Pain Relief / Pain Management – Spinal Injections

People who suffer from chronic spinal pain can often be helped with various types of spinal injections for pain management as well as to help make a diagnosis. Done correctly, spinal injections are safe and very effective.

If you’re seeking an Oakland, Sacramento or even Central Valley pain clinic, consider working with us at Gracer Medical Group. Dr. Gracer is well-known pain specialist whose expertise is sought by patients, the media and other healthcare professionals. Contact us today and you could be feeling much better soon.

Cervical, Thoracic, or Lumbar Epidural Steroid Injection:

For relief of pressure and inflammation on a nerve root, usually caused by a disc protrusion, narrowing of the nerve canal, or by scarring after back surgery.

This procedure involves placing a needle under fluoroscopic guidance either into the foramen, or hole, where a specific nerve comes out of the spine or into the center of the spine where the nerves run together down the spinal canal. A combination of local anesthetic, such as lidocaine, and a cortisone like drug, such as triamcinolone, that decreases the inflammation and swelling around the nerve is injected. This combination is very effective in relieving the pain and can also help diagnose the cause of the pain when it’s selectively injected in the area of specific nerve roots.

Dr. Gracer is also using ozonated oxygen for these injections because recent studies indicate that this may be as or even more effective than the usual steroid containing solutions.

Cervical, Thoracic, or Lumbar Facet Joint Injection and Median Branch Nerve Block:

For relief of pain in the facet joints-the supporting joints found behind and to the side of the intervertebral discs. Median branch nerves innervate the facet joints, which are a common source of pain.

This injection is used to confirm the diagnosis of facet joint pain as well as to decrease the inflammation and pain from these joints. During this procedure a needle is placed under fluoroscopic guidance into the joint and the ligaments around the joints. A combination of local anesthetic, such as lidocaine, and a cortisone like drug, such as triamcinolone, is injected. With the onset of the local anesthetic, the pain often abates almost immediately indicating that the particular facet joint injected is the cause of the pain. At other times the median branch nerve that serves the facet joint is blocked with a local anesthetic. Pain reduction after this procedure also indicates that the facet is the pain source.

Patients with this problem are often excellent candidates for RIT (prolotherapy). Others may be helped by radio frequency ablation of the medial branch nerves (see below).

Stellate Ganglion Block:

For the treatment of pain in the arm and face called reflex sympathetic dystrophy (RSD), or chronic regional pain syndrome I (CRPS I). The stellate ganglion controls the sympathetic nervous system to the side of the face and the arm.

Under fluoroscopic guidance, a needle is placed into the neck and directed to a specific location on the C-7 vertebra. X-ray dye is injected to ensure that the needle placement is correct and then local anesthetic is injected into this site. The anesthetic spreads down the vertebral column to reach the stellate ganglion. The local anesthetic markedly diminishes the amount of sympathetic stimulation to the nerves of the face upper back and arms. This increases blood flow and can help correct the underlying cause of RSD which is abnormally increased sympathetic nerve activity. These injections are often done in a series to obtain full efficacy.

Cervical, Thoracic, and Lumbar Discography:

To determine which specific spinal discs are causing a patient’s pain.

Needles are placed into the discs under fluoroscopic guidance. A mixture of X-ray dye and antibiotic is injected into the discs facilitating clear visualization of the disc structure. Pressure is measured at the time of injection to evaluate the integrity of the discs.

When a normal disc is injected, it is not painful. When an abnormal disc is injected, the patient’s pain is recreated, allowing for specific diagnosis. This procedure is often used before spinal surgery to be sure of which discs are causing the patient’s pain.

In Europe many physicians are using ozone instead of X-ray dye for discography. This enables the simultaneous treatment of many disc problems, while at the same time providing the necessary diagnostic information. (See below)

Dr. Gracer currently has a study underway using this ozone technique in appropriate patients.

Percutaneous Discectomy:

For the non-surgical treatment of disc protrusions that may otherwise require surgery.

Using a technique similar to that used for a discogram, a needle is placed into a disc. Then an apparatus called a disc DeKompressor, a product ofStryker, Inc., is placed through the needle into the disc. Disc material is then removed using a special auger-like drill. The results of this procedure are excellent and help many patients avoid surgery to relieve disc pain. This is an outpatient procedure and patients are ambulatory without significant post procedure pain within a few days. Ozone discolysis is often performed after the discectomy and is completed using the same needle to speed healing. (See below)

Intradiscal Ozone Discolysis:

For the non-surgical treatment of disc protrusions and other painful disc conditions.

Also similar to a discogram, a needle is placed into the disc. A mixture of ozone and oxygen is then injected into the disc. This decreases intradiscal pressure and initiates a large anti-inflammatory effect that leads to healing. This treatment method is common in Italy where it was developed, as well as in many other countries all over the world. Several large studies have been published that show the efficacy of this procedure.

Dr. Gracer currently has a study underway using this treatment modality and is the first physician in the United States to use this safe and effective modality.

Radio Frequency (RF) Lesioning:

For the treatment of pain from the facet joints and sacroiliac joints as well as for certain types of headaches that originate from the cervical spine (neck). This treatment is used after a test injection of a local anesthetic such as lidocaine onto specific nerves supplying these areas effectively blocks the pain.

Under fluoroscopic guidance, special needles are placed onto these nerves and RF energy is applied using a carefully controlled computerized protocol. This process destroys these nerves without injuring the nerve sheath (myelin sheath) that protects them. These nerves can grow back over months causing the return of the pain, but because the myelin sheath is uninjured the nerves reconnect in the correct orientation, minimizing the chance of a painful and hard to treat disordered re-growth of nerve tissue called a neuroma.

RF lesioning can be repeated frequently providing long lasting pain relief. Dr. Gracer often combines this treatment with other complementary modalities.

Types of Interventional Pain Procedures