Patient information on frequently performed pain treatment procedures

Narcotics for Chronic Pain

Narcotic pain medication is used for chronic pain. Its usage is controversial due to problems like tolerance, dependence and addiction. Patients are considered for narcotic medication pain management after all other reasonable interventions are considered. Many times narcotic management contracts are signed. The contract helps outline how compliance with the use of narcotic medications will achieve the best results and it describes what circumstances would cause the contract to be cancelled. Many times the use of the narcotics is used in conjunction with other pain management treatments, as narcotics are not effective in controlling all of the pain.

Epidural Steroid Injections

Epidural steroid injections are most commonly used to treat conditions that affect the spine, from the neck to the lower back. Patients that are experiencing pain in the neck, shoulder, back, arms or legs due to disc problems, arthritis and spinal stenosis are frequently treated with an epidural steroid injection. The steroid injection is injected into the epidural space which is located in the spinal canal. The steroid that is injected has a powerful anti-inflammatory action. It helps block the pain by reducing the inflammation of the nerves in the affected area. This injection is frequently performed with an x-ray procedure so that precise placement of the medication can be verified. The injection can cause some local discomfort. Local anesthetic is used to numb the area. The injection usually takes one to three days to take effect. The effect of the injection can last up to a month. Sometimes multiple injections are needed.

Facet Injections

Not to be confused with epidural steroid injections, the facet injection is also done in the back. Facet joints link the back of the back bones together. The joints help with restricting spine motion to prevent injury to the back. The procedure for the injection is similar to an epidural steroid injection, however sometimes the facet injection is used as a diagnostic procedure to help determine the exact location of the cause of the pain. In general after a facet injection if the patient has had relief from pain for more that two hours the facet joint is most likely causing the pain. If the injection fails to relieve the pain, than the joint is most likely not the source of the pain.

Trigger point injections

A trigger point is an area of muscle tissue that feels like a knot or a band and when this area is touched it refers pain to other areas of the body. Trigger points are caused injury to muscle tissue due to overuse, viral syndromes, and underlying structure problems. Disc problems, scoliosis, arthritis are a few conditions that can cause painful trigger points. To treat trigger points, injections of local anesthetics, steroids and other substances are injected into the area of muscle tenderness. A trigger point injection will alleviate pain for up to one month. Most commonly trigger point injections are done so that the patient can participate in physical therapy programs to treat the underlying cause of the problem.

Radio-frequency treatments

Radio-frequency involves destruction/deactivation of small facet nerves by using heat generated by radio-frequency waves. The procedure is done using both local anesthetic to numb the area locally and sedation. X-ray guidance of the radiofrequency needle tip is done to ensure precise placement. Patients experience pain for about 10-15 seconds during the deactivation of the nerve. Some people experience immediately relief of their pain following the procedure. Injection site soreness can last for two weeks sometimes masking the true affect of the radiofrequency procedure. Studies show that there is a 50% of chance of significant pain relief following this procedure. Individual results may vary.

Helping your health care provider treat your pain

A very complete history of your pain is important. The date the pain started, where it started, the intensity, whether or not the pain radiates, what may have caused the pain and the duration of the pain are very important descriptive facts to tell your provider. You should make available all available x-ray studies, lab tests, notes of prior treatments from other providers, other serious health illness information and the effect that the pain has on work and other activities in your life.