Pain management procedures

 

Introduction

  • Pain management procedures (PMPs) are usually not a cure for chronic pain.
  • However they can provide an effective way to improve your overall pain management.
  • PMPs provide pain relief so other long-term pain treatments have a better chance of working: please see the PainHealth website.
  • PMPs allow you to reduce pain medications & engage more effectively in physiotherapy & behavioural therapies.
  • Sometimes pain procedures can actually ‘switch off’ sensitive nerves & produce long-term pain relief.

 

Pain management procedures

IMPORTANT: Please read our information about the risks of pain management procedures

Low back pain

  • Facet joint steroid injection
  • Facet joint (medial branch) nerve block
  • Facet joint neurotomy
  • Cluneal nerve block
  • Sacroiliac joint steroid injection
  • Sacroiliac joint neurotomy

 Leg pain (sciatica)

  • Epidural steroid injection (nerve-root injection)
  • Epidural steroid injection (caudal catheter technique)

Neck pain & whiplash

  • Facet joint (medial branch) nerve block (C5/6)
  • Facet joint (medial branch) neurotomy (C5/6)
  • Muscle trigger point injections
  • Thoraco-cervical epidural catheter steroid injection

Headaches & facial pain

  • Occipital nerve block, pulsed radiofrequency treatment or cryoneutotomy (freezing nerve)
  • Facet joint (medial branch) nerve block (C2/3)
  • Facet joint (medial branch) neurotomy (C2/3)
  • Sphenopalatine ganglion block
  • Stellate ganglion block
  • Trigeminal nerve branch (of the face) blocks and pulsed radiofrequency treatment.
  • Botox injection

Knee pain

  • Knee joint steroid injection
  • Knee joint viscotherapy injection
  • Knee infrapatellar nerve block
  • Adductor canal saphenous nerve block
  • Knee genicular nerve blocks & neurotomies

Hip, thigh & buttock pain

  • Hip joint steroid injection
  • Hip joint obturator nerve branch block
  • Hip joint obturator nerve branch neurotomy
  • Greater trochanteric bursa steroid injection
  • Piriformis injection and pulsed radiofrequency treatment

Shoulder pain

  • Shoulder joint steroid injection
  • Suprascapular nerve block & pulsed radiofrequency treatment
  • Suprascapular nerve block and cryoneurotomy (nerve freezing)

Abdominal wall pain

  • Anterior cutaneous nerve entrapment syndrome (ACNES) block
  • Anterior cutaneous nerve (phenol) chemical neurotomy

Pelvic & tailbone (coccyx) pain

  • Pudendal nerve block and pulsed radiofrequency treatment
  • Ganglion impar block and pulsed radiofrequency treatment
  • Peri-coccygeal steroid injection

Nerve pain

  • Intercostal nerve block, chemical (phenol) or cryoneurotomy (ribs pain)
  • Ilioinguinal or genitofemoral nerve blocks & pulsed radiofrequency treatment (groin or testicle pain)
  • Lateral cutaneous nerve to thigh block & pulsed radiofrequency treatment (pain in outer thigh)
  • Capsaicin (8%) patch therapy (chilli pepper)
  • Botox A subcutaneous field injection
  • Percutaneous Electrical Nerve Stimulation (PENS)

Leg pain

(poor blood circulation)

  • Lumbar sympathectomy

Facet joint steroid injection

  • Facets joints are small stabilizing joints on the outside of the spine.
  • Up to 30% of back & neck pain cases may be due to facet joint arthritis.
  • Using an x-ray machine a small amount of local anaesthetic & steroid (cortisone) is injected into the facet joint.
  • Facet joint injections (FJIs) may reduce back or neck pain for weeks-to-months, but their effects are variable.
  • 1-in-5 patients report a good reduction in pain following FJI.
  • FJIs are more effective in patients over 60 years of age.

