Pain Management & Back Procedures

Interventional radiology is revolutionizing modern healthcare by changing the way many conditions, including back pain and other back problems, are treated. At SIR, we understand how difficult living with pain can be. That’s why our philosophy is to treat the whole person and to include family in every step of the process, from providing critical information to maximizing patient comfort during and after treatment for pain. We try to accommodate any special needs and will inform the patient of special preparations prior to treatment.

Pain Management & Back Procedures

Here are some important facts about back pain:

  • Two primary causes of back pain are pinched nerves and disc pain.
  • 98% of lower back pain is the result of a pinched or irritated nerve in the back.
  • Every year 15 million doctor office visits are made for lower back pain.
  • More people age 45 and under visit their doctor for lower back pain than for any other ailment.

Herniated Disc/Pinched Nerve

With a herniated disc, the disc itself is not painful, but rather the leakage from the disc is pinching or irritating a nerve. The resulting pain is referred to as radiculopathy, or pain that radiates from the affected nerve to other parts of the body. Pain from a pinched nerve in the lower back that radiates down the leg is often referred to as sciatica.

In the past, treatment for a herniated disc meant rest, pain medications, injections, and physical therapy. For those who did not respond to these treatments, surgery—and a long, difficult recovery—was the only alternative. But now, a new breakthrough interventional radiology technique called Plasma Disc Decompression provides an option when conservative treatments have not been successful and the patient is not yet ready for surgery.

Disc Pain

With a degenerated disc that causes low back or leg pain, the disc space itself is the source of pain. This is commonly referred to as axial pain.

Spinal Fractures

Along with pinched nerves and disc pain, spinal fractures may result in considerable discomfort and pain. Spinal fractures are often caused by osteoporosis, a weakening of the bones that may also lead to curvature of the spine. In the past, those with osteoporosis either lived with the curvature, called “widow’s back,” or had difficult, often painful surgery. Vertebroplasty and Kyphoplasty are procedures that offer safe, pain-free alternatives to surgery or a lifetime of suffering.

Pain Management Procedures

Arthrogram

An arthrogram is a series of images performed to evaluate the condition of a joint after a contrast agent is injected to the joint. At SIR, arthrograms frequently use a special type of x-ray called fluoroscopy to guide needle placement into the joint, inject the appropriate amount of contrast, and take pictures of the joint. Arthrograms show the surfaces of soft tissues lining the joint as well as the joint bones, whereas a regular x-ray shows only the joint bones. Arthrograms are often used to study shoulders (for rotator cuff tears) but have diagnostic and therapeutic uses for other areas, such as hips, knees, ankles, wrist, elbow, and jaw.

Celiac Plexus Block

The celiac plexus is a bundle of nerves that surrounds the aorta, the main artery in the abdomen. While these nerves control basic nerve functions, they can carry pain information from the abdomen back to the spinal cord and brain. A Celiac Plexus Block is an injection of medication that helps relieve this abdominal pain, often caused by cancer or chronic pancreatitis.

Discogram

A discogram is a diagnostic test used to determine if the source of back pain may be an intervertebral disc, a disc that acts as a cushion between the vertebrae and allows motion of the vertebrae. During a discogram, dye is injected into the soft center of the disk, sometimes reproducing the patient’s back pain. It may be necessary to inject several intervertebral discs to pinpoint the cause of the back pain.

Epidural Steroid Injection (ESI)

Epidural steroid injection (ESI) may bring relief to those who suffer from low back pain or sciatica. It may be used to treat neck pain and mid-back pain as well. ESI on the neck and cervical spine may be complicated and risky, and Dr. Grubbs is one of the few physicians in the Sarasota-Bradenton area who performs this procedure.

ESI is an outpatient procedure that takes about 20 to 30 minutes. Before the procedure, the patient is brought into the CT suite and lies flat on the stomach. Using a local anesthetic, one of SIR’s board-certified anesthesiologists numbs the patient’s lower back. Then utilizing state-of-the-art CT imaging, Dr. Grubbs safely guides the needle into the epidural space. He first injects contrast to make sure the needle is accurately placed within the epidural space, and he then injects the steroid. The patient may feel pressure as the steroid is injected, but this should not be painful. After the procedure, the patient spends about 30 minutes to an hour in the post-op recovery area and then may go home with a driver.

