Trigger point injections are injections to the muscle belly. Injections are aimed at taut bands or
areas of spasm within the muscle belly. Taut bands can be painful and the underlying cause of pain
generation. Trigger point injections are diagnostic and therapeutic. If there is significant relief
after trigger point injections, certainly one can consider that the muscle spasm is a pain
generator. The injection consists of anesthetic as well as antiinflammatory medication.
Epidural steroid injections are a procedure to place medication both antiinflammatory as well as
anesthetic in the epidural space. The epidural space is located within the spine around the spinal
cord and nerve roots. The goal of epidural injections is diagnostic and therapeutic. Epidural
injections can relieve pain that is generating from disc herniations as well as irritated or
pinched nerve roots. These procedures are performed under fluoroscopic guidance.
Facet blocks are performed under fluoroscopic guidance and can be diagnostic and therapeutic.
Injections are performed at the facet joint or the medial branch nerve. Improvement after this
type of injection would be diagnostic for facet joint related pain.
Facet rhizotomy is a long acting facet block either done chemically or with thermal heat. This
procedure is indicated if the patient does receive benefits from the facet block, however does not
offer prolonged relief.
This procedure is done in the neck, anesthetic blockade is performed at the stellate ganglion.
The goal of this procedure is for blockade of the sympathetic chain. This is diagnostic and
therapeutic for evaluation and treatment of RSD.
Lumbar sympathetic block is performed about the lumbar area. The goal of this procedure is for
blockade of the sympathetic chain. This would be diagnostic and therapeutic for evaluation and
treatment of RSD.
An IDET procedure is a procedure done for a pathologic disc usually with annular tear that has
been identified as a pain generator. The goal of procedure is to destroy sensory nerve endings
that are transmitting painful signal. The ultimate goal is to relieve pain from discogenic
This is a minimally invasive procedure for treatment of a herniated disc. This is a procedure that
could be done in an outpatient setting under fluoroscopic guidance to remove herniated disc
material. The ultimate goal is to relieve pressure on the exiting nerve root as well as relieve
Botox is a long acting treatment for muscular pain. Botox acts locally at the injection site to
relieve muscle spasm and to relieve pain. Benefits of this can last up to three to six months.
This is also used for intractable headaches that do not respond to more conservative measures.
Occipital nerve is located in the back of the neck at the junction of the head. Occipital
entrapments can occur with underlying spasm commonly causing occipital headaches. This can
subsequently produce symptoms radiating to the top of the head as well as in back of the eyes.
Occipital blocks can be diagnostic and therapeutic for occipital neuralgia/occipital headaches.
Electrodiagnostic studies are a diagnostic procedure to assess underlying neuropathic problems.
EMG/NCS can be diagnostic for cervical or lumbar radiculopathy/pinched nerve, neuropathy or
distal nerve entrapment such as carpal tunnel syndrome. EMG/NCS can be helpful in determining
acute versus chronic conditions and identify neuropathic recovery. EMG/NCS are commonly used in
conjunction with MRIs to correlate anatomical findings and neuropathic function.
Physical therapy combines passive and active treatment. Passive treatments include moist head pad,
ice packs for analgesia; Ultrasound treatment for production of heat at the muscle bone interphase
and stimulate blood flow; Electrostimulation to improve blood flow as well as muscle relaxation
and analgesia; Massage treatment for muscle relaxation as well as analgesia to increase
extensibility of soft tissue. Active treatments include exercising and stretching as well as
cardiovascular treatment to improve strength, range of motion as well as endurance. Physical
therapy is a treatment as well as an education and experience to learn how to do things on your
own and eventually be progressed to a home exercise program.
Future care needs and life care planning are based on physical impairments as well as functional
disabilities. This plan can outline what a patient will need in the future in terms of active and
passive treatments, durable medical equipments, medical care medication as well as interventional
injections and surgery. Costs can be included in a life care plan.
A physiatrist/physical medicine rehabilitation specialist is a specialty of identifying physical
impairments and how those physical impairments result in physical disabilities and subsequent
handicap. A physical medicine rehabilitation specialist specializes in the neuromuscular and
skeletal system to identify physical impairments and functional disabilities. A disability
evaluation may lead to conclusions of physical restrictions as well as compensatory strategies
to maximize functional independence.
A sphenopalatine ganglion block (SPG) is performed with a cotton tip probe with saturation of
anesthetic at the SPG ganglion, which is located in the posterior aspect of the nose. This
procedure is commonly used in relieving headaches as well as an adjuvant for pain management.
Epidural lysis of adhesions indicated typically in a postoperative patient who has epidural
scarring formation. Epidural scarring can cause irritation, inflammation and swelling around
the nerve roots. Epidural lysis of adhesions are performed to breakup scar tissue and relieve
irritative focus of nerve roots.