Facet joint nerve block

  • Local anaesthetic is injected around the medial branch nerves coming from the facet joints, to test if these joints are the source of  person’s back or neck pain.
  • If the pain settles after the local anaesthetic injection (usually 4 hours or so) it’s likely the facet joints are causing the pain.
  • Click here for patient information about facet joint procedures from the Faculty of Pain Medicine.

Facet joint (medial branch) neurotomy

  • Using an x-ray machine a small needle is placed near the medial branch nerves going to the facet joint.
  • Via this needle a tiny electric charge is used to heat (cauterize) the nerve.
  • This procedures is called a facet joint neurotomy (FJN).
  • A FJN may produce long periods (months) of back-or-neck pain relief in 1-in-4 patients.
  • Before performing a FJN, a patient must first report good pain relief after a facet joint injection or nerve block.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.
  • Click here for more detailed information about facet joint neurotomies.

 Cluneal nerve block

  • Low back & buttock pain may be caused by compression of the cluneal nerves as they pass over the top of the hip bone (iliac crest).
  • Using an x-ray machine the cluneal nerves are blocked with a local anaesthetic & steroid injection as they pass over the hip bone.
  • Cluneal nerve blocks may provide back pain relief lasting for months in 1-in-4 patients.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.

Sacroiliac joint steroid injection

  • Sacroiliac joints (SIJ) are the largest joints in the body.
  • SIJs may cause low back & buttock pain in 20% of cases.
  • Using an x-ray machine local anaesthetic & steroid is injected into the SIJ.
  • SIJ injections may help patients with back pain due to inflammatory arthritis (e.g. ankylosing spondylitis).
  • SIJ injections are less effective in patients with joint ‘wear & tear’ or after an injury (e.g. after childbirth).

Sacroiliac joint neurotomy

  • Using an x-ray machine small needles are placed near the nerves going to the sacroiliac joint (SIJ).
  • Via these needles a tiny electric charge is used to heat (cauterize) the nerves.
  • This may produce long periods (months) of pain relief (for low back & buttock pain) in 1-in-4 patients.
  • Before performing a SIJ neurotomy a patient must first report good pain relief from a SIJ injection.

Muscle trigger point injection

  • Sometimes neck, shoulder or low back pain is associated with tight muscle knots called trigger points.
  • Injecting these trigger points with local anaesthetic via a fine needle is sometimes helpful for muscle pain.

Epidural steroid injection 

  • A protruding spinal disc may irritate a nearby nerve causing leg pain (sciatica).
  • Using an x-ray machine a fine needle is placed into the epidural space next to the irritated nerve.
  • A small amount of local anaesthetic & steroid (cortisone) is injected around the nerve, via the needle.
  • Epidural steroid injections may reduce leg pain (sciatica) for weeks-to-months in 1-in-4 patients.
  • Epidural steroid injections DON’T treat low back pain, only leg pain.
  • Click here for more information about epidural steroid injections from the Faculty of Pain Medicine.
  • Click here for more information about caudally-directed epidural steroid injections.

 Occipital nerve block

  • Many headaches are associated with sensitivity of the nerves in the back of the scalp called the greater & lesser occipital nerves.
  • These nerves are blocked with a local anaesthetic & steroid injection just under the skin of the scalp at the back of the head.
  • Some patients report excellent relief of headaches lasting for months & it’s a relatively low-risk procedure.
  • We sometimes perform C2/3 facet joint steroid injections or nerve blocks in the upper neck to treat headaches.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.
  • Click here for more details.

Suprascapular nerve block

  • Using an ultrasound machine to see the path of the needle, local anaesthetic & steroid is injected near the suprascapular nerve as it passes over the shoulder blade.
  • This is a low risk procedure and many patients report good relief of their shoulder pain.
  • Pulsed radiofrequency treatment: the nerve is temporarily blocked by electrical pulses sent down the needle.
  • Cryoneurotomy: Sometimes we freeze the nerve at – 80 degrees C with a fine probe to switch off nerve activity for months.
  • Chemical neurotomy: On some occasions we permanently dissolved the nerve with a chemical called phenol.
  • Click here for more information about Suprascapular Nerve Blocks.

