Common Pain Treatments
Advanced Pain Care MD provides several options including therapy, chiropractic adjustments, medications & injections, weight loss programs, and more.
Lumbar Epidural Steroid Injections
Cervical Epidural Steroid Injection (CESI)
Trigger Point Injection (TPI)
Trigger point injections are given to patients who suffer from muscle pain or spasms just about anywhere in the body. Dr. Ring or Dr. Olowe will decide if it is safe, but most of the time they are able to deliver medicine to the painful area. Often these painful areas are located in the neck, head, lumbar, upper back, hip, knee, wrist, elbow, shoulder, and other soft tissue areas. Trigger points can help to relax the muscles and also make movement easier. Trigger point injections are not painful and may be repeated. Fibromyalgia often causes many painful areas throughout the body. TPI for fibromyalgia patients is very helpful.
Knee Injections (Orthovisc and Synvisc)
Knee injections can be performed to alleviate knee pain. Chronic arthritis or osteoarthritis can and has been successfully treated by orthovisc or synvisc injections. Our doctors can easily perform these injections in the office. You will see an improvement in your symptoms within days. Oftentimes these injected substances are called synthetic joint lubricant. Steroid injections with kenalog, aristocort, or depomedrol can be performed on your knees in the office.
Medial Branch Blocks
Medial Branch Blocks are performed to relieve facet-mediated pain. Dr. Ring can perform these injections in your neck or back. Typically, facet joint injections are performed as a part of a workup for back or neck pain. The injection of local anesthetic into the facet joint area is diagnostic and potentially therapeutic. Using X-ray guidance, Dr. Ring will place the injection directly into the facet joint area. Pain relief following this injection generally confirms that the facet is the pain generator.
Patients referred for facet injections most often have acute injury, chronic injury, or degenerative disease of the facet joints. However, even if the facet joint appears radiologically normal, facet injections still may be of use, as radiologically occult synovitis can cause facet pain, particularly in younger patients. There are many diagnoses such as facet-mediated pain, post-laminectomy syndrome, or non-radicular pain occurring after laminectomy, which are an acceptable reason to perform facet injections.
Patients with lumbar facet pain (so-called facet syndrome) typically present with back, buttock, or hip pain. If the patient has only back pain, this pain may radiate into the buttocks or hips, and the pain is typically worse with extension. Radiculopathy, leg weakness, and leg numbness are not normally considered part of the facet syndrome and suggest nerve root compression, although this may be secondarily caused by facet hypertrophy and can actually be part of the facet syndrome.
Occasionally, synovial cysts (out-pockets of the facet joint synovium) may be symptomatic. Most often, they cause foraminal or spinal stenosis. Typically, on T2-weighted MRIs, synovial cysts are seen as rounded areas of increased signal intensity with a peripheral rim of decreased signal intensity. These cysts are located adjacent to a facet joint. The injection of steroids into the associated facet joint is effective in resolving synovial cysts in 30-40% of patients, although repeated injections may be necessary.
Cervical or thoracic facet pain is not characterized as easily as lumbar facet pain, and it can occur with a variety of symptoms, depending on the level and the individual patient. Headaches, neck muscle spasms, and general or focal neck pain can originate from the facet joints. Chest or rib pain can occur. In particular, the upper cervical facets can often cause occipital headaches.
Radio Frequency Ablation (RFA)
These procedures can be performed in the neck, thoracic area, lumbar, or sacral region. RFA is a treatment that uses heat to destroy the nerve near a problem joint. This procedure helps to keep pain impulses from traveling to the brain and helps to relieve the patient’s symptoms. RFA is performed after pain relief is obtained following a diagnostic block. RFA is done under fluoroscopic guidance and a contrast dye may be injected into the affected area to help get a better image. During the procedure, a probe is placed by way of the skin and the proper stimulation occurs. Once the probe is placed near the nerve, it is heated to 80 degrees Celsius for 90 seconds. RFA will provide a semi-permanent cure as the nerve fiber will restore itself usually within 12 months.
Thoracic Epidural Steroid Injection (TESI)
Dr. Barry Ring performs these procedures for the following reasons: thoracic spinal stenosis, thoracic radiculopathy, thoracic discogenic pain, thoracic herniated nucleus pulposus, thoracic spondylosis, post-laminectomy syndrome, thoracic degenerative disc disease, or Herpes Zoster (also called shingles). Rib pain or broken rib pain are also reasons for TESIs. The goal of the injection is to reduce pain in the mid-back and chest and improve your ability to function. Sometimes these procedures help you to take less or no medication for your pain and usually help you avoid surgery. TESIs for painful shingles can help alleviate the signs and symptoms of shingles very quickly. TESIs for fibromyalgia can be very efficacious.
