Treatment Options

Precision Nerve Injections

A facet joint injection is a minimally invasive procedure that can relieve neck or back pain caused by inflamed facet joints. Two approaches for treating facet joint pain can be used. First, blocking or numbing the medial branch nerves (nerves that supply facet joints with sensation) with an injection can be used as a diagnostic test to determine if the pain is actually coming from the facet joint.

Radiofrequency

Radiofrequency ablation is a medical procedure where part of the electrical conduction system of dysfunctional tissue is ablated using high frequency alternating current to treat a medical disorder. An important advantage of RF current (over previously used low frequency AC or pulses of DC) is that it does not directly stimulate nerves and can, therefore, often be used without the need for general anaesthetic. RFA has become increasingly accepted in the last fifteen years with promising results.

IDET

IDET (Intradiscal Electrothermal Annuloplasty) is a new procedure for discogenic back pain management. The IDET process takes about an hour to complete and is done as follows:

• The procedure is performed with a local anaesthetic and mild intravenous sedation.
• A hollow introducer needle is inserted into the painful lumbar disc space using a portable x-ray machine for proper placement.
• An electrothermal catheter (heating wire) is then passed through the needle and positioned along the back inner wall of the disc (the annulus), the site believed to be responsible for the chronic pain.
• The catheter tip is then slowly heated up to 90 degrees Celsius for 15-17 minutes.
• The heat contracts and thickens the collagen fibers making up the disc wall, thereby promoting closure of the tears and cracks. Tiny nerve endings within these tears are cauterized (burned), making them less sensitive.
• The catheter is removed along with the needle, and after a short period of observation, the patient goes home.
• A lumbar support is worn for 6 to 8 weeks, followed by an appropriate course of physical therapy. Lifting and bending precautions are necessary during this time to allow for adequate healing of the disc.

Click here to learn more about IDET.

Spinal Cord Stimulation

Neurostimulation therapy (spinal cord stimulation) may help relieve pain and restore comfort by blocking the pain signals to the brain. This therapy stimulates the area near the spinal cord with mild electrical impulses. Neurostimulation can be an effective alternative when other pain management therapies have not worked.

The neurostimulator is a small, surgically placed device that generates and delivers mild electrical impulses near the spinal cord area through one or more leads (a flexible insulated wire). The stimulation from these leads replaces pain with a mild, tingling sensation. Based on the pain needs, physicians have the ability to customize the pain relief stimulation.

Neurostimulation systems include a hand-held patient programmer that is used to easily change stimulation levels, similar to a remote control. This programmer allows the patient to easily adjust settings and to turn the system on or off.

Prior to receiving a neurostimulation system will be the opportunity to experience the therapy for a short time. After this screening test, your doctor will determine whether the patient is a good candidate for the therapy.

Unlike other surgery, neurostimulation therapy is completely reversible, meaning that at any time the doctor can turn off or completely remove the system.

Click here to learn more about spinal cord stimulation.

Epidural Steroids

An epidural steroid , a simple procedure for treating pain, involves injecting an anesthetic and a steroid into the epidural space to reduce inflammation.

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Implantable Morphine Pumps

Intrathecal drug delivery, also known as a pain pump, is a pain management therapy that delivers pain medication to the fluid around the spine. Because the medication is delivered directly to pain receptors, drug delivery therapy can offer significant pain control using a much smaller dose than oral medications. A pump (a small, round, battery- powered device that stores and delivers pain medication) is surgically placed in the abdomen. A thin tube, called a catheter, is inserted near the spine and connected to the pump. The doctor fills the pump with pain medication using a needle. The pump then sends the medication through the catheter to the spinal area where pain receptors are located. The area where the pain medication is delivered is called the intrathecal space.

Physical Therapy

The Physical Therapy Department focuses on the musculoskeletal needs of our patients. As team players, the spine specialist, physical therapist, and occupational therapist all work together with the patient and family members to aid in the patient’s recovery. The spine specialist determines the patient’s injury and type of surgery needed when necessary. Based on the medical evaluation, the spine specialist recommends physical therapy and occupational therapy when indicated. The physician provides the therapist with a prescription, including a diagnosis and recommendation of duration, frequency, and treatment. A rehabilitation program is devised based upon the therapist’s initial evaluation. A treatment plan is then designed to meet the patient’s specific goals, and the patient is progressed per the treatment protocols. The physical therapist designs a personalized exercise program to treat the patient’s injury or surgical procedure. The role of the therapist is to evaluate and manage a program designed to accomplish the goals set by both the patient and the therapist. Based on the patient’s evaluation and objective measurement, the type of treatment may include a muscle strengthening program, a flexibility and general conditioning program, or a pain management program. Treatment may include a specific exercise or rehabilitation program and modalities such as moist heat, paraffin, ultrasound, electrical stimulation, iontophoresis, ice, a home exercise program, or “hands on,” consisting of myofascial release, soft tissue massage, passive range of motion, or joint mobilization, as needed.

Medication

Pharmacologic treatment is the mainstay of pain therapy. Almost half of individuals who suffer from pain choose a nonprescription analgesic as their initial choice for pain relief. There are three basic categories of pain medications: non-opoids, opoids, and co-analgesics. Pain management physicians use these medications either separately or in combination to relieve patients’ pain. Some principles of analgesic therapy are drug specific. However, some general principles guide all pharmacologic treatment of pain. First, the pain specialist will identify and treat the underlying cause of the pain. However, pain management can begin before the source of the pain is determined. Second, the doctor will select the simplest approach to pain management. Although invasive methods are sometimes required, most pain can be relieved via simple methods. Cost of treatment is also a consideration in some cases. Third, the pain doctor will select an appropriate drug. Individualization of a pain management regimen begins with selection of an appropriate drug. Factors that guide this process include a check for accumulation of toxic metabolites, potential for addiction, as patient factors (e.g., age, coexisting diseases, other medications, preferences, response to previous treatments). Finally, the pain care team will establish a management plan, which may include the later addition of other drugs.

Psychological Support

Debra Cole, MEd, LPC is a behavioral medical consultant and licensed psychotherapist. Debra received both a Bachelors in Psychology and a Masters in Clinical Counseling at the University of North Texas in Denton, Texas. Amongst her training, she was employed on staff at the Pride Rehabilitation Institute of Dallas for Ergonomics and has consulted with pain management physicians, orthopaedic surgeons, chiropractors, neurologists, psychiatrists and general physicians.

She provides psychological support for patients whose lives have been interrupted by chronic pain due to medical conditions and injuries. Behavioral Services provided include psychological assessment, rehabilitative counseling, stress management, relaxation skills, coping skills, and detox counseling. A chronic pain support group is also provided.