pain management procedures details

發布時間:2013年08月18日 作者: 點擊數: 【字體:

Epidural Steroid Injections

Reasons to perform the procedure:

Steroids are medications that reduce inflammation and pain.  They may be injected into the epidural space in your spine to help relieve your back, leg, neck, or arm pain.

Before the procedure:

You will be informed where and when to report for the procedure.  You may be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.

Description of the procedure:

Your consent will be obtained.  You will lie on your stomach for the procedure.  The skin on your back or neck will be cleaned with antiseptic and numbed with medication.  A needle will be inserted through the skin, and the steroid medication along with a local anesthetic (numbing medication) will be injected into the epidural space.

After the procedure:

The steroids will take at least 24-48 hours to work, so you may have a temporary increase in pain.  You will be discharged shortly after the procedure.

Potential Complications: (rare)

·               Bleeding

·               Temporary numbness or weakness

·               Infection

·               Spinal headache

·               Nerve damage

Follow-up:

You will receive further instructions from your doctor.

 

Radiofrequency Ablation

Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain.In fact, multiple clinical studies show that radiofrequency neurotomy significantly reduces pain severity and frequency for 1 to 2 years in the majority of patients.

Radiofrequency neurotomy involves applying heat to certain nerve pathways to "shut off" the transmission of pain signals to the brain. It is performed on an outpatient basis and requires only local anesthetic and mild sedation, alleviating the possible complications of open surgery and general anesthesia. It has a high success rate low complication rate, and is covered by Medicare and most private insurers.

Benefits of radiofrequency ablation include:

·               Pain relief for up to 2 years

·               Significant and longer lasting pain relief compared to steroid injections

·               Low complication and morbidity rates

·               Appreciable pain relief compared to surgery: Nearly half of back pain sufferers are not helped by surgery

·               Greater range of motion

·               Lower use of analgesics

·               Improved quality of life

·               Short recovery time

Radiofrequency Ablation Step-by-Step

Before the Procedure

Your doctor will confirm your diagnosis by making sure that you’ve had at least 2 successful medial branch blocks. If you are a good candidate, your doctor will ask you for the following information:

·               Current medications, including herbal supplements, and their dosages

·               Drug, iodine, or latex allergies

·               Current health conditions

·               Your physician or the healthcare staff will also request that you:

·               Do not take aspirin, ASA-containing products (including Alka-Seltzer® or Pepto-Bismol®) or herbal remedies for 5 days before your procedure

·               Do not use ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDS) for 3 days before your procedure

·               Do not eat or drink anything for at least 6 hours before your procedure, except necessary medications with sips of water

·               Arrange for someone to drive you home after the procedure

During the procedure

Radiofrequency neurotomy is performed while you are awake but sedated. To begin, the area to be treated is numbed with a local anesthetic. Using x-ray guidance, your doctor will insert a needle and electrode into the treatment location. After confirming correct placement, a high-frequency electrical current is passed through the electrode, heating up and lesioning the sensory nerve. Once the procedure is complete, the needle and electrode are removed.

After the Procedure

Typically patients go home within 1 to 3 hours. You may experience some initial discomfort immediately after the procedure, but most patients are able to return to work and their normal daily activities within 24 to 48 hours. After a few days, you should notice a marked decrease in pain and continued improvement over the next several weeks. You can expect pain relief lasting up to 2 years. Because nerves do repair themselves, your pain may return, but the procedure can be done again with similar results.

 

 

 

 

Discogram

Discography

Reasons to perform the procedure:  

·               Discogram is a diagnostic procedure to determine if your vertebral disc(s) is/are your source of back pain.

·              Images the structural integrity of the disc

·              Provides real-time information for detailed diagnostics

·              Aids in treatment planning

·              Minimally invasive

Types of Discs

Before the procedure:
You will be informed where and when to report for the procedure.  You may be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.


Description of the procedure:                     
A doctor will speak with you and a consent will be obtained. First an IV is started, an antibiotics will be infused to minimize the risk of disc infection, and you may also be given medicine for relaxation if you so desire.  Next, while lying on an x-ray table your skin will be cleaned and prepared.  Then a needle will be inserted into each disc. To ensure proper placement of the dye, the procedure is performed under fluoroscopy of x-ray. If the disc is the source of your back, spine, extremity and/or leg pain the injection will temporarily reproduce your symptoms, thus resulting a positive discogram.  If the disc is not the source of your pain the injection will not reproduce your symptoms or cause any discomfort, thus resulting a negative discogram.  

After the Procedure:   
Following the procedure, you may experience some additional discomfort. You will then return to your original state within one week. The discomfort may be treated with your regular pain medication.

