this technique if you have arthritis and steroid injections did not provide long-enough relief. Learn more about viscosupplementation.
  4.  How long will the relief last?
    Relief from steroid injections can last up to several months, while relief from viscosupplementation may be longer.
PLATELET-RICH PLASMA THERAPY

Platelet-Rich Plasma Therapy Overview

Platelet-Rich Plasma (PRP) therapy is an innovative approach to promote and stimulate healing from a tissue and bone injury using body’s own cells (autologous). Platelet-rich plasma therapy uses blood plasma that has a high concentration of platelet cells. Platelets are “first responders” of the body to the site of injury and contain growth factors and other cell types called cytokines that start the healing process.

Several clinical trials have shown this therapy to be effective and safe to treat various forms of muscle, tissue and joint disorders. It is also used to target pain generating from arthritis of the shoulder, knee, elbow and spine. It is also now commonly utilized to target soft tissue and fascia related pain in neck, feet and lower back.

It is an FDA approved non-surgical treatment that is safely performed in an office setting without the need for sedation or anesthesia. Platelet-rich plasma therapy has gained international attention from the medical communities and media by demonstrating its benefits in treatment of injuries sustained by several high profile professional athletes throughout the world.

Benefits Platelet-Rich Plasma Therapy

Benefits of treating chronic pain with Platelet-rich plasma therapy therapy may include:

  • Pain relief from healing of underlying injury
  • Use of body’s own cells (autologous)
  • Avoidance of a major surgery
  • Improved quality of life and increased ability to perform activities of daily living
  • Reduced need for oral medications for pain and avoidance of side effects such as nausea, vomiting, sedation, and constipation
  • Natural, Safe, Effective, FDA approved treatment

Common Questions about Platelet-Rich Plasma Therapy

  1. How long does Platelet-rich plasma therapy take?
    The whole procedure takes about 1 to 1.5 hours. Patient’s own blood is drawn into a tube and spun down in a special centrifuge machine. The plasma rich in platelets is collected and injected into the injured tissues under ultrasound guidance using universal sterile precautions. Patients are discharged from the office the same day and may resume their normal activities and return to work.
  2. Do I have to take special precautions for this procedure?
    No. We recommend patient’s to continue their usual medications and speak to their provider for specific questions. The contraindications to this procedure are infection of the injury site, cellulitis of the skin, routine use of blood thinners, and prior history of allergic response to blood transfusions.
  3.  How many treatments do I need?
    In general, most patients require 2-3 treatments to have the maximum benefit from this therapy. These treatments are performed 3-4 weeks apart. It is also possible that patients may feel better after the first treatment and the subsequent treatments are performed only if absolutely needed.
FACET JOINT INJECTIONS AND RADIOFREQUENCY ABLATIONS

Facet Joint Pain Overview

The facet joints are small joints on the back of your spine, and are found in all levels from your low-back to your neck. Facet joint pain is usually due to arthritis or degeneration of the joints and is usually described as an ache that stays along the spine and is worse with prolonged sitting, standing or driving. If your pain condition is consistent with facet joint pain, your physician will likely recommend one of the following procedures.

Facet Joint Procedures

Facet Joint Injections

One method for relieving facet joint pain is to directly inject steroid and local anesthetic into the affected joints themselves. Facet joint injections are performed with x-ray guidance.

Medial Branch Blocks

The small nerve which transmits pain impulses from the facet joint is called the medial branch nerve. This nerve can be blocked by the injection of local anesthetic and steroid under x-ray guidance.

Medial Branch Radio frequency Ablation (RFA)

In cases where either medial branch blocks or facet joint injections provided good relief that did not last enough, radio frequency ablation may be performed to provide longer pain relief. RFA also targets the medial branch nerve, but uses radio frequency energy (a type of heat) to stun the nerves. This procedure can provide pain relief for up to 6- 12 months.

FAQs about Facet Joint Treatments

  1. How long do Facet Joint procedures take?
    Facet joint injections are usually done at up to six sites at a time and take 10 to 15 minutes. Radio frequency ablation usually takes roughly 30 minutes.
  2. Is Radio frequency Ablation permanent?
    Radio frequency ablation does not permanently destroy (or “burn”) the medial branch nerves. The nerves will slowly regenerate/grow back over time, which is why this procedure may need to be repeated.
  3.  How will I feel afterwards?
    The majority of patients feel relief of their usual pain shortly after the procedure due to the injection of local anesthetic on the medial branch nerves. However, some patients will experience temporary muscle stiffness.
  4. How long will the relief last?
    Relief from injections is highly variable and can range from weeks to a month or two. Relief from RFA is more predictable and typically lasts up to 12 months.
EPIDURAL STEROID INJECTIONS

Overview of Epidural Steroid Injections Treatment

Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve pain. They are most commonly performed for patients with spine pain and radiating pain into either the arms or legs.

