Procedures

When medication and physical therapy aren’t effective at relieving chronic pain, your pain management specialist may recommend an interventional procedure.

Celiac Plexus Block

The celiac plexus is a bundle of nerves in the abdomen. A celiac plexus block (CPB) injects a numbing agent or steroid medicine to calm the nerves. The procedure is performed using X-ray guidance to ensure accurate positioning of the needle and usually takes about thirty minutes to complete.

Differential Nerve Block

A differential nerve block is a diagnostic procedure to identify the source of undetermined pain and guide treatment planning. Patients are offered mild sedation to ensure their comfort. A numbing agent is injected into the spine through a catheter to evaluate the effect on pain levels. The procedure takes a few hours and normal activities can typically be resumed the following day.

Discography

Discography is a diagnostic procedure for patients with lower back pain that doesn’t respond to conservative treatment. This test can determine if the pain is due to degenerative changes in or damage to the intervertebral discs, the cushions that separate each vertebrae in the spine.

Under mild sedation, a contrast solution is injected into the spine. Images of the disc are captured with X-ray to determine if the disc is the source of pain and develop an effective treatment plan. The procedure takes about 30 minutes.

Epidural Steroid Injection

Epidural steroid injections are used to treat conditions that affect the spine from the neck to the lower back. These conditions include herniated discs, protruding discs, degenerated discs, osteoarthritis of the spine, spinal stenosis and scar tissue or other changes following neck or lower back surgery.

To perform the procedure, the doctor uses X-ray guidance to precisely inject a small amount of local anesthetic and steroid. The goal is to calm inflammation and reduce pain. Results and the length of time between injections will vary.

Facet Joint Block

A facet joint block is a diagnostic procedure to determine the cause of back or neck pain. The facet joints are small joints between each spine level that may cause pain in the neck, mid back, or low back. A small amount of a numbing agent is injected near the nerves that provide sensation to the facet joint.

Intercostal Nerve Block

Intercostal nerve blocks are used to treat pain and inflammation of the chest wall which can develop after surgery or be caused by a variety of medical conditions including shingles and rib fractures. Depending on which nerves are involved, this type of block may also be used to improve respiratory function.

The image-guided procedure involves injecting a local anesthetic and steroid medication around one or more of the intercostal nerves, which run from the spine to the breastbone under each rib. Intercostal nerve blocks are generally well tolerated and can be performed as an outpatient procedure.

Peripheral Nerve Block

A peripheral nerve block can be used to identify the nerve that is causing pain and to block it. Peripheral nerve blocks are most often used to treat neuralgias, neuritis and osteoarthritis.

Using ultrasound guidance or a nerve stimulator, the doctor locates the nerve to be blocked and injects a local anesthetic in the area surrounding the nerve. The procedure takes approximately 10 minutes to perform.

Stellate Ganglion Block

The stellate ganglion is a bundle of nerves at the base of the neck that control blood flow to the upper extremities, elevate the eyelid, widen the pupil of the eye and control sweat production. A stellate ganglion block may be performed to reduce pain sensations being transmitted by these nerves to the head, neck, arms and hands. It may also be used to improve blood flow in patients with peripheral vascular disease.

Using X-ray or ultrasound guidance, the doctor locates the ganglion and injects a local anesthetic or steroid medication near the area. The procedure takes 5-10 minutes to perform.