Treatment Options

One of the biggest challenges in determining how to relieve pain is identifying the source of pain. Sometimes, patients’ descriptions of pain and imaging tests like X-rays and MRIs aren’t enough to pinpoint the specific joints or nerves involved. This is where our partners at Pain Care Consultants can help.

With the help of special imaging equipment, numbing medication can be injected into a specific region of the back. If the patient reports an improvement in pain after the injection, that region is likely where the pain originates. This provides important information for selecting treatment strategies.

Once the source of the pain is identified, the goal of treatment is to not only alleviate the pain, but also allow the patient to return to normal activities as quickly as possible. There are a number of treatment options available, most of which use X-ray guidance to deliver the therapy directly to the location of pain. Some examples include:

• Epidural steroid injections: Steroids, usually along with an anesthetic, are injected into the epidural space, the space surrounding the spinal cord. This helps reduce inflammation and can provide pain relief, often for months at a time. Epidural steroid injections can be used both as diagnostic and treatment tools.
• Nerve root injections: Similarly, nerve root injections, sometimes called blocks, can be used to diagnose or treat specific inflamed nerves that are causing back pain. Injecting a steroid near the nerve root calms compression and irritation. Nerve root injections can be administered three times per year.
• Facet joint injection: Small joints along the spine may also be injected with an anesthetic and steroid to decrease inflammation and improve pain symptoms.
• Radiofrequency rhizotomy or neurotomy: If facet joints are the source of pain, this procedure may provide relief for 9 to 14 months or longer. Special radiofrequency needles are placed in the affected joint. Heat is used to target nerves in that area and block their ability to send pain signals.
• Spinal cord stimulation: An implanted electrical device delivers a low-current voltage to the spine to block the pain sensation. Not everyone is a candidate, but it can be very helpful for some patients.
• Intrathecal pumps: Pain medication is delivered directly to the spinal cord by placing a small pump under the skin. The pump is programmed to deliver specific amounts of medication over time.

Most successful interventional pain management strategies adopt a multidisciplinary approach, working with a team of medical professionals to address all aspects of a patient’s care. Treating the pain is important but improving the patient’s overall well-being is the ultimate goal.