Injections are performed under X-ray guidance. If an initial series of three injections fails to provide lasting relief, your physician will discuss options for altering the treatment plan.

There are three different ways to do an epidural steroid injection and your physician will choose the route that offers the best chance of relieving your pain based on several factors.

3 Types of Epidural Steroid Injections

Caudal Epidural Steroid Injections

The Caudal approach involves an injection at the base of your spine near your tail bone. An advantage of this approach is that it can be done easily even if you have had major spine surgery.

Interlaminar Epidural Steroid Injections

The Interlaminar approach can be performed at all levels of the spine from the low- back to the neck. This approach may not be possible if you have had spine surgery in the injection area. An advantage of this approach is that medication may be delivered closer to the area of pain.

Transforaminal Epidural Steroid Injections

The Transforaminal approach involves placement of the needle into the area where your spinal nerve exits the spine. It can be done throughout the spine, but is done most frequently in the low-back. This approach can be used in areas of prior surgery, and may deliver medication most accurately to the area of nerve irritation.

Epidural Steroid Injections FAQs

  1. How long does an Epidural steroid injections take?
    Epidural steroid injections of any approach usually take about 10 to 15 minutes total. Your procedure may take slightly longer if your physician recommends an approach at two different levels of your spine.
  2. How will I feel afterwards?
    Some patients feel improvement right away, while others have a temporary sensation of pressure at the site. The main benefit from the steroid usually takes effect in 48-96 hours.
  3. How long will the relief last?
    Relief from an Epidural steroid injections or series of ESIs varies from person to person. Usually one can expect pain relief to last for 1 to 6 months, and the average is approximately two months.
BURSA INJECTIONS

Overview of Greater Trochanter Bursa Injections

The greater trochanter is located at the side of your hip on each side. The trochanter has a cushioning bursa that overlies it, and this bursa may become inflamed causing trochanteric bursitis. This pain is typically felt as a severe tenderness over the hip pointer that is worse with any pressure or when you lie on that side to sleep.

Injections of local anesthetic and steroid under either x-ray or ultrasound guidance can provide good lasting relief of this pain, and may be done every several months.

FAQs about Bursa Injections

  1. How long does trochanteric bursa injection take?
    Bursa injections usually take roughly 5 minutes per side, and may not need to be done in the Procedure Suite.
  2. How will I feel afterwards?
    You may have a temporary sensation of pressure in the area, but use of local anesthetic will begin to relieve your pain within 10 to 15 minutes.
  3. How long will the relief last?
    Relief usually lasts from 1 to 2 months.
MYOFASCIAL RELEASE

Myofascial Release Overview

Pressure on sensitive points in the muscle may result in pain. Myofascial pain syndrome can occur after repeated injury or overuse of muscles. Sometimes it manifests a tender muscle knot and pain can be persistent.

A focus of treatment is the release of muscle tightness for symptoms of decrease in flexibility, soft tissue dysfunction in any part of the body. Conditions such as muscle dysfunction from injuries, fibromyalgia, and migraines, etc. may benefit from treatment. Myofascial release may be followed by trigger point injections to provide additional benefit.

FAQs about Myofascial Release

How long does it take?

Depending on the number of areas to be treated, may take 10 minutes to 45 minutes or more.

How will I feel afterward?

Relief of a percentage of muscle tightness is appreciated during and after treatment. Continued relief may be felt beyond that point. May experience muscle soreness in treated areas for a few days.

How long will the relief last?

Pain relief is variable from individual to individual, but can last up to 1 week to 1 month or beyond.

SACROILIAC JOINT INJECTION

Sacroiliac joint Dysfunction Overview
Sacroiliac joint is formed from the connection of sacrum with the pelvis on either side. Sources of pain or inflammation can result from degenerative joint changes, decreased or increased range of motion, injury, dysfunction of surrounding soft tissue structures. This can cause pain on either side of buttocks just below the lumbar spine.

Sacroiliac Joint injection
Under Fluoroscopic guidance, Injection of steroid and local anesthetic into the joint space to aide in decreasing the inflammation, relieve pain, and improve functioning.

