Pomona Pain Management Doctor | epidural injection, ganglion impar block, impar ganglion block, lumbar sympathetic block, joint injection, sacroiliac joint pain, steroid injection, cortisone, spine pain, Southern California Center for Pain Management, Dr. Bryan Lee, MD Pomona

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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Lumbar Sympathetic Block (LSB): This is a “nerve block” or injection of local anesthetic +/- steroid into the “sympathetic nerve” bundle that is located along both sides of your spinal column.
Indications for a Lumbar Sympathetic Block (LSB): This is an excellent injection for patients suffering lower extremity pain (i.e. leg/foot) due to a sympathetically mediated pain, such as Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS). The injection will reduce not only pain, but swelling, color changes, and sweating associated with this very painful condition. This nerve block is also used for patients suffering from Shingles related pain of the lower trunk (lower body) or lower extremity (i.e. leg/foot).
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).  Afterwards, the doctor will begin by “numbing” the injection site (in your lower back, close to the spine) 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 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 a year or more. 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 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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