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Advanced Spine & Pain Care: Interventional Pain Management

Most adults (90 percent) will suffer some kind of back pain during the course of their lives, while another 67 percent will experience neck pain. Back and neck pain are among the most common reasons for doctor visits, and are oftentimes responsible for lost workdays, disability, and high healthcare costs. Effective pain management is contingent upon an accurate diagnosis of the cause of the pain, and not simply empirical treatments.

 At Starling Physicians we invest in a thorough work up of patients’ symptoms, in order to arrive at the most accurate and complete diagnosis, maximizing patient outcomes. Furthermore, we take a multi-disciplinary approach to pain management, which includes: interventional treatments, functional therapies, and medication management. Our goal is to reduce pain, minimize the burden of medications, and improve function in order to maximize our patients’ quality of life.

We treat a wide range of conditions including:
  • Lower Back Pain and Neck Pain
  • Spinal Stenosis
  • Sciatica
  • Degenerative Disc Disease
  • Disc Herniation
  • Radiculopathy
  • Facetogenic Pain
  • Sacroiliitis
  • Spondylosis
  • Spondylolisthesis
  • Shingles (Post-herpetic neuralgia)
  • Arthritis Pain
  • Work Injury Pain
  • Nerve (Neuropathic) Pain
  • Headaches And Migraines
  • Occipital Neuralgia
  • Trigeminal Neuralgia
  • Complex Regional Pain Syndrome (CRPS)
  • Compression Fractures
  • Post Laminectomy Syndrome

We work closely with our orthopaedic team, especially our spine specialist, to develop a comprehensive treatment plan to provide relief for chronic or acute pain.

Interventional Treatments

We offer a number of pain procedures that are performed, under x-ray and/or ultrasound guidance by a skilled physician, with specialized training in interventional and minimally invasive procedures. These procedures are performed on an outpatient basis, usually under light sedation and/or with a numbing agent, with minimal or NO recovery time.  

Some of the most common treatments are described below.

  • Epidural Injections: These injections are primarily used for radicular pain (nerve root inflammation); however, they also can be useful for some types of axial spine pain (i.e. discogenic pain, spondylosis, spinal stenosis). Injections generally include a numbing agent and a steroid.
  • Facet Injections: These injections are intended to provide relief for those suffering from primarily chronic axial back or neck pain, or those suffering from acute pain. Injections generally include a numbing agent and a steroid.
  • General Joint and Trigger Point Injections: These types of injections are given into soft tissue joints including the hip, knee, and shoulder. They are used to provide myofascial and joint pain relief.
  • Radiofrequency Ablation: Usually used to treat low back and neck pain, especially when caused by arthritis. This technique uses a radio wave to produce an electrical current, which is then used to heat an area of nerve tissue. This method decreases the pain signals from that area.
  • Spinal Cord Stimulation: This technique treats chronic spinal and radicular pain by applying gentle electrical currents around the spinal cord. Using x-ray guidance, electrical leads are placed into the epidural space, while a tiny generator is placed into the soft tissues of the lower back. The generator emits electrical signals to the spinal column and blocks the ability for the brain to perceive pain.
  • Diagnostic and Other Advanced Procedures: There are a number of other interventional procedures that can be used to diagnose the source of pain or provide relief. Such procedures include: provocative discography, selective nerve root, medial and lateral branch blocks, and kyphoplasty.
Functional Therapies

Functional and alternative therapies complement conventional treatments of chronic pain (intervention and medication management). We help patients determine which combined therapies may assist them in pain reduction and improved function. Options may include:

  • Physical therapy
  • Dry needling
  • TENS
  • Cognitive therapy and or pain psychology
  • Alternative medical treatments (acupuncture, yoga, and hypnotherapy)
  • Other
Medication Management

Our interventional pain management team emphasizes therapeutic approaches that minimize the use of chronic pain medications.  Nonetheless, from time to time medications do comprise part of a multi-disciplinary approach to pain management.  The risks and benefits of medications (specifically opiates, which have added risk of dependency, tolerance, addiction, and accidental overdose), are reviewed with each and every patient, prior to initiation and continuation of this therapy.

When to See a Pain Management Specialist

There are a number of reasons to seek care from a pain management specialist. These include:

  • To ascertain the cause (diagnosis), of the patient’s pain, which is instrumental in treatment.
  • Pain is persistent despite conservative therapy.
  • Referral from another medical provider or orthopaedic specialist who believes there is a specific intervention that can be offered to relieve pain.
  • Pre-surgical evaluation requiring a diagnostic nerve block.
  • Surgery is contemplated for pain symptoms but not utilized as an option.
  • Failure of spine surgery to relieve pain symptoms (post-surgical pain syndrome).
  • Common Questions About Interventional Pain Management

    What is interventional pain management?

    Interventional pain management is a subspecialty dedicated to the treatment of acute and chronic pain using minimally invasive techniques. Pain management physicians specialize in a wide range of pain blocking techniques to aid with the patient’s comfort and, ideally to restore the patient’s functional activity and quality of life.

    Interventional pain management is different from other pain management practices because it emphasizes the importance of a precise diagnosis so treatