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Advanced Treatment for Chronic Pain

Dr. Bakshi performs a wide range of advanced pain management treatments for chronic pain. These treatments include the following:

Epidural Steroid Injections (ESI): Cervical, Thoracic, and Lumbar

Epidural steroid injections, also called ESIs, are an effective method to treat inflammation leading to back pain. The injections reduce nerve inflammation produced by a narrowing of the spinal passage through which the nerves travel. The treatment is performed by carefully injecting the anti-inflammatory medication into the epidural space, guided by X-ray. The epidural space is inside the bony spinal canal, outside the tube holding the spinal fluid (thecal sac). Local anesthetic may be injected along with the steroid medication. Several methods may be employed:

  • Laminar ESI: The steroid injection is placed in the epidural space to decrease lower back or leg pain resulting from compressed or inflamed nerves. The steroid reaches the nerves and discs to reduce inflammation and pain. These injections can reduce the pain associated with spinal stenosis, herniated discs, and inflamed nerves.
  • Caudal: The medication is injected into the sacral hiatus at the bottom of the spine, above the tailbone to relieve lower back and leg pain resulting from sciatica, herniated disks, bone spurs, damaged discs, or other condition.
  • Transforaminal: Referred to as a “nerve block,” the injection is placed next to the nerve where it exits the spinal column, so the medication enters the nerve sleeve, travelling upward into the epidural space to achieve a concentrated delivery into the area causing chronic pain.

How is an Epidural Steroid Injection Performed?

Our New York pain management patients are normally brought to an operative suite and will lie flat on an X-ray table. The lower back will be cleaned and then is numbed with an injection of local anesthetic. Live X-ray guidance is used to guide insertion of the needle into the epidural space and needle location confirmed by injecting contrast dye. The steroid is then slowly injected, after which the patient will rest and be monitored for a short period, and then discharged.

Facet Injections: Cervical, Thoracic, Lumbar

Facet injections are a treatment with local anesthetic and/or steroid medication to anesthetize facet joints. The facet joints give the spine its flexibility, allowing for twisting and turning.

  • Intra-articular: Anti-inflammatory steroid medication and anesthetic is injected into the facet joint to treat lower back pain and restore motion.
  • Diagnostic: Facet injections can be performed to diagnose pain source. The nerves entering the facet joints are injected with anesthetic to determine whether the facet joint is the source of pain.
  • Radiofrequency Ablation: After a diagnosis of facet mediated pain is established with diagnostic injections, radiofrequency ablation can be performed to treat facetogenic pain. Fluoroscopy guidance (X-ray) is used to direct a needle to the targeted nerves, through which an electrical current creates heat to lesion the affected nerves halting the nerve from sending pain signals.

Facet Injection Procedure

The patient will be brought to the operative suite and will lie face down on an X-ray table. The skin and tissue above the facet joint in neck or back will first be numbed with a local anesthetic. Using live X-ray guidance, a small needle is placed into the facet joint space or adjacent to the nerve and medication is then delivered into the target area, requiring about ten to thirty minutes to complete.


Sacroiliac Joint Injections

The sacroiliac joint (SI) is in the pelvis, linking the pelvis (iliac) to the lowest part of the spine above the tailbone (sacrum). Sacroiliac joint injections include local anesthetic and steroid medication, which are injected into the joint. These injections can be used diagnostically to identify the source of pain, and therapeutically to relieve chronic lower back and leg pain.


How Are They Performed?

The patient will be brought to the operative suite an will lie on the X-Ray table, the injection site sterilized, and numbed with local anesthetic. Using X-ray guidance, a needle will be placed in the sacroiliac joint, contrast will be injected (X-ray dye) to ensure accurate needle placement, after which the steroid is injected to relieve chronic pain.


