Interventional Procedures

Greater Occipital Nerve Block

The greater occipital nerve is located just above the neck on either side of the back of the head. The greater occipital nerve block is most often used for occipital “tension” headaches and/or myofacial pain. Pain relief associated with the block stems from the use of anesthetics and steroids that reduce the tension and/or inflammation in the myofacial. After the block you may feel numbness in the back of the head.

However, the headache should decrease and/or resolve. Some complications include: seizures, dizziness, and numbness at the base of the skull, nausea, hematoma, or swelling at the injection site.

Dorsal Column Stimulation

Pain messages travel to the spine via nerve pathways and then the spine carries these messages to the brain. Dorsal Column (spinal cord) stimulation is an advanced treatment for chronic pain. It stimulates targeted nerves along the spine with low-level electrical impulses.

These impulses interfere with the transfer of pain signals to the brain. The pain sensations are replaced with a more pleasing tingling sensation.

Dorsal Column Stimulation is effective in treating chronic nerve pain for neck, upper extremities and lower extremities, and lower back.

Caudal Block

The caudal area is located at the bottom of the spinal cord. The caudal block is used to relieve low back pain, rectal pain, coccydynia, and leg pain. This is accomplished by introducing anesthetic into the epidural space, which would reduce pain inflammation around the nerve roots. The injections are normally repeated on a two-week interval with a maximum of three blocks per series concurrently with physical therapy for the best results After the block you may observe a decrease in blood pressure, numbness and weakness in your legs, or difficulty with urination. The symptoms should resolve within 4 to 6 hours.

Cervical Epidural Steroid Injections

Cervical epidural steroid injections decrease the pain along nerves in the cervical (neck) epidural space. Since these nerves travel to other parts of the body the cervical epidural steroid injection is effective in reducing swelling and inflammation around the discs and as a result the pressure on the nerves is greatly reduced. This produces pain relief and decrease of symptoms. Cervical epidural steroid injections are typically preformed when the patient is diagnosed with disc herniation in the neck, pinching nerves, arthritis, or intolerable neck pain and headaches. Cervical epidural steroid injections are useful in managing head, face, neck, shoulder and upper extremity pain.

Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections block the pain impulses along nerves in the lumbar (lower back) epidural space by decreasing nerve root irritation. Since these nerves travel to other parts of the body the lumbar epidural steroid injection is effective in reducing swelling and inflammation that is around the discs and nerves. The injections do not cover up the pain, but instead decrease the swelling and inflammation of the discs and as a result the pressure on the nerves is greatly reduced. This produces pain relief and many times a decrease of symptoms. Lumbar epidural steroid injections are useful in managing low back pain, as well as hip and leg pain.

Thoracic Epidural Steroid Injections

Thoracic epidural steroid injections are useful in managing chest and upper back pain by blocking the pain along nerves in the thoracic (chest) epidural space. The thoracic epidural steroid injection is effective in reducing swelling and inflammation of the discs, the pressure on the nerves is greatly reduced thus producing pain relief and a decrease of symptoms. These injections decrease nerve irritation and chest pain.

Trigger Point Injection

Trigger point injection is a technique used to reduce neck pain, headaches, low back pain and muscle spasms. Trigger points are bundles of fibers inside a muscle that become knotted. They are inelastic and unable to contract or relax. There is marked muscle tenderness, loss of range of motion, and muscle weakness. There can be localized pain as well as referred pain. There is spot tenderness along the taut band (knotted area) and muscle tightness. This is usually due to an injury. If the trigger point pain fails to decrease with the conservative measures and trigger point injection may be the next best option.

Facet Joint Injections

The facet joints are small joints in the back of the spine that support and aid in rotation and bending of the spine and provide the spine with both stability and flexibility. They are located in the cervical region, Thoracic region and the lumbar region. When these joints become inflamed from trauma or arthritis the result can be pain upon extending or twisting of the spine, and may also be associated with pain to the buttocks and lower back. A facet joint injection is a precise diagnostic tool that also provides excellent therapeutic results. Using fluoroscopic (x-ray) guidance, physicians are able to see and accurately target the affected joint(s).

Radiofrequency Denervation

Radiofrequency denervation, also known as facet thermal joint ablation, is a procedure that is aimed at destroying the nerves that carry pain signals directly to the facet joints. The facet joints are the places in the vertebrae where the spine connects. Many small nerves that carry signals to the brain surround each facet joint and when inflamed they send pain signals to the brain. But, when radiofrequency denervation is preformed, the nerves that are causing the pain are burned. Burning the nerve keeps some pain messages from traveling to the brain, thus giving long time relief. It is still possible in the future that the nerves may grow back and in that case the procedure may need to be repeated. The procedure is effective is reducing pain due to arthritis, injuries, or degeneration.

Paravertebral Blocks

Paravertebral blocks are preformed along the spine on the different cervical, thoracic, and lumbar levels. The blocks interfere with the pain messages being sent to the brain from the individual levels of the block, resulting in a reduction of pain in the spine and back.

Axillary Block

Axillary blocks are used to block the impulses along the nerves in the arm and hand. Axillary blocks are effective in blocking all the sensation during surgery as well as aiding in the diagnosis and treatment of nerve pain involving the arm and/or hand.

Brachial Plexus Block

The brachial plexus is a group of nerves that control the arm and shoulder. There are four different techniques to administer the block depending on the location of the pain in the arm. The four different methods include axillary (underneath the arm), interscalene (side of the neck where the neck meets the shoulder), supraclavicular (above the clavicle, shoulder base), and infraclavicular (below the clavicle, shoulder bone). The brachial plexus blocks are used for acute and chronic pain of the arm and/or the hand, or shoulder. After the block you may feel weak or numb but the numbness should subside after about 4 to 6 hours.

Intercostal Nerve Block

Intercostal nerve blocks are highly effective in relieving severe pain from fractures of the ribs, sternum, pleurisy and acute herpes zoster. After the block is injected you may experience some numbness or soreness at the injection sites.

Your Physician

Dr. Richard L. Smith – A Harvard fellowship trained physician who is double board certified in anesthesiology and pain management.

Dr. Smith is a caring compassionate physician who has practiced pain management for over 20 years. Dr. Smith has treated over 10,000 patients with chronic and acute pain and helped them find relief.

“Let Dr. Richard L. Smith be your first resource for your Pain Management needs”