Potential Complications: (rare)
•    Bleeding
•    Temporary numbness or weakness
•    Infection
•    Spinal headache
•    Nerve damage
•    Hoarseness of voice
•    paralysis

Follow-up:
You will receive further instructions from your doctor. Depending on the result of the discogram, you may be candidate for surgery, IDET or medical management.

 

 

Disc Decompression

Disc decompression is a highly effective procedure shown to be successful for 90 percent of patients.

Multiple clinical studies have shown that disc decompression has a high success rate, and low complication rate. This minimally invasive procedure reduces pressure on the nerve root by removing disc nucleus while preserving disc strength and future treatment options, including surgery.

Disc decompression is typically performed on an outpatient basis and requires only local anesthetic and mild sedation, alleviating the possible complications of open surgery and general anesthesia. This invasive procedure completes the continuum of care for patients who want a minimally invasive alternative to surgery.

Benefits of disc decompression include:

·               Significant pain relief

·               Reduced used of pain medication

·               Return to previous levels of activity

·               Quantifiable disc material removal

·               Less scarring

·               Quick recovery: generally 3-5 days

·               Low complication and morbidity rates

·               Outpatient procedure requiring only local anesthetic alleviates possible complications of open surgery and general anesthesia

Results compared to surgery:

·               Decreased complication rate: 0.5% vs. 3% with open surgical discectomy

·               Lower re-herniation rate: 5% vs. 10-15% compared to open lumbar discectomy

 

 

Disc decompression step by step :

 

Before the procedure

Your doctor will confirm that a herniated disc is causing your symptoms by using an imaging study, such as an MRI or CT. These tests help to determine the location of the herniated disc and whether or not disc decompression is the most appropriate treatment for you. If you are a good candidate, your doctor will ask you for the following information:

·               Current medications, including herbal supplements, and their dosages

·               Drug, iodine, or latex allergies

·               Current health conditions

Your physician or the healthcare staff will also request that you:

·               Abstain from aspirin, ASA-containing products (including Alka-Seltzer® or Pepto-Bismol®) and herbal remedies for 5 days before your procedure

·               Abstain from ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDS) for 3 days before your procedure

·               Abstain from eating or drinking for at least 6 hours before your procedure, except necessary medications with sips of water

·               Wear loose-fitting clothes that are easy to take off and put on

·               Arrange for someone to drive you home after the procedure is complete

During the procedure

Disc decompression is performed while you are awake but sedated. Your back is numbed by a local anesthetic. Using x-ray guidance, a small needle is inserted through the skin and into the herniated disc. When the probe is in the correct position, the herniated disc tissue is removed, thereby reducing the size of the disc herniation.

After the procedure

After the procedure, you’ll be placed in a recovery room for a short period of time where your vital signs will be monitored. Typically, patients go home within 1 to 3 hours of treatment. For the first three days following the procedure, apply ice to the treatment area for 1-2 hours each day, and limit driving, bending, twisting, and lifting weight over 10 pounds. Recovery time varies with each person, but many patients are able to resume work and daily activities in one week.

 

 

Sympathetic Nerve Blocks

Reasons to perform the procedure:

The stellate ganglion is a group of nerves that supply the head, upper extremities, and organs of the chest.  A stellate ganglion block may be performed to determine the cause of pain in these areas, or to treat pain.

Before the procedure:

You will be informed where and when to report for the procedure.  You may be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.

Description of the procedure:

Your consent will be obtained, and an intravenous (IV) catheter will be placed in your arm.  You will lie on your back for the procedure.  Your neck will be cleaned with antiseptic and numbed with medication.  A needle will be inserted into your neck usually under x-ray guidance near the stellate ganglion, and local anesthetic (numbing medication) will be injected.

After the procedure:

You will be asked to rate your pain.  Your IV will be discontinued, and you will be discharged home.  Drooping of your eyelid and redness of the eye on the affected side is expected and only temporary.

Potential Complications:

·               Difficulty breathing

·               Collapsed lung

·               Bleeding

·               Infection

·               Seizures

·               Hoarseness of voice                    

Follow-up:

You will be given a pain diary to help you keep track of your pain.  You will receive further instructions from your doctor.

 

 

Celiac Plexus Block and Neurolysis

Reasons to perform the procedure:

The celiac plexus is a group of nerves that supply organs in the abdomen.  A celiac plexus block may be performed if you are experiencing severe chronic abdominal pain or abdominal pain from cancer.

Before the procedure:

You will be informed where and when to report for the procedure.  You will be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.  You will be asked to not take your long acting pain medication the morning of the procedure, but you can take you short acting medication.