Epidural Steroid Injection (ESI)
A lumbar epidural steroid injection delivers anti-inflammatory medicine directly to the affected area of the back to reduce inflammation that may be irritating the nerve root and causing low back and/or leg pain (sciatica). This does not just “cover up your pain.” This treats the problem. Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain, disc bulges, sciatica, disc herniations, radiculopathy, or leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of many low back pain and leg ailments. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
Shoulder Injections
Shoulder injections are used for diagnostic, as well as therapeutic purposes. The common substances injected include corticosteroids and hyaluronans. Corticosteroids are strong anti-inflammatory medications reducing swelling and inflammation. These are often used in conjunction with physiotherapy rehabilitation and other medications for a more lasting cure of many conditions, such as subacromial impingement syndrome, AC joint pathology, and inflammatory arthritides. Hyaluronans also have anti-inflammatory benefits, as well as coating pain receptors, stimulating endogenous synovial fluid production and lubrication effects. They seem to have a role in degenerative synovial joint disease where surgery is not indicated.
Electrodiagnostic Studies (EDS)
EDS include nerve conduction studies (NCS) and electromyography (EMG). This test is used to evaluate nerves and muscles in the diagnosis of compressive nerve injuries, neuromuscular disease, and myopathies. It is most often used to evaluate people who complain of numbness and/or tingling anywhere in the arms, hands, legs, or feet, or a sensation that one of these body parts feels like it “falls asleep.” EDS is also used to study nerves in people who have pain or odd sensations that travel down part of an arm or leg. There is a small amount of discomfort usually experienced while performing EDS. NCS involves using a nerve stimulator that delivers a mild shock to directly assess how fast nerves are conducting signals. EMG is performed with a small pin that is inserted into the muscle that records electrical muscle activity. If you are having this test done, you should wear or bring a short-sleeved shirt if you are having symptoms in your neck, arms, or hands. Wear or bring a pair of shorts if symptoms are in your low back, legs, or feet. Your arms, hands, legs, and feet should be clean without any creams or lotions applied before having the test performed. After the test, it is normal to have a small amount of muscle soreness, if any at all.
Acupuncture
Our physicians use some of the newest and oldest treatments for acupuncture. We are happy to utilize just this technique to alleviate your pain. Oftentimes our physicians will utilize this technique, other therapies, or other physiotherapeutic approaches to alleviating your pain.
Carpel Tunnel Injections (CT)
Dr. Ring and Dr. Olowe perform CT injections to alleviate carpel tunnel syndrome (CTS). This is effectively done in the office setting. Using new technology, Dr. Ring and Olowe can use ultrasound guidance to diagnose and treat carpal tunnel pain.
Caudal Epidural Steroid Injection (KESI)
In patients with a suspected disorder of the lumbar spine canal (a narrowing of the spinal canal called spinal stenosis), a caudal epidural injection can be performed to differentiate between other disorders, such as those of the hip. A needle can be used to access the spinal column via the sacrum. Medication (depomedrol and local anesthetic) is then injected. The same technique can be utilized to treat RSD/CRPS (Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome).
Studies have shown that, in the majority of patients, the medication spreads throughout the lumbar spine region and to all the nerve roots. In properly selected patients, there is often a lessening of symptoms, and they are able to walk better without pain. As a result, it is possible to delay surgery or eliminate the need for surgery. Oftentimes Caudal Epidurals can be done by Dr. Ring to alleviate failed back syndrome, or as an inferior approach to lower back pain in patients who have previously had back surgery.
Chiropractic Adjustments
A Chiropractic Adjustment is a specific thrust given in a particular line of drive to correct a subluxation, better known as a misalignment, of the vertebra or bone. Our Chiropractors have extensive training in the art of delivering this kind of manipulation to bones and affected areas of the spine. There are many different kinds of Chiropractic techniques, including but not limited to: Diversified, Gonstead, Thompson, Sacral-Occipital Technique, Activator Technique, Graston, Blair, HIO Technique, Full-Spine Specific, Chiropractic Bio-Physics (CBP), and many more. While all treatments are effective at eliminating subluxation and freeing up nervous system interference, these techniques should be tailored to the individual patient. Some techniques require more force and may not be appropriate for osteoporotic males and females; while football players probably would not like the light force technique display by the Activator technique. Our Chiropractors know that people are not the same. So modifications are made by our Chiropractors to assess your individual needs.
Discography
Dr. Ring will often perform what is called a provocative discogram. A discogram is a diagnostic test in which contrast dye is injected into a disc in the patient’s spine. Discograms help to pinpoint which disc is causing the patient’s back or leg pain. It is often done to consider what further treatment is needed. As a part of the discogram, a post-disco CT scan will be scheduled to show where and how the disc is damaged. During the discogram, you may be given medication to help you relax. The area is numbed with a local anesthetic. The needle is placed into each disc being tested. Then the contrast dye is injected into one of the discs. You may feel increased pain when the contrast dye is injected. Dr. Ring will then ask if your pain is in the same as the pain you usually feel. At least three of your disc levels will be tested for comparison. After the discogram, the patient is given pain medication. The procedure takes approximately 30-45 minutes to complete. Dr. Ring will then have you obtain a CT scan. After the discogram results are obtained, Dr. Ring may perform percutaneous discectomy procedures. These may include nucleoplasty, decompressor discectomy, or biacuplasty.