Facet Block

The facet joints are small stabilizing joints located between and behind adjacent vertebrae. They are can become painful due to arthritis, injury, or stress from being in almost constant motion. Facet joint disorders are among the most common of recurring low back and neck problems. The cervical, thoracic, and lumbar facet joints can be injected with a small amount of local anesthetic and/or steroid to anesthetize them and block the pain. The injection helps diagnose the cause and location of pain and also provides longer term pain relief by reducing inflammation.

Intravenous (IV) Ketamine

IV Ketamine is an infusion therapy that treats a variety of pain conditions:

  • Neuropathic pain
  • Centralized or intense widespread pain
  • Complex regional pain syndrome, or CRPS—chronic or excessive pain that most frequently affects one of the limbs (arms, legs, hands, or feet) and usually occurs after an injury or trauma to that limb)
  • Hypersensitivity or hyperalgesia—an extreme reaction to a stimulus that is normally only slightly painful, such as a pinch
  • Allodynia—pain from a stimulus that normally does not cause pain, such as touch or temperature

IV Ketamine may reverse the symptoms for these conditions by blocking the specific pain receptors. It may be a viable option for pain management if conventional approaches, such as medications, physical therapy, and standard clinical interventions, are not successful in alleviating the pain.

IV Ketamine therapy is also used to treat depression and is especially effective in treating posttraumatic stress disorder (PTSD), resulting in often significant and rapid reduction in the severity of PTSD symptoms severity.

IPL Laser Therapy

RevitaLife offers the most technologically advanced and powerful Class IV Cold Laser Therapy available today as a safe and effective option to treat pain and inflammation.

Class IV Cold Laser Therapy uses a laser beam to activate certain areas of the body to generate very specific types of response. The type of response that can be obtained depends on the strength of the laser beam. Approved by the FDA in 2006, the Class IV Cold Laser stimulates cellular activity, expediting the healing processes to reduce inflammation and repair damaged tissue.

Class IV Cold Laser Therapy is a deep-tissue penetration that significantly increases the body’s cellular production of adenosine-triphosphate (ATP) to reduce inflammation and heal the affected area. This powerful deep-tissue penetration safely and effectively treats more conditions than traditional low-level laser therapy.

Advantages of Class IV Cold Laser Therapy include:

  • Provides healing and immediate pain relief with no side effects, drug interaction effects, or invasive surgery
  • Treats acute and chronic conditions as well as post-surgical pain
  • Takes only about ten minutes

Numerous studies have shown that Class IV Cold Laser Therapy can help with a variety of conditions. The following list represents some common uses of this therapy but is not all-inclusive of the conditions that can be helped:

  • Arthritis
  • Back pain
  • Bursitis
  • Carpal tunnel syndrome
  • Diabetic complications, e.g., neuropathy and foot ulcers
  • Fibromyalgia
  • Heel spurs
  • Knee pain
  • Migraines
  • Neck pain/whiplash
  • Nerve root pain
  • Plantar fasciitis
  • Postoperative pain
  • Repetitive stress injuries
  • Shingles
  • Shoulder pain
  • Strains and sprains
  • Tendonitis
  • Tennis elbow
  • TMJ

Other conditions that may be helped by Class IV Cold Laser Therapy include:

  • Wounds that are slow to heal and have been resistant to treatment, including slow healing fractures
  • Multiple trigger points (sore spots in the muscles) that do not go away, including areas associated with fibromyalgia
  • Soft tissue injuries
  • Ulcers

At RevitaLife, we use technology from K-Laser to provide our patients with drug-free, surgery-free laser therapy to relieve pain.

For a detailed article about K-laser's treatment and benefits, click here. To see a video, click here.

Plasma Disc Decompression

The spine is made up of a series of bones, or vertebrae, connected by discs. These discs have a strong outer surface called the annulus and a soft, gel-like center called the pulposus. If the outer layer is damaged or weakened by age, the gel of the pulposus can leak. This is referred to as a slipped or herniated disc, and it can press on nerves causing pain, numbness, tinkling, or weakness in the in the leg and/or arm, as well as the neck and/or arm.

For those with herniated discs who have not responded to conventional treatment that includes meds, rest, injections and/or physical therapy but are not ready for surgery, Plasma Disc Compression (PDD) offers a safe and effective alternative. However, this procedure is not for those with spinal fractures or degenerative disc disease.

During this procedure, a needle is placed into the disc using state-of-the-art CT imaging for guidance. A device is then inserted through the needle and into the center of the disc where excess tissue is removed. This reduces the pressure on the vertebrae, which in turn eases pressure and reduces pain. Plasma Disc Compression is extremely safe, with few risks or complications. To accelerate healing of the herniated or bulging disc, PDD can be combined with Platelet-Rich Plasma (PRP) and stem cell procedures.

For more information about PRP and stem cell procedures, click here.

Dr. Grubbs and other interventional radiologists play a critical role in developing new minimally invasive techniques for treatment of spinal fractures, and they continue to investigate new cements that have the potential to convert to bone and actually simulate bone growth.

Radiofrequency (RF) Nerve Destruction

RF Nerve Destruction is a nonsurgical technique used to manage chronic pain. With this technique, heat energy is created and delivered via an RF needle to targeted nerves that carry pain impulses. The resulting nerve lesion, or area of tissue destruction, often provides long-term relief and is appropriate for patients who have already undergone injection techniques for pain. RF Nerve Destruction can reduce or eliminate pain for a few months or up to as long as a year.

Sacroiliac (SI) Joint Pain

The SI joints are located next to the spine and connect the sacrum with the hip on both the left and right sides. Inflammation or dysfunction of these joints is responsible for an estimated 15-20% of chronic low back pain. Historically, the treatment of SI joint pain has been one of the most challenging conditions to treat. Recently, however, several treatments have proven to be effective in reducing this type of pain.

  • SI Joint Injections—Injections are performed for either diagnostic or therapeutic purposes, or they may be both simultaneously diagnostic and therapeutic in nature. Using fluoroscopy for guidance, contrast is injected into the joint to ensure proper needle placement and insertion of a numbing medication. Following the procedure, the patient is asked to perform some normal activities to determine if the pain still persists. If the pain is significantly diminished, the diagnosis is confirmed that the SI joint is the source of the problem. The patient may undergo additional injections and/or be referred to physical therapy to promote further pain reduction.
  • Sinergy™ Cooled Radiofrequency (RF)—This procedure is a minimally invasive treatment that uses cooled RF energy to target the nerves causing chronic pain. Circulation of water through the Sinergy ™ device while heating the nerve tissue enables the physician to create a large-volume treatment area. Patients may experience relief for up to 24 months with improved physical function and reduced use of medications.

Sacroplasty

Also referred to as sacral vertebroplasty, this procedure is used for patients who have painful sacral insufficiency fractures resulting from osteoporosis or osteopenia, rheumatoid arthritis, significant steroid use, anorexia, high pelvic radiation, hip joint replacement, liver transplant, and other causes. The sacrum, also known as the tail bone, is the large, triangular bone located between the base of the spine and the coccyx. Sacral insufficiency fractures may result in the inability to walk, walking slowly with pain, or immobility due to pain in the buttocks, back, hip, groin and/or pelvis. Using a CT scanner and fluoroscopy, Sacroplasty involves the injection of a bone cement that creates internal support and results in rapid and significant relief.

Selective Nerve Root Block

The nervous system controls everything we do and feel so when a nerve is damaged, it will signal the body to feel pain. If severe leg or arm pain is impacting your quality of life, a Nerve Root Block may be beneficial. This procedure is similar to other injections used to treat pain. Like an Epidural Steroid Injection, the patient is asked to lie flat on the stomach. The skin is numbed with a local anesthetic by one of SIR’s board-certified anesthesiologists. Dr. Grubbs will then use advanced CT imaging to guide the needle to the nerve root. After he injects contrast to confirm the needle’s location within the nerve root, he injects a compound of medicine that includes a local anesthetic and a steroid.

The procedure takes about 20 to 30 minutes, followed by about 30 minutes in post-op recovery.  Immediate pain relief should occur in the days following the procedure, but the Nerve Root Block may need to be repeated in a few months.

Stellate Ganglion Block

A Stellate Ganglion Block is an injection of local anesthetic into the sympathetic nerve tissue of the neck, located on both sides of the voice box in the neck. This injection is performed to diagnose and manage pain in the face, head, arms, and chest caused by nerve injuries, shingles, or persistent angina. It also improves mobility and reduces swelling, color, and sweating changes in the upper extremity. The Stellate Ganglion Block can be for diagnostic or therapeutic purposes, or both.

Trigger Point Injection

A trigger point is an area of spasm and inflammation in skeletal muscle. Common sites of trigger points include the upper and lower back, shoulder areas and, less commonly, in the extremities. A palpable nodule may be present in the muscle where the trigger point is located. There is much tenderness in the area of the trigger point, and pain may radiate from the trigger point to an area around it. An injection is administered directly into the trigger point and may or may not include an anesthetic, corticosteroid, or mixture. The injection makes invalidates the trigger point and relieves the pain.

Spinal Fractures from Osteoporosis

Pain Management & Back Procedures

Almost 700,000 spinal bone fractures occur every year, mostly to women over the age of 60 as a consequence of osteoporosis, a condition marked by the progressive weakening of bones. While age and gender are risk factors for this condition, other risk factors for osteoporosis include:

  • Family history of osteoporosis
  • Post-menopausal
  • Abnormal absence of menstrual periods
  • Anorexic or bulimic
  • Lack of calcium in the diet
  • Long-term use of corticosteroids or anticonvulsants
  • Lack of exercise
  • Smoking
  • Excessive alcohol consumption

Spinal fractures are considered to be the most debilitating and feared result of osteoporosis. These “compression” fractures are caused when the weakened vertebrae of the spine collapse. When more than one vertebrae collapse, deformities like “widow’s hump” occur. Constant pain, limited activity, and reduction in the quality of life are generally the result. Much more difficult to manage than other fractures, spinal fractures can be managed by surgery, but this is risky and should be used only as a last resort.

Vertebroplasty and Kyphoplasty, described below, are two procedures used in the treatment of spinal fractures related to osteoporosis. In some cases, they also may be used where the vertebrae are damaged by cancer.

Cement Vertebrae


Vertebroplasty

For many years, reduced activity and pain medications, many of which have problematic side effects, were the only options for relief of pain from spinal fractures. About ten years ago, a minimally invasive procedure called Vertebroplasty was developed with outstanding results. An estimated 75-90% of people treated with Vertebroplasty report complete or significant reduction in pain, and relief is often immediate. Vertebroplasty is an extremely safe procedure with few risks or complications.

During this outpatient procedure, a bone “cement” is inserted to stabilize and prevent further deterioration of the collapsed vertebrae. Early intervention, preferably within the first few months following a fracture, provides the best results. Vertebroplasty may be used in the near future in high-risk patients to treat fragile vertebrae before they break.

Kyphoplasty Procedure

Kyphoplasty

Another relatively new procedure, known as Kyphoplasty, restores the collapse in the vertebrae and is used to correct abnormal wedging of the collapsed vertebra. Kyphoplasty prevents loss of height and the “hunchback” that is associated with spinal fractures. It is most effective when performed within six weeks of the fracture.

In this procedure, using CT fluoroscopy, a balloon catheter is (1) guided into the affected area, (2) inflated to the maximum, (3) then deflated and removed (see photo). The cavity created by the balloon is filled with the bone cement that corrects the abnormal wedging and helps restore the spine to more normal alignment.

After Kyphoplasty, people often have less pain and require fewer pain medications. Because they have improved mobility, they have a better quality of life.