Description of the Procedure:

Your consent will be obtained, and an intravenous (IV) catheter will be placed in your arm.  The nurse will give you IV fluid before your procedure.You will lie on your stomach for the procedure.  Your back will be cleaned with antiseptic ad numbed with medication.  Under x-ray guidance or CT scan, needles will be inserted through the skin and local anesthetic (numbing medication) will be injected to block the celiac plexus.

After the Procedure:

You will be asked to rate your pain.  You will go to the recovery room to be monitored.  Your IV will be discontinued, and you will be discharged home.

Potential Complications:

·               Bleeding

·               Diarrhea

·               Infection

·               Pain during the procedure

·               Failure to relieve the pain

·               Collapsed lung

·               Bloody urine

·               Low blood pressure

·               Paralysis (rare)

·               Low blood pressure

Follow-up:

You will be given a pain diary to help you keep track of your pain.  You will receive further instructions from your doctor.

 

 

Sympathetic Nerve Blocks - Lumbar Blocks

Reasons for the procedure:

You may receive a lumbar sympathetic block if you are experiencing pain in your legs, or poor circulation your legs.  It may determine if your problem is related to the sympathetic nervous system.

Before the procedure:    

You will be informed where and when to report for the procedure.  You may be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.

Description of the procedure:

Your consent will be obtained, and an intravenous (IV) catheter will be placed in your arm.  Thermometers will be placed on the affected leg to measure temperature changes. You will lie on your stomach or side for the procedure.  The skin on your back will be cleaned with antiseptic and numbed with medication.  Under x-ray guidance, a needle will be inserted through the skin of your lower back to an area near the spine, and local anesthetic (numbing medication) will be injected around the sympathetic nerves.

After the procedure:

You will be asked to rate your pain.  You will go to the recovery room to be monitored.  You IV will be discontinued, and you will be discharged home.

Potential Complications:

·               Muscular pain in your back

·               Bleeding

·               Temporary weakness or numbness in your legs

·               Bloody urine

·               Infection

·               Nerve damage            

Follow-up:

You will be given a pain diary to help you keep track of your pain.  You will receive further instructions from your doctor.

 

Celiac Plexus Neurolysis

Reasons to perform the procedure:

The celiac plexus is a group of nerves that supply organs in the abdomen.  A celiac plexus neurolysis may be performed if you are experiencing severe chronic abdominal pain from cancer or persistent pain associated with chronic pancreatitis that is not relieved by medications or other conservative measures. It is expected that the neurolysis will provide long-term relief (3 months or so) of your pain.

Before the procedure:

You will be informed where and when to report for the procedure.  You will be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.  You will be asked to not take your long acting pain medication the morning of the procedure, but you can take you short acting medication.

Description of the Procedure:

Your consent will be obtained, and an intravenous (IV) catheter will be placed in your arm.  You will lie on your stomach for the procedure.  The nurse will give you IV fluids before the procedure. Your back will be cleaned with antiseptic ad numbed with medication.  Under x-ray guidance or CT scan, needles will be inserted through the skin and local anesthetic (numbing medication) and then ethanol will be injected to neurolyse (destroy) the celiac plexus.

After the Procedure:

You will be asked to rate your pain.  You will go to the recovery room to be monitored.  Your IV will be discontinued, and you will be discharged home.

Potential Complications:

·               Bleeding

·               Diarrhea

·               Infection

·               Pain during the procedure

·               Failure to relieve the pain

·               Collapsed lung

·               Bloody urine

·               Low blood pressure

·               Paralysis (rare)

·               Low blood pressure

Follow-up:

You will be given a pain diary to help you keep track of your pain.  You will receive further instructions from your doctor.

 

 

 

Intercostal Blocks

Reasons to perform the procedure:

You may have an intercostal nerve block if you are experiencing chronic pain of the chest wall and upper abdomen.

Before the Procedure:    

You will be informed where and when to report for the procedure.  You may be asked not to eat or drink after midnight the night before.  You will be examined by your doctor and asked to rate your pain.

Description of the Procedure:

Your consent will be obtained, and an intravenous (IV) catheter will be place in your arm.  You will lie on your stomach for the procedure.  Your back will be cleaned with antiseptic and numbed with medication.  Under x-ray guidance, needles will be inserted through the skin of your chest to an area under the ribs, and local anesthetic (numbing medication) will be injected.

After the Procedure:   

You will be asked to rate your pain.  You will go to the recovery room to be monitored.  You IV will be discontinued, and you will be discharged home.

Potential Complications:

·               Bleeding

·               Infection

·               Collapsed lung

Follow-up:

You will be given a pain diary to help you keep track of your pain.  You will receive further instructions from your doctor.

 

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