Lateral Branch Blocks
The lateral branch nerves are small nerves that branch off the sacral spinal nerves and provide sensation to the sacroiliac joint. These nerves can be blocked by the injection of local anesthetic with or without steroid under X-Ray guidance. If beneficial, radiofrequency ablation of the nerves can be performed to provide longer lasting relief.

Lateral Branch Radiofrequency Ablation (RFA)

In cases where either the sacroiliac joint injection or the lateral branch blocks provided good relief but did not last long enough, radiofrequency ablation may be performed to provide longer lasting relief. RFA targets the nerves by using heat energy to stun the nerves. RFA can provide relief for up to 6-12 months.

FAQs about Sacroiliac Joint Treatments

  1. How long do Sacroiliac Joint(SIJ) procedures take?
    SIJ procedures can take 10 to 15 minutes. Radio frequency ablation usually takes roughly 30 minutes.
  2. Is Radio frequency Ablation permanent?
    Radio frequency ablation does not permanently destroy (or “burn”) the lateral branch nerves. The nerves will slowly regenerate/grow back over time, which is why this procedure may need to be repeated.
  3. How will I feel afterwards?
    The majority of patients feel relief of their usual pain shortly after the procedure due to the injection of local anesthetic. However, some patients will experience temporary muscle stiffness.
  4. How long will the relief last?
    Relief from injections is highly variable and can range from weeks to a month or two. Relief from RFA is more predictable and typically lasts up to 12 months.
PIRIFORMIS INJECTIONS

Piriformis Overview
Tightness and inflammation of the piriformis muscle can cause back or buttock pain that is usually worse with prolonged sitting. The sciatic nerve may be irritated by tightness of this muscle which may lead to nerve pain in the lower extremity that can be similar to that caused by a herniated disc in the lumbar spine.

Under Fluoroscopic guidance, Injection of steroid and local anesthetic into the piriformis muscle with can aide in decreasing the inflammation, relax the muscle and relieve pain.

FAQs about Piriformis Injections

How long does a Piriformis injection take?
Injections into the piriformis muscle usually take 10 to 15 minutes.

How will I feel afterward the injections?
Relief of buttock and sciatica pain is usually noticed shortly after the injection due to the use of local anesthetic, but steroids take effect in 24-48hrs.

How long will the relief last?
Pain relief is variable from individual to individual, but can last up to 2-3 months.

GENICULAR NERVE BLOCKS

Genicular nerve/knee pain overview
Knee pain can be chronic, debilitating, and can lead to loss of function. Genicular nerve blocks are indicated for those who have osteoarthritis (DJD), those who want to avoid knee replacement, those who have had knee replacement or any type of knee surgery, and those with chronic knee pain.

 Genicular Nerve Blocks
The genicular nerves transmit pain impulses to the knee and surrounding structures. These nerves can be blocked by the injection of local anesthetic and with or without steroid under x-ray guidance.

Genicular Radio Frequency Ablation (RFA)
In cases where the genicular blocks provide good relief that did not last enough, radio frequency ablation may be performed to provide longer pain relief by stunning the nerves.

FAQs about Genicular Nerve Blocks/RFA Treatments

  1. How long do genicular nerve procedures take?
    Injections are usually done at up to 3 sites at a time and can take 10 to 15 minutes. Radio frequency ablation may take roughly 30 minutes.
  2. Is Radio frequency Ablation permanent?
    Radio frequency ablation does not permanently destroy (or “burn”) the medial branch nerves. The nerves will slowly regenerate/grow back over time, which is why this procedure may need to be repeated.
  3. How will I feel afterwards?
    The majority of patients feel relief of their usual pain shortly after the procedure due to the injection of local anesthetic on the nerves. However, some patients will experience temporary muscle stiffness.
  4. How long will the relief last?
    Relief from injections is highly variable and can range from weeks to a month or two. Relief from RFA is more predictable and may last for a longer period of time.
OTHER TREATMENTS/PROCEDURES
  • MEDICATION OPTIMIZATION: Working with our care team, we utilize the multimodal model to optimize medication utilization.
  • OPIOID DETOXIFICATION: Opioid addiction is a treatable and chronic disease. The CDC has declared an “opioid epidemic” in the U.S. Our goal is to minimize adverse outcomes that relate to this condition. There is increased success with individualized management consisting of behavioral therapy and medication. This is a value proposition of Privium Care Providers. Our patients enroll into a care team that formulates a care plan to reduce opioid dependence. Let us work as a team to help break the cycle and get you back to living your best life.
  • CARPEL TUNNEL INJECTIONS
  • BOTOX






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