Knee joint injections & nerve blocks

  • Steroid is injected into the knee joint to temporarily reduce knee pain.
  • Artificial joint fluid (viscotherapy) can be injected into the knee to improve joint lubrication & reduce pain.
  • Knee pain can also be treated with an infrapatellar nerve block (a small sensitive nerve branch just below the knee cap).
  • Using an x-ray machine the three main nerves to the knee (genicular branches) are blocked by performing a neurotomy via a fine needle (cauterizing the nerves).
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked (days-to-weeks) using electrical pulses sent down the needle.

Hip joint injections & nerve blocks

  • Hip pain may be treated by injecting local anaesthetic & steroid into the joint using an ultrasound or x-ray machine to place the needle.
  • The obturator nerve going to the painful hip can be blocked by performing a neurotomy (cauterizing the nerves) via a fine needle placed near the nerve using an ultrasound or x-ray machine.

Greater trochanteric bursa injections

  • The greater trochanteric bursa is a fluid filled sac that acts as a shock absorber for the tendons & muscles of the thigh.
  • If this bursa or nearby tendons become inflamed, pain can develop in the upper-outer thigh, especially with walking, climbing stairs or rolling in bed at night.
  • Using an ultrasound machine to see the path of the needle, local anaesthetic & steroid is injected near the bursa.
  • This is a simple, fast & low-risk procedure; most patients report good relief of their thigh pain.

 Abdominal nerve entrapment blocks

  • Some patients with abdominal pain have a trapped nerve in the muscles of the abdominal wall called the rectus sheath.
  • These trapped nerves can be pinpointed as tender areas in the abdominal wall.
  • Using an ultrasound machine to see the muscles, these nerves are blocked with a local anaesthetic & steroid injection via a fine needle.
  • Sometimes a nerve-dissolving fluid called phenol is injected for longer-lasting pain relief.
  • This is a relatively low-risk procedure which often works well for patients with long-standing abdominal pain.

Pelvic & coccygeal (tailbone) blocks

  • Pain in the pelvic region & tailbone (coccyx) is common (especially in younger females) & has many possible causes.
  • Very often however, a specific cause cannot be found.

Ganglion impar block

  • The ganglion impar is a small bundle of nerve fibres located at the tip of the tailbone (coccyx).
  • These nerves transmit pain signals from the the tailbone & pelvis.
  • Some patients develop tailbone pain (coccydynia) after falling heavily on their bottom & fracturing their coccyx.
  • Some patients develop  pain in the pelvis related to nerve pain or cancer.
  • Using an ultrasound machine to see the needle, local anaesthetic & steroid is injected near the ganglion impar nerves via a small needle through the tailbone.
  • Sometimes a nerve-dissolving fluid called phenol is injected for longer-lasting pain relief.

Pudendal nerve blocks

  •  Pudendal nerves are the two main nerves going from the pubic region (vagina, or penis & scrotum) to the spine.
  •  Sometimes these nerves become trapped in the pelvis & produce nerve pain & numbness in the pubic region.
  •  Using an ultrasound machine to see the path of the needle, local anaesthetic & steroid is injected near the nerves.
  •  The needle is placed through the buttock muscles with the patient laying on their front.

 Other nerve blocks

  • We also perform injections of painful surgical scars, nerve blocks of the groin (groin pain after hernia repair) and intercostal nerves (between the ribs).

PENS

  •   PENS mean percutaneous electrical nerve stimulation.
  •   A fine needle is placed under the skin in a painful area & painless electrical impulses are sent down the needle for 30 minutes.
  •   These electrical impulse reduce nerve firing in the region of pain.
  •   PENS is a low risk procedure that may reduce pain in a localised area for weeks-to-months.
  •   PENS often helps for nerve (neuropathic) pain conditions such as shingles or trapped nerves.

Neuromodulation (spinal cord stimulation)

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