IMPORTANT
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.”
- 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.
Below is a list of treatments we offer, for more information on some of the types of treatment, please see:
- Facet joint steroid injection
- Facet joint (medial branch) nerve block
- Facet joint neurotomy
- Cluneal nerve block
- Sacroiliac joint steroid injection
- Sacroiliac joint neurotomy
- Epidural steroid injection (nerve-root injection)
- Epidural steroid injection (caudal catheter technique)
- 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
- 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.
- Injection of other medications may be appropriate depending on your specific situation.
- Knee joint steroid injection
- Knee joint viscosupplementation injection
- Knee infrapatellar nerve block
- Adductor canal saphenous nerve block
- Knee genicular nerve blocks & neurotomies
- 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 joint steroid injection
- Suprascapular nerve block & pulsed radiofrequency treatment
- Suprascapular nerve block and cryoneurotomy (nerve freezing)
- Anterior cutaneous nerve entrapment syndrome (ACNES) block
- Anterior cutaneous nerve (phenol) chemical neurotomy
- Pudendal nerve block and pulsed radiofrequency treatment
- Ganglion impar block and pulsed radiofrequency treatment
- Peri-coccygeal steroid injection
- Intercostal nerve block, chemical neurolysis or cryoneurotomy (rib 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)
- Medications that can be applied topically (directly to the skin) – may or may not be appropriate, will need discussion with your treating specialist.
- Injections of other medications that can help with nerve pain – may or may not be appropriate, will need discussion with your treating specialist.
- Percutaneous Electrical Nerve Stimulation (PENS)
- Lumbar sympathectomy
- 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.
- 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.
- 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.
- 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 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).
- 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.
- 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.
- 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.
- 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.
- 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.