Pain management procedures: The basics.
- 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.