Pain Management
Our board certified musculoskeletal and interventional radiologists perform highly effective, minimally invasive pain management procedures using image guidance. These image-guided therapies treat conditions that might require surgery in a comfortable outpatient setting. Because of their training and skill, our radiologists perform your procedure quickly and accurately. Treatments are obtained only by referral from your physician. Pain management injections and procedures are ordered by your physician for diagnosis and/or therapeutic treatment of pain in most joints of the body and in all areas of the spine (lumbar). In some cases, the spinal injection procedure will be used in combination with other imaging exams, such as CT.
Before your exam, a technologist will contact you with specific instructions for your procedure. Please note that, due to the effects of some medications, you will need to have someone drive you home after the exam. Our technologist will give you information and instructions on potential after-effects from the local anesthetic and medications used with your procedure. The total appointment time for most of our procedures is 30 to 60 minutes.
Injections for Joint Pain
A joint injection may be considered for patients with symptoms such as arthritis, injury or mechanical stress, leading to hip, buttock, leg or low back pain. The injection can help relieve the pain as well as help diagnose the direct cause of pain. Injections involve injecting medicine directly into the joint.
Diagnostic: 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. If complete pain relief is achieved while the joint is numb, it means this joint is likely to be the source of pain.
Pain Relief: Along with the numbing medication, steroid Depo-Medrol is also injected into these joints to reduce inflammation, which can often provide long-term pain relief.
A technologist will contact you with specific instructions. Please note that, due to the effects of some medications, you may need to have someone drive you home after the exam.
You will lie on the exam table and the skin over the injection site is sanitized. The physician numbs a small area of skin with an anesthetic (a numbing medicine). You may feel a sting that will last for a few seconds. The physician uses x-ray guidance (fluoroscopy) or ultrasound to direct a tiny needle into the joint. Several drops of contrast dye are then injected to confirm that only the medicine reaches the joint. A small mixture of anesthetic and steroid Depo-Medrol are then slowly injected into the joint. The injection itself only takes a few minutes, but the overall procedure usually takes between 30 and 60 minutes.
After the joint injection procedure, you will remain resting on the table for a few minutes, and then be asked to move the area of usual discomfort to try to trigger the related pain. You may or may not obtain pain relief in the first few hours after the injection, depending upon whether the joint that was injected is the main source of your pain. On occasion, you may feel numb or experience a slightly weak or odd feeling in the leg for a few hours after the injection. On the day of the injection, you are advised to avoid driving and doing any strenuous activities.
On the day after the procedure, you may return to your regular activities. When the pain has improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid recurrence of pain. Injections are also commonly coupled with other treatments (medications, physical therapy, etc.) in an attempt either to maximize the benefit or prolong the effects. If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief.
Epidural Steroid Injections
Lake Medical Imaging offers only L-spine epidurals. An epidural steroid injection is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years. The goal is to reduce pain, so that you may resume normal activities and a physical therapy program.
A steroid injection includes both a corticosteroid and an anesthetic numbing agent. The drugs are delivered into the epidural space of the spine, which is the area between the bony vertebra and the protective dura sac surrounding the spinal nerves and cord.
If you take blood thinning medication (Coumadin, Plavix, etc.), you may need to stop taking it several days before the procedure. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.
The procedure is usually performed in an outpatient center using x-ray fluoroscopy. Arrange to have someone drive you to and from the center the day of the injection.
The procedure may last between 15 and 45 minutes, followed by a recovery period. You will lie on an x-ray table. Local anesthetic is used to numb the treatment area, so discomfort is minimal throughout the procedure. In order to provide feedback to the physician, you remain awake and aware during the procedure.
With the aid of an x-ray fluoroscope, the doctor directs a hollow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy allows the doctor to watch the needle in real-time on the x-ray monitor, ensuring that the needle goes to the desired location. Some discomfort occurs, but it’s more common to feel pressure rather than pain.
You will be monitored for 20 minutes to ensure that you are not experiencing numbness, tingling or full loss of sensation from the waist down. If any of the aforementioned symptoms occurs, you will be required to remain in-office – between two to five hours – until the effects wear off.
You should be able to walk around immediately after the procedure. Rarely, a temporary leg weakness or numbness may occur, so someone should drive you home. You should be able to resume your full activities the next day. Soreness around the injection site may be relieved by using ice and taking a mild pain reliever, such as Tylenol.
You may notice a slight increase in pain, numbness, or weakness as the numbing medicine wears off and before the corticosteroid starts to take effect, which could be three to four days.
Sacroiliac Joint Injections
The sacroiliac joint, located in the lower spine above the tailbone, is the largest joint in the spine. Inflammation of the sacroiliac joint can cause low back and buttock pain. Using CT, local anesthetic and steroid medication are injected into the sacroiliac joint. If pain is relieved, it could mean the joint is the pain generator.
Stop taking all blood thinning medication.
The injection site is sanitized and draped. Skin-numbing medication is injected into and around the procedure site. CT guidance is used during the procedure to guide the needle into the proper position. CT injections will include an anesthetic and a steroid.
You will be discharged home with written instructions. The area around the injection site will feel numb. Relief from typical symptoms may last for six hours following the injection.
Nerve Root Blocks
A nerve root block is an injection of local anesthetic (numbing medicine) and steroid injected under X-ray guidance into the area where the nerve exits the spinal column. A nerve root block is usually ordered by your doctor for pain in the arm or leg that follows the path of a single nerve. A nerve root block may be diagnostic (a test to determine the source of your pain) and/or therapeutic (to relieve your pain). If you get a period of sustained pain relief from the injection, the block may be repeated.
You will be asked to put on a gown. You will then be positioned on your stomach, back, or side on a special fluoroscopic or CT table that will give the doctor easiest access to the injection site(s). A technologist or nurse will be there to make you as comfortable as possible, both during and after the procedure.
Nerve blocks usually take only minutes to administer. The radiologist will then identify the spot the needle needs to be placed, using palpation and/or imaging guidance. He or she will clean the area with antiseptic solution, and then the needle will be inserted at a specific depth to deliver the medication as close to the problematic nerve(s) as possible. Contrast material may be injected to confirm needle position prior to injection of medicine.The doctor will tell you when the needle is inserted and when the injection is done.
When finished, you will be allowed to rest for 15 to 30 minutes to let the medication take effect. The nurse will also make sure you don't have any unexpected side effects before you leave our office.
