Pain Management Procedures

Epidural Steroid Injections (ESI) are performed for relief of low back pain and/or leg pain. The epidural space is a tissue space surrounding the nerves and spinal cord. The ESI distributes medication to several nerves in the lower spine simultaneously, though it can be directed to the side and level felt to be the likeliest source of one’s symptoms. A series of three injections may be prescribed to obtain maximum benefit.

Procedure
The patient is placed on their stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed to the facet joint using either a CT scan or x-ray guidance. A small amount of anesthetic and steroid medication are injected into the joint. X-ray contrast may be used. A minimum of two levels are injected: the level suspected to be causing the pain, and the one above the area of suspicion. You will likely briefly experience your usual pain and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

Normal activity can be resumed after the procedure; although it’s best to avoid those movements and activities that typically cause you pain.

Please arrive 15 minutes prior to your appointment time. The doctor will talk with you before beginning the procedure to answer any questions. An IV is started in the arm for sedation. You are then taken to the Special Procedure room in the Radiology Department. You are placed on your stomach. You are given pain medications, but you will be awake during the procedure.

After Discharge
We recommend that someone drive you home after a lumbar nerve root block, as your legs may be weak. If you drive yourself, you must wait 30 minutes to make sure that your legs are not weak. You may drive yourself after a cervical or thoracic nerve root block. Normal activity can be resumed after the procedure; although it is best to avoid those movements and activities that typically cause your pain.

Side Effects
If you are diabetic, the use of steroids may increase your blood sugar levels for several days. Please consult your physician or your diabetes doctor about this treatment. The spread of anesthetic around the nerve can cause temporary weakness and/or numbness. You may have an allergic reaction to the iodine in x-ray contrast. Occasionally, the needle is inadvertently passed to the next tissue layer where steroid should not be deposited. If this occurs, you will be required to rest at the hospital for two to three hours, and have the procedure rescheduled for several days later.

Facet pain is neck or back pain made worse by twisting the body or bending backwards. The area is painful if it is pressed. The pain radiates (spreads out) from your back or neck. For example, pain may extend from your low back to your hips or legs. Please inform the x-ray staff if you have had reactions to x-ray contrast in the past. The purpose of this procedure is to determine if your pain arises from the facet joints, and to provide pain relief. A series of three injections may be prescribed to obtain maximum benefit.

Procedure
The patient is placed on his/her stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed to the facet joint using either a CT scan or x-ray guidance. A small amount of anesthetic and steroid medication are injected into the joint. X-ray contrast may be used. A minimum of two levels are injected—the level suspected to be causing the pain, and the one above the area of suspicion. You will likely briefly experience your usual pain, and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

After Discharge
Normal activity can be resumed after the procedure; although it’s best to avoid those movements and activities that typically provoke you pain.

Side Effects
If you are diabetic, the use of steroids may increase your blood sugar levels for several days. Please consult your physician or your diabetes doctor about this treatment. Report any fever or worsening pain to the radiology nurse. You may have brief weakness and/or numbness due to the anesthetic spreading around the nerves. Patients can react to the iodine in the x-ray contrast. Please inform x-ray staff if you have had reactions to x-ray contrast in the past.

Nerve root blocks (NRB) are performed to relieve pain in one’s neck, back, or legs, and to confirm whether one’s pain and/or numbness arises from irritation of a particular nerve. The nerve root emerges from an opening near the spinal column and medication is deposited precisely at that site. A series of three injections may be prescribed to obtain maximum benefit.

Procedure
The patient is placed on his/her stomach. The skin is cleansed with an antiseptic solution and numbed with a local anesthetic. A needle is passed to the nerve root using either a CT scan or x-ray guidance. A small amount of contrast may be used. Anesthetic and steroid medication are then injected into the area surrounding the nerve. The procedure takes approximately 30 minutes.

After Discharge
We suggest that someone drive you home after a lumbar nerve root block, as your leg may be weak. If you drive yourself, you must wait 30 minutes to make sure your legs are not weak. You may drive yourself after a cervical or thoracic nerve root block. Normal activity can be resumed after the procedure; although it is best to avoid those movements and activities that typically provoke your pain.

Side Effects and Risks
If you are diabetic, the use of steroids may increase your blood sugar levels for several days. Please consult with your physician or your diabetes doctor about this treatment. Report any fever or worsening pain to the radiology nurse. You may have temporary weakness and/or numbness due to the anesthetic’s effect on the nerves. You may have an allergic reaction to the iodine in the x-ray contrast. Please inform x-ray staff if you have had reactions to x-ray contrast.

Vertebroplasty procedures are used for compression fractures of the spine. It can also be used for bone pain related to cancer. Compression fracture is the collapse of the individual bones of the spine (vertebrae), usually due to osteoporosis. Osteoporosis is the loss of bone structure, in which bone becomes more porous (contains more holes). As the bone becomes increasingly fragile, the weight of the body compresses the vertebrae, causing pain. When conservative treatments (pain medication, bedrest, a brace) don’t work, percutaneous vertebroplasty is the treatment of choice.

Procedure
You will check in at the Ambulatory Treatment Unit (ATU) at Valley Medical Center. The doctor will talk with you before the procedure to answer any questions. An IV is started in the arm for sedation. You are then taken to the Special Procedure room in the Radiology Department. You are placed on your stomach. Patients are given pain medications, but will be awake during the procedure. The collapsed vertebrae is viewed under fluoroscopy (x-ray). The cement (polymethyl methacrylate) is then mixed and injected into the bone. The cement hardens in five to seven minutes. Multiple vertebrae may be treated at this time. The total procedure takes approximately two hours. You will then return to ATU to lie on your back for about one hour. The second hour you can slowly begin to move. Expect to stay in the ATU for two to four hours after this procedure. You may stay overnight if you are uncomfortable going home. Please have someone drive you home after the procedure.

After Discharge
In the first 24 hours after the procedure, plan to rest and do not drive a car. The day after the procedure, expect some soreness. Within 48 hours your pain should be reduced. 80% of patients report marked reduction in pain by the second day. You should be able to resume your normal activity slowly. The radiology nurse will call you at intervals of two weeks, two months, and six months. Feel free to call earlier if you have concerns. It is important that you follow up with your health care provider to begin medicines to help treat the osteoporosis. These drugs help to build bone, and reduce bone loss.

Side Effects and Risks
There is a risk of infection anytime a needle is inserted into the body. If you have a fever, redness and/or discharge at the needle insertion site, increased pain, or new pain, please report this to the radiology nurse. There is a small risk of nerve damage, which the doctor will explain at the time of the procedure.

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