Epidural Steroid Injections provides relief by delivering either anti-inflammatory medications such as steroids and or local anesthetics (numbing medication) into the spinal canal where the nerves originate from the spinal cord. These injections can be performed at different parts of the spine depending on the symptoms. These areas are cervical, thoracic or lumbar. Since the nerves may be irritated or compress from a herniated disc or changes in the structure of the vertebra, this may alleviate symptoms to allow for further rehabilitation and hopefully avoid surgery. The epidural is the space outside of the spinal canal where spinal nerves come out the spinal cord, pass through the epidural space, and are distributed to the body. On epidural injections are performed under fluoroscopy X-ray imaging for optimal precise location. Finally depending on the approach, these injections are also considered either transforaminal or translaminar. These injections help radicular or sciatic pain.
Caudal epidural block is the injection is essentially similar to epidural injections. However, the approach is through the sacral canal and the sacral bone. Procedure is used to evaluate and treat conditions of the pelvic, bladder, perineal, genital, rectal and lower extremity. It may be used to palliate acute pain in adults and children-postoperative pain. .
The facet (zygapophysial) joint is a small joint that connects the posterior portion of the adjunct vertebras. It is affected by degenerative/inflammatory processes and trauma. It is one of common causes of neck and back pain. Cervical intra-articular block could be both diagnostic and therapeutic. The medial branch(s) may also be blocked to determine if radiofrequency may be an option for long-term treatment. The medial nerve is a branch of the posterior nerve root that supplies sensation to the facet joint. So, it may be effective in controlling persistent chronic facet joint pain.
The use of radiofrequency (RF) denervation of the medial branch achieves the long term control of the facet pain syndrome. In other words, the nerve impulses are disrupted by heating up the nerves with radiofrequency. The temporary or long-term relief can provide opportunity for rehabilitation measures.
The Stellate Ganglion is the sympathetic nerve origin to supply the arm and face. Blocking this ganglion will decrease the sympathetic outflow to the distributed area. It is the therapeutic approach for the complex regional pain syndrome (Reflex sympathetic dystrophy) and acute vascular insufficiency.
These specialized blocks are used to alleviate symptoms in certain pain syndromes that is mediated by the sympathetic nervous system. Lumbar sympathetic ganglions lie on the sides of lumbar vertebras. Blocking these ganglions/nerves will interrupt the transmission of the sympathetic nerves, which mediate the pain sensation in some pain disorders. The indications include: circulatory insufficiency in the leg, reflex sympathetic dystrophy, causalgia or complex regional pain syndrome (CRPS) pain.
Celiac plexus is also a network of sympathetic nerve fibers that transmit the pain signal from abdominal organs. The indications of this block maybe used to evaluate and manage abdominal pain disorders.: acute and chronic pancreatitis, pancreatic cancer pain, abdominal angina associated with visceral arterial insufficiency.
Spinal cord stimulation implant is an advanced pain management procedure. It is based on the “gate control theory”. Large myelinated A-beta fiber stimulation could “close the gate” in the spinal cord and manipulate the pain signals carried by C-fibers and A-delta fibers. It involves the placement of stimulating leads in the epidural space and the implant of a pulse generator. The indications include post back surgery pain syndrome, complex regional pain syndrome and peripheral ischemia. If the initial trial is successful, then a permanent generator system may be placed. Similar to a cardiac defibrillator.
Dr. Dominguez is no longer implants these devices. However, on the case by case basis we may accept to manage the required pump refills. Briefly, Intrathecal infusion pump implant involves the placement of a catheter in the spinal cannel and implantation of an infusion pump. It provides an access to deliver the medication in the spinal cannel continuously. It could be used in spasticity condition and intractable cancer pain and non-malignant pain.
Peripheral nerve infusion is mostly used for acute pain management. A small stimulating lead is placed juxtaposition (right next to) to the affected peripheral nerve under ultrasound. Similar to spinal cord stimulation, the frequency and amplitude of stimulation is adjusted to effective pain relief. If the initial trial is successful, then a permanent generator may be placed. Similar to a cardiac defibrillator.
Recommended only for myofascial pain syndrome as indicated below, with limited lasting value. A trigger point is a discrete focal tenderness located in a palpable taut band of skeletal muscle, which produces a local twitch and/or may radiate to different parts of the body. These injections may provide temporary or prolonged relief and allow for rehabilitation modalities to be implemented.
Trigger point injections with a local anesthetic with or without steroid may be recommended for the treatment of chronic low back or neck pain with myofascial pain syndrome when all of the following criteria are met: (1) Documentation of circumscribed trigger points with evidence upon palpation of a twitch response as well as referred pain; (2) Symptoms have persisted for more than three months; (3) Medical management therapies such as ongoing stretching exercises, physical therapy, NSAIDs and muscle relaxants have failed to control pain; (4) Radiculopathy is not present (by exam, imaging, or neuro-testing); (5) Not more than 4 injections per session; (6) No repeat injections unless a greater than 50% pain relief is obtained for six weeks after an injection and there is documented evidence of functional improvement; (7) Frequency should not be at an interval less than two months; (8) Trigger point injections with any substance (e.G., saline or glucose) other than local anesthetic with or without steroid are not recommended.
The history of acupuncture spans thousands of years. It is one of the traditional Chinese medicines. Disposable needles are inserted in the body according to the acupuncture points and meridians. Acupuncture is recognized by the World Health Organization as an effective treatment of pain. Several evidenced-based studies have demonstrated the efficacy of acupuncture in treating pain. Acupuncture is not a stand-alone treatment but should be considered as part of multidisciplinary approach, especially in patients who wish to explore non-pharmacologic strategies. Although we no longer provide this service in our office, we support this viable option and therefore we will be happy to refer to an acupuncturist.
If the patient requires physical therapy, they will be referred to a facility of their choice. We have several physical therapists in our building.
Will do I need to make an appointment?
Since most patients who seek our services have long-standing history of persistent pain, medical records are very important. Furthermore, due to increasing regulation on pain management medication, it is important that we follow medical state guidelines to ensure that we are delivering high quality care at all levels. Once we receive the records, they will be reviewed and then an appointment will be made.
Do we accept credit cards?
Yes, we do. With the exception of American Express, we accept all major credit cards.
Where I get other information regarding similar services?
What are the side effects of steroid medications?
Does the building have an elevator?
Yes, the building has an elevator.