Epidural Steroid injections– a common procedure used to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve.
Neurolytic Blocks– an injection of alcohol or phenol around a group of nerves to provide long lasting relief after a previous diagnostic block has provided effective temporary relief. Alcohol or phenol will damage the nerves that will therefore have longer pain alleviating effects than a local anesthetic drug (Novocain). After the nerves have been damaged, they will try to repair than originally experienced. Therefore, these blocks are usually only performed for the treatment of pain after other modalities have been tried. Even though this block is considered permanent, it may not be. It may last for several weeks or months. If the pain returns, this block can be repeated. The procedure is the same as with the local anesthetic
Radio Frequency Lesioning- a procedure that may be used to reduce certain kinds of chronicpainby preventing transmission of pain signals. It is a safe procedure in which a portion of nerve tissue is heated to cause an interruption in pain signals and reduce pain in that area.
Diagnostic Nerve Block– A local anesthetic is injected in very small amounts onto target nerves, and the patient is then assessed for any change in pain symptoms. If a particular pain-carrying nerve or group of nerves is/are numbed and a patient notes significant improvement in pain symptoms, the location of the pain generator is likely confirmed. If a patient notes no change or limited change in pain symptoms following a diagnostic nerve block, the treating physician may conclude that a patient′s pain is originating from a different area.
Therapeutic Nerve Block– A Nerve Block involves the injection of a local anesthetic like Lidocaine or Bupivicaine onto a target nerve or group of nerves. An example of a therapeutic nerve block used to treat chronic pain is the Stellate Ganglion Block, performed in the front of the neck to treat Complex Regional Pain Syndrome (CRPS or RSD). The local anesthetic works by interrupting conduction of electrical impulses along the target nerve for a limited period of time. The duration of the numbing effect varies with the local anesthetic used. Lidocaine usually lasts for one hour, and Bupivicaine lasts for 3-4 hours. When the local anesthetic effect wears off, nerve conduction and function to the numbed area resumes normally.
Transcutaneous Nerve Stimulations– A small electrical device delivers electrical impulses across the skin. The device is usually about the size of a personal stereo, although lightweight versions not much bigger than a credit card are available.
The device is connected by wires to sticky pad electrodes, which are placed on the skin in the area of the pain. This allows a small, low-intensity electric charge to be passed across the area.
TENS is thought to work in two ways:
- On a high frequency, by selectively stimulating certain ‘non-pain’ nerve fibres to send signals to the brain that block other nerve signals carrying pain messages.
- On low frequencies, by stimulating the production of endorphins, natural pain-relieving hormones.
The device is usually used for 15 to 20 minutes, several times a day, and is controlled by the user rather than a health professional. Pain relief may be rapid and last for days.
Spinal Cord Stimulation Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain.
Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location.After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.
When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.