Pain Management
Radiofrequency Lesioning
The nervous system of the body is the network through which important messages are sent at extremely high speeds. These messages can be vital to the human’s survival, but in some cases can be too inflated or erroneous in nature. In these cases, the extra notes transferring through the system can be converted into disproportionate amounts of pain, especially when a nerve cord itself is disturbed. Radiofrequency nerve ablation is used to dull these messages superficially, so they either cease to exist or resemble the relevant amount of pain.
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Spinal Cord Stimulator
A spinal cord stimulator is an electronic device that is implanted in the body to help relieve chronic pain. Also known as a dorsal column stimulator, the device sends low electrical currents through wires placed near the spinal cord, allowing patients to control when pain relief is offered.
The device does not cure chronic pain, but usually provides a 50% or greater decrease in pain and allows patients to be more active and require less pain medication. This procedure is usually considered when other solutions, such as surgery, injections and medications, have failed. Before implantation, patients will often be asked to go through a trial period with an external device. The trial will test patients’ pain levels and see if they improve with the help of the device.
During the implantation of the permanent device, wires are fed with a needle and positioned on the spinal cord. Placement of the device is dependent on the site of the pain. The device can be removed if necessary. The battery of the device must be replaced every 2 to 5 years. Proper care following the procedure is required and includes limiting movement and avoiding driving for the first few weeks.
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Spinal Tap Diagnostic
Also known as a lumbar puncture, a spinal tap is a diagnostic procedure that involves removing a small amount of cerebrospinal fluid (CSF) from the spine to analyze it and help detect or rule out conditions such as meningitis, encephalitis, multiple sclerosis and certain cancers.
During the spinal tap procedure, you will lie on your side while a needle is inserted into the spinal canal to measure its internal pressure and carefully remove a small sample of fluid to be analyzed. A blood sample will also be removed from the arm and tested with the spinal fluid. This procedure usually takes about 45 minutes and is performed with a local anesthetic to minimize discomfort.
Once the CSF has been removed, it is examined for a number of different factors in order to accurately diagnose the patient’s condition. Lab technicians analyze the fluid for:
- General appearance
- White blood cell levels
- Protein levels
- Glucose levels
- Bacteria and fungi
After the spinal tap procedure, some patients may experience a spinal headache, bloody discharge or infection as a result of the needle injection. You may be instructed to lie flat for some time after the procedure, and avoid exercise and other strenuous activity for the first day after the spinal tap. The results of this test will be available within a few days. Your doctor will decide upon the best treatment option for you after evaluating the results of your procedure.
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Selective Nerve Blocks
Selective nerve root blocks, or SNRBs, are steroid injections that help doctors diagnose the exact source of low back and leg pain arising from the compression and inflammation of one of the spine’s many nerve roots. Nerve root damage is often associated with a far lateral disc herniation. SNRBs can temporarily relieve nerve root pain if the injection is delivered directly to the damaged area.
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Sympathetic Nerve Blocks—Stellate, Lumbar, Thoracic
A sympathetic nerve block involves the injection of a medication to numb a nerve and interrupt the pain signals it sends to the brain. It is used to both diagnose damage and treat pain caused by the sympathetic nerves, which run throughout the spine. The sympathetic nerves are responsible for essential bodily functions, including the regulation of blood vessels, heart rate, perspiration and more.
A therapeutic nerve block is used to treat pain and typically contains a local anesthetic that will relieve pain. Nerve blocks used to treat chronic pain can work for up to 6 to 12 months and can be repeated as needed. Diagnostic nerve blocks insert an anesthetic for a certain amount of time to determine the source of the pain.
Sympathetic nerve blocks can be performed along several areas of the spine. A stellate block focuses on the sympathetic nerves in the upper spine, including those that run to the chest, arms, neck and head. A lumbar sympathetic nerve block targets the sympathetic nerves of the lower spine that affect the legs and feet. A nerve block of the thoracic region involves the sympathetic nerves in the middle of the spine that reach the abdomen.
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Transforaminal Epidural Steroid Injections
A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the injection often feels like just pinching and pressure.
Immediate pain relief is found because of the injection of anesthesia, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with pain that radiates through the arms or legs rather than just back or neck pain.
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