FAQS – Frequently Asked Questions
How is my pain diagnosed?
A thorough history and physical exam are the basis for a preliminary diagnosis. Additional diagnostic tests may be necessary to confirm a diagnosis.
What are some of the common tests used to diagnose my pain?
Some of the common tests used to diagnose your pain are:
- MRIs (magnetic resonance imaging)
- CT Scans (computed tomography)
- Bone Scans
- EMG (electromyography)
What treatment options are available?
A comprehensive treatment plan may include the following: medications, physical or occupational therapies, preventive skills training and an appropriate home exercise plan. If necessary, we may give injections at the pain site such as trigger point injection, epidural, or joint injection. Also, cognitive behavior management can go a long way in controlling your pain.
How will I be informed of my treatment plan?
Our nurses, physicians and nurse practitioner will educate you about your medications, any side effects and appropriate expectations of time frames and levels of improvement.
What is an epidural injection and what is it for?
An epidural is an injection that delivers steroids directly into the epidural space in the spine. Sometimes a flushing solution (either lidocaine or normal saline) is also used to help “flush out” inflammatory proteins from around the area that may be the source of pain.
An epidural injection is typically used to alleviate chronic low back and/or leg pain. While the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for patients during an episode of severe back pain. More importantly, it can provide sufficient pain relief to allow the patient to progress with their rehabilitation program.
What are the risks?
As with all invasive medical procedures, there are potential risks associated with lumbar (lower back) epidural steroid injections– but they tend to be rare. Risks may include:
- Infection: Minor infections occur in 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
- Bleeding: Bleeding is a rare complication and is more common among patients with underlying bleeding disorders.
- Nerve damage: While extremely rare, nerve damage can occur from direct trauma by the needle, or secondarily from infection or bleeding.
- Dural puncture (“wet tap”): A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually gets better within a few days. Although rare, a blood patch may be necessary to alleviate the headache.
- Paralysis is not a risk since there is no spinal cord in the region of the epidural steroid injection.
How many will I need?
Depending on your diagnosis and your response, from 1 to 3 injections.
What is a trigger point injection?
Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
What is a sacroiliac joint injection?
The sacroiliac facet joints are located in the region of the low back and buttocks where the pelvis actually joins the spine. If the joints become painful, they may cause pain in the low back, buttocks, abdomen, groin or legs.
A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief experienced will help confirm or deny the joint as a source of pain. Additionally, the temporary relief of the numbing medicine may better allow a physical therapist to treat that joint. Also, time release cortisone (steroid) will help to reduce any inflammation that may exist within the joint(s).
What is a facet joint injection?
Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.
What types of specialists do you work with?
- Spine Surgeons
- Orthopedic Specialists
- Alternative medicines including massage, acupuncture, etc.
What are the realistic goals for pain relief?
The realistic goal of pain management is to improve your ability to function in daily life at work and at home, and generally improve your overall well-being.
Are advanced pain therapies such as pain pacemakers or pain-control pumps available?
Yes, but remember, prior to a complete physical and history, we cannot be sure that they are the right treatment for you.