Discography

Discography is a diagnostic test to identify which disc(s) is the source of chronic back pain. A contrast dye is injected into specific discs to pressurize the disc and determine which discs are causing pain. This diagnostic test may be advised for those who suffer from chronic back, groin, hip, or leg pain to identify the source(s) of the pain to aid a surgeon in the decision on what levels need surgical intervention. Following the procedure, patients will be sent for a post-discography CT Scan.


Discography Procedure

Patients will be brought to the operative suite and will lie on their stomach on an X-ray table. Images of your spine structure will be taken with a fluoroscopy (X-ray) system to reveal the exact location of various discs. Local anesthetic will be injected to numb the skin and tissue. A needle will be placed in the center of a disc, assisted by X-ray dye (contrast) for accurate placement. The disc will then be pressurized using a pressure monitor to try and replicate a patient’s pain. The procedure requires about 30 to 45 minutes to complete, after which you will be monitored and then released to have a post-discography CT scan.

Trigger Point Injections

A trigger point is a knotted or tight muscle that when pressure is applied, triggers pain signals to another part of your body. The injections deliver medications to reduce inflammation by relaxing the tight muscle to improve blood flow and promote healing and recovery.

What is the Trigger Point Injection Procedure?

You will be lying down or seated for the procedure. Various muscle areas will be pressed to identify the painful area, and then a small needle is placed into the painful muscle, with a mixture of anesthetic and injected. The entire procedure requires only a few minutes to perform, after which you can return home.


Hip Injections

Hip joint injections are included in some of our NYC pain management treatments in which medication is injected directly into the hip joint to diagnose or treat chronic pain in hips.

How is the Hip Injection Procedure Performed?

Live X-ray (fluoroscopy) and contrast dye are used to guide accuracy of needle placement. You will be lying on a table, and the injection site sterilized. Local anesthetic will be injected, and the steroid medication slowly and gently injected into the hip joint. Some patients are more comfortable with IV sedation. You may experience a sensation of pressure and minor pain during the injection.


Bursa Injections

A bursa is a fluid-filled sac, lubricating the motions of muscles moving over bone. When a bursa is inflamed, these injections can reduce chronic pain associated with arthritis, bursitis, and other inflammatory conditions. These injections can be performed to diagnose the source or relieve chronic pain in hip.

Bursa Injection Procedure

You will lie on a treatment table, and the area to be treated cleaned and draped. Your skin will be numbed with local anesthetic. With X-ray guidance, the needle will be placed in the correct area, with local anesthetic and steroid medication injected, and the procedure is complete, requiring about ten to fifteen minutes, followed by a short period of observation, after which you can return home.


Lumbar Sympathetic Blocks

Lumbar sympathetic blocks are an injection of medication into your back, along the outside of the spine, to relieve lower back and leg pain, and may be the appropriate pain management treatment for several conditions, including:

  • Complex Regional Pain Syndrome: Chronic pain affecting arms or legs, CRPS involves symptoms such as burning, throbbing pain, sensitivity, swelling, muscle spasms, stiffness, tremors, and decreased motion.
  • Vascular Insufficiency: Pain associated with vascular insufficiency may be successfully alleviated with a lumbar sympathetic block.
  • Peripheral Neuropathy: Damaged or diseased nerves can lead to chronic pain, which may be relieved with a lumbar sympathetic block.

Spinal Cord Stimulation

If other treatments for chronic back pain have not led to relief, spinal cord stimulation may be effective. A device delivering electrical pulses can be implanted in the upper buttock, sending a mild electrical current to your spinal cord to relieve chronic back, leg, or arm pain that has not responded to other treatments. The electrical pulses work by modifying the pain signals prior to reaching the brain.

IV Sedation can be used with any of these procedures to make the treatment more comfortable. This can be discussed, in more detail, with Dr. Bakshi at your evaluation.

At Dr. Stieber's Advanced Back and Spine Care, our focus is patient safety and comfort when performing our procedures and Pain Management plays a vital role in this. Learn more about our procedures and how our pain management in New York can help you.

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