Joint Injections

Published on January 8, 2012 by in Procedures

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Picture: Knee Joint Injection

Joint Injections for Painful Joints:  Joint Injections are usually given for various “arthritis” of the joints, usually osteoarthritis. When your joint (e.g. knee) is “inflamed” due to “arthritis”, you will experience pain in the joint. One good treatment for a painful joint is injection of local anesthetic and a steroid into the joint to decrease or eliminate the inflammation causing your pain.

Indications for Joint Injections: Any joint in your body can become inflamed and painful. Some common painful joints experienced by patients are the shoulder, hip and knee joints. These joints under a tremendous amount of motion and “wear and tear” from use.

Technique: At Southern California Center for Pain Management, Dr. Bryan Lee can perform steroids injections into your joints and relief your pain. Depending on your situation and the joint involved, your injection(s) can be performed either in the office or at a surgery center with X-ray guidance (for accuracy and safety) +/- conscious sedation (“twilight sleep”) for your comfort.

If your joint injection is performed in the office, it will be a simple affair in which Dr. Lee does the injection under local anesthesia with the aid of your anatomical landmarks for needle placement. There is usually minimal recovery time needed. When you are ready, Dr. Lee will give you instructions for post-procedure care and discharge you home.

If your procedure is to be performed at a surgery center, you will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, pulse oximeter, etc) on you, the nurse will give you IV sedation (if ordered).  Afterwards, the doctor will begin by “numbing” the injection site with a local anesthetic.  Afterward, with the aid of the fluoroscope, Dr. Lee will perform the actual injection(s), in which a local anesthetic and steroid combination is injected into your painful joint.  After appropriate monitoring, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.

Pain Relief Response and Duration: Most patients can expect joint injection(s) either alone or in a series to provide relief for months and even years, in some cases. But, like any medication, the steroid will “wear off” with time and you may require repeat injection(s). There will be a minority of patients who do not respond or only get relief for days to weeks. Unfortunately, Dr. Lee cannot always predict how long your pain relief will be or how you will respond, as different patients respond differently.

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Radiofrequency Ablation

Published on January 3, 2012 by in Procedures

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Radiofrequency Ablation or Lesioning: Radiofrequency ablation (RFA) is a procedure in which a special machine (i.e. the RFA machine) that uses high temperature “radiofrequency energy” to destroy the small nerve fibers carrying pain signals, thus interrupting those pain signals from reaching the brain, where pain is perceived (i.e. felt by you). RFA will usually give you pain relief for a peroid of months (e.g. 6-9 months), although many patients report relief for up to years. It is only a “semi-permanent” procedue, because the “destroyed” nerves can regenerate over time.

Indications for Radiofrequency Ablation: At SCCPM, Dr. Lee performs radiofrequency ablation for mechanical neck and back pain due to facet pain (i.e. facet joint disease). A variation of RFA, called “Pulsed Radiofrequency Ablatation” is very effectively used for patients suffering from occipital neuralgia (a type of headache), ilioinguinal neuralgia (i.e. groin pain), and other types of neuralgia or neuritis (pain due to abnormal nerve activity).

Technique: At SCCPM, radiofrequency ablations are performed at the surgery center under live x-ray (fluoroscopy) for safety and accuracy.  The doctor will usually order IV sedation (i.e. “twilight sleep”) as an option for your comfort.  You will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, pulse oximeter, etc) on you, the nurse will give you IV sedation (if ordered).  Afterward, the area of interest will be sterilely prepped, and then the doctor will begin by “numbing” the injection sites with a local anesthetic.  Afterward, with the aid of the fluoroscope, Dr. Lee will use RFA needle(s) placed at the sites where the painful nerves of interest are located. To further pinpoint the painful nerves, Dr. Lee will perform a “sensory test” and a “motor test” in which he will use the RFA machine to confirm with you that he has found the correct, painful pain fibers to destroy.  Once all confirmations are positive, the RFA machine will be programmed to deliver radiofrequency energy to the tips of the RFA needles, which in turn destroys the painful nerve fibers at high temperatures.  After RFA is completed, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.

Pain Relief Response and Duration:Generally, RFA can lead to longer lasting pain relief than local anesthetic-steroid based nerve blocks. Furthermore, using RFA minimizes the use of steroid medications, which can have side effects. Dr. Lee will generally offer RFA if the nerve blocks are effective but not long lasting for the patient. As mentioned earlier, this is a semi-permanent procedure as the painful nerve fibers can regenerate over time. When this happens, Dr. Lee can repeat the RFA, as with other nerve blocks.

