Frequently Asked Questions
1. How is my pain diagnosed?
A thorough history and physical exam is the basis for a preliminary diagnosis. Then,
diagnostic tests may be necessary to confirm a diagnosis.
2. What are some of the common tests used to diagnose my pain?
Some of the common tests used to diagnose your pain are:
* MRIs (magnetic resonance imaging),
* CT Scans (computed tomography),
* Bone Scans,
* EMG (electromyography) and
* X-rays.
3. What treatment options are available?
A comprehensive treatment plan may include the following: medications, physical or
occupational therapies, preventative skills training and an appropriate home exercise plan. If
necessary, injections at the pain site such as epidural, trigger point or joints. Also, cognitive behavior management can go a long way in controlling your pain.
4. How will I be informed of my treatment plan?
Our nurses, physicians and nurse practitioner will educate you about your medications, any
side effects and appropriate expectations of time frames and level of improvement.
5. What is an epidural injection and what is it for?
An epidural is an injection that delivers steroids directly into the epidural space in the spine.
Sometimes a flushing solution (either lidocaine or normal saline) is also used to help "flush out"
inflammatory proteins from around the area that may be the source of pain.
The epidural space is the space between the dura mater (a membrane) and the vertebral wall
and is filled with fat and small blood vessels. It is located just outside the dural sac. The
dural sac
surrounds the nerve roots and cerebrospinal fluid (the fluid that the nerve roots are bathed in).
An epidural injection is typically used to alleviate chronic low back and/or leg pain. While the
effects of the injection tend to be temporary - providing relief from pain for one week up to one
year - an epidural can be very beneficial for patients during an episode of severe back pain.
Importantly, it can provide sufficient pain relief to allow the patient to progress with their
rehabilitation program.
6. What are the risks?
As with all invasive medical procedures, there are potential risks associated with
lumbar (lower back) epidural steroid injections. Generally, however, there are few risks
associated with epidural steroid injections and they tend to be rare. Risks may include:
Infection. Minor infections occur in 1% to 2% of all injections. Severe infections are rare,
occurring in 0.1% to 0.01% of injections.
Bleeding. Bleeding is a rare complication and is more common for patients with underlying
bleeding
disorders.
Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the
needle, or secondarily from infection or bleeding.
Dural puncture ("wet tap"). A dural puncture occurs in 0.5% of injections. It may cause a
post-dural puncture headache (also called a spinal headache) that usually gets better
within a few days. Although rare, a blood patch may be necessary to alleviate the headache.
Paralysis is not a risk since there is no spinal cord in the region of the epidural steroid injection.
7. How many will I need?
Depending on your diagnosis and your response, from 1 to 3 injections.
8. What is a trigger point injection?
Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain
trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots
can be felt under the skin. Trigger points may irritate the nerves around them and cause
referred pain, or pain that is felt in another part of the body.
9. What is a sacroiliac joint injection?
The sacroiliac facet joints are a small joint in the region of the low back and buttocks where
the pelvis actually joins with the spine. If the joints become painful they may cause pain in the
low back, buttocks, abdomen, groin or legs.
A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the
joint, the amount of immediate pain relief experienced will help confirm or deny the joint as a
source of pain. Additionally, the temporary relief of the numbing medicine may better allow a
physical therapist to treat that joint. Also, time release cortisone (steroid) will help to reduce
any inflammation that may exist within the joint(s).
10.
What is a facet joint injection?
Facet joints are small joints at each segment of the spine that provide stability and help guide
motion. The facet joints can become painful due to arthritis of the spine, a back injury or
mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back)
facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints
and block the pain. The pain relief from a facet joint injection is intended to help a patient better
tolerate a physical therapy routine to rehabilitate his or her injury or back condition.
11. What types of specialists do you work with?
* Neurologists
* Spine Surgeons
* Orthopedic specialists
* Psychologists
* Alternative medicines including massage, acupuncture, etc.
12.
What are the realistic goals for pain relief?
The realistic goal of pain management is to improve your ability to function in your daily life
at work and at home and therefore your overall well being.
13.
Are advanced pain therapies such as pain pacemakers or pain-control pumps available?
Yes, but remember, prior to a complete physical and history, we can not be sure that they
are the right treatment method for you.
