Pain Management


Discography, or a discogram, is an injection that helps doctors locate a painful disc before performing lumbar fusion surgery in patients whose pain has not responded to conservative treatments. A discogram may be ordered when other diagnostic injections have failed to pinpoint the source of the pain, which may affect the back, legs, groin or hips.

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Epidural Blood Patch

Pain Treatment | Pain Management | Wilsonville OR | Portland ORAn epidural blood patch is an injection of your own blood into the epidural space, which surrounds the spinal cord. It is done for patients experiencing severe headaches after receiving a spinal injection. These headaches occur as a result of spinal fluid leaking into the epidural space. An epidural blood patch stops the leak, making the headache go away.

An epidural blood patch only requires local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. The skin on your back, as well as the skin surrounding one of your veins, is cleaned with an antiseptic solution. Then, a small intravenous catheter is inserted into your vein. Once the needle has been properly positioned over the epidural space, your doctor will draw about 20-25cc of blood from your vein and inject it into the epidural space. While an epidural blood patch only takes a few minutes to perform, you will remain at our office for about an hour and a half; this includes consulting with your doctor before the procedure and recovery room observation afterwards.

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Facet Joint Injection

A facet injection is a minimally invasive treatment option for pain caused by inflamed facet joints. Facet joint pain is often related to spinal stenosis, sciatica or arthritis and is characterized by neck, arm, low back or leg pain. Each vertebra has four facet joints that connect it to the vertebra above and below. The injection may also be used as a diagnostic test to determine if facet joint inflammation is the source of a patient’s pain.

A facet injection is a combination of a long-lasting steroid and a local anesthetic that are injected either into the joint capsule or its surrounding tissue. The steroid reduces inflammation and can relieve pain for a few days to a few years. This procedure can be repeated up to three times a year for those who experienced successful but short-term pain relief.

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Interlaminar Epidural Steroid Injections

Pain Treatment | Pain Management | Wilsonville OR | Portland OREpidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.

Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself. Intralaminar ESIs require inserting the needle between the lamina, a small section of bone that covers the spinal cord, of two vertebrae. The medication enters the epidural space in the midline and from there is able to reach the nerve roots on either side of the spine.

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Medial Branch Blocks

A medial branch block is a minimally-invasive procedure to diagnose and treat neck or back pain. This procedure can determine whether a facet joint-which connects the bones of your spine, providing support as you move-is the source of your pain. Next to the facet joints are the medial branch nerves, which transmit pain signals from these joints to your brain.

Before undergoing a medial branch block, you will be given intravenous medication to help you relax. With the assistance of imaging technologies, a small needle will be inserted near your medial branch nerve. Once it is situated properly, an anesthetic will be injected through it.

The effectiveness of a medial branch block varies depending on your individual condition. Patients whose pain returns after a short period of time may require a different form of treatment if it is confirmed that the facet joint is not the source of the pain.

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Peripheral Nerve Blocks

A nerve block is a procedure used to treat or diagnose severe pain. The block is placed by injecting an anesthetic into the affected nerve to either numb the pain or determine if the pain is coming from the nerve. If the pain is relieved when the block is injected, it can be assumed that the pain is caused by the nerve. After a diagnostic nerve block, the procedure may be repeated as a more long-term treatment method.

Nerve blocks are placed with the help of ultrasound imaging, and injected directly into the affected nerve. Pain outside the spinal area is diagnosed with a peripheral nerve block, which may be inserted in the occipital nerves in the cervical area, the ilioinguinal nerve in the pelvic area or other motor nerves. Nerve blocks are not an option for all patients and can cause serious side effects.

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