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Ganglion Impar Block

Published on January 3, 2012 by in Procedures

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Ganglion Impar: This funny name is for a cluster of nerve generally located directly in front of the tailbone. This nerve cluster receives pain signals from the tailbone, perineum, rectum, anus, urethra, and vagina. So, in general, the ganglion impar mediates pain from the pelvic organs and your tailbone.

Indications for a Ganglion Impar Block: A ganglion impar block is an excellent injection to treat pain from the tailbone. Also, it is very effective for blocking pain from the perineal and pelvic organs mentioned above, including due to cancer.

Technique: At SCCPM, lumbar sympathetic blocks are performed at the surgery center under live x-ray (fluoroscopy) for safety and accuracy.  The doctor will usually order IV sedation (i.e. “twilight sleep”) as an option for your comfort.  You will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, pulse oximeter, etc) on you, the nurse will give you IV sedation (if ordered).  Afterward, the area of interest will be sterilely prepped, and then the doctor will begin by “numbing” the injection site (in the tailbone region) with a local anesthetic.  Afterward, with the aid of the fluoroscope, Dr. Lee will use thin needle(s) for the actual injection(s), in which a local anesthetic +/- steroid combination is injected.  After appropriate monitoring, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.

Pain Relief Response and Duration: Most patients can expect a response at the first injection. In fact, the local anesthetic will usually provide relief immediately. The steroid medication is meant to prolong and improve the relief with the local anesthetic. You may require more than one injection for long term relief, depending on the severity and duration of your pain. You and Dr. Lee will decide exactly on the number and course of your treatment. Like any medication, the local anesthetic and steroid will “wear off” with time and you may require repeat injection(s). For most patients, one or a series of injections will allow pain relief for months and even years. Unfortunately, Dr. Lee will not be able to predict your response as each patient’s disorder and severity is unique.

 

 

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Facet Blocks

Published on January 2, 2012 by in Procedures

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Facet Joint Injections                Facet Medial Branch Nerve Injections

Facet Blocks/Injections: these are injections into either the facet joints directly, or on the “medial branch” nerves to go into the facet joints. Facet blocks (i.e. nerve blocks for facet pain) can be done in all levels of the spine, including the cervical (neck), thoracic (upper and mid back), and lumbar (low back) spine.
Common Indications for Facet Blocks: Facet blocks are used to treat facet mediated pain. The “facet” joints are small joints between two connecting vertebrates. The vertebrates are the spine bones that make up your spine. These facet joints, like all bony joints in your body, can become “inflamed” and develop “arthritis”. Consequently, you will develop pain in the area of the diseased facet joints. For example, if the cervical facets (in the neck) become diseased, you will develop pain in the neck. Likewise, lumbar (low back region) facet disease would lead to pain in the low back. Facet pain is usually localized to the area of the spine where the facet joint is inflamed (i.e. diseased). There are currently no definitive radiological or blood test to diagnose facet mediated pain. One of the best method to diagnose facet mediated pain is with facet blocks. Facet Blocks can be both “diagnostic” (i.e. confirm the diagnosis of facet mediated pain) and “therapeutic” (i.e. provide pain relief).
Technique:  At SCCPM, facet blocks are performed at the surgery center under live x-ray (fluoroscopy) for safety and accuracy.  The doctor may order IV sedation (i.e. “twilight sleep”) as an option for your comfort.  You will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, pulse oximeter, etc) on you, the nurse will give you IV sedation (if ordered).  Afterwards, the doctor will begin by “numbing” the injection site with a local anesthetic.  Afterward, with the aid of the fluoroscope, Dr. Lee will perform the actual injection(s), in which a local anesthetic +/- steroid combination is used.  After appropriate monitoring, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.
Pain Relief Response and Duration: Most patients can expect pain relief immediately or 1-2 days after the injection(s). The immediate relief is due to the local anesthetic, while the long term relief comes from the steroid.  If a steroid mixture is used, most patients can expect to have duration of pain relief for months or even year(s). However, there will be a minority of patients who do not respond or respond only temporarily. Again, there is no way for Dr. Lee to predict your response as each patient’s pain and response differs. However, if you indeed have facet mediated pain, you should have pain relief with this type of injection.

As with all medications, the steroid drug will wear off with time and you may require repeat injections. There are currently no rule as to how many injections a patient will need and how often. It is up to the patient and Dr. Lee to decide on the number and course of treatment needed. In general, if the facet blocks prove beneficial, Dr. Lee can then recommend Radiofrequency Ablation of the facet medial branch nerves for long lasting pain relief.

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