Dorsal Column Stimulators (DCS)
Spinal Cord Stimulation is a relatively non-invasive surgical procedure that involves stimulation of nerves in the spinal cord by placing electrodes in the space above the epidural space. Dr. Ring uses SCS as a treatment for chronic pain of the trunk and/or limbs. SCS is performed after less invasive treatment options such as medications, physical therapy, epidural steroid injections, or nerve blocks have been attempted. An SCS trial is inserted for 3 days to determine the efficacy of spinal cord stimulation. If the trial stimulator works well for the patient, a permanent system is placed. The receiver or power source is implanted under the skin on your abdomen or buttocks. The power source is small and cannot be seen underneath the patient's clothing. After the system is in place, the settings are checked to make sure they are at the right level for the patient.
Dr. Ring recently implanted the first peripheral nerve stimulator for the relief of occipital neuralgia, a severe headache, in Hobart, Indiana. He will continue to utilize spinal cord stimulation to improve functionality and reduce pain. Dr. Ring has used dorsal column stimulators effectively for the treatment of Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD), diabetic neuropathy, phantom limb pain, occipital neuralgia, radiculopathy, failed back syndrome, and other painful syndromes.
Selective Nerve Root Blocks (SNRB)
Selective Nerve Root Blocks are used primarily as a diagnostic tool for pain. Back pain can occur when nerve roots become compressed and inflamed. While MRIs can be used to show which nerves are causing the pain, they don’t always work successfully. Electro diagnostic studies, EDS, also may not always locate the pain generator. In cases when this happens, an SNRB injection can be performed in order to isolate the source of the pain. Dr. Ring has and can easily perform these injections. Oftentimes surgeons will want these injections prior to surgery to outline exactly what level or levels are causing your pain.
Sacroiliac Joint Injection (SIJ)
Sacroiliac joint injection is an injection that reduces the inflammation in the joint space. The sacroiliac joints are located in the back where the lumbosacral spine joins the pelvis. The injection consists of steroid and local anesthetic. Prior to the procedure, a small amount of contrast dye is used to confirm proper needle placement. This procedure will most likely be done in an outpatient setting under fluoroscopy. After the injection, you may feel that your pain has subsided or has lessened. If the first injection does not relieve your pain in about a week, the physician may recommend you to have one more injection. RFA of the sacral nerves may be Dr. Ring’s long-term plan for chronic SIJ pain.
Facet Joint Injections
Dr. Ring can perform these injections in your neck or back. Typically, facet joint injections are performed as a part of a workup for back or neck pain. The injection of local anesthetic into the facet joint area is diagnostic and potentially therapeutic. Using X-ray guidance, Dr. Ring will place the injection directly into the facet joint area. Pain relief following this injection generally confirms that the facet is the pain generator.
Patients referred for facet injections most often have acute injury, chronic injury, or degenerative disease of the facet joints. However, even if the facet joint appears radiologically normal, facet injections still may be of use, as radiologically occult synovitis can cause facet pain, particularly in younger patients. There are many diagnoses such as facet-mediated pain, post-laminectomy syndrome, or non-radicular pain occurring after laminectomy, which are an acceptable reason to perform facet injections.
Patients with lumbar facet pain (so-called facet syndrome) typically present with back, buttock, or hip pain. If the patient has only back pain, this pain may radiate into the buttocks or hips, and the pain is typically worse with extension. Radiculopathy, leg weakness, and leg numbness are not normally considered part of the facet syndrome and suggest nerve root compression, although this may be secondarily caused by facet hypertrophy and can actually be part of the facet syndrome.
Occasionally, synovial cysts (out-pockets of the facet joint synovium) may be symptomatic. Most often, they cause foraminal or spinal stenosis. Typically, on T2-weighted MRIs, synovial cysts are seen as rounded areas of increased signal intensity with a peripheral rim of decreased signal intensity. These cysts are located adjacent to a facet joint. The injection of steroids into the associated facet joint is effective in resolving synovial cysts in 30-40% of patients, although repeated injections may be necessary.
Cervical or thoracic facet pain is not characterized as easily as lumbar facet pain, and it can occur with a variety of symptoms, depending on the level and the individual patient. Headaches, neck muscle spasms, and general or focal neck pain can originate from the facet joints. Chest or rib pain can occur. In particular, the upper cervical facets can often cause occipital headaches.
Botox for Headaches
Botox is a form of botulinum toxin, a neurotoxin produced by the bacteria that causes botulism. When the Botox botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3 months. Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents the activation of pain networks in the brain. One treatment lasts for 10-12 weeks, and typically two Botox treatments reduce the number of headache days by approximately 50%. Contact our office to see if this treatment can be beneficial to you.
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