Pain management procedures

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.

Neuromodulation (spinal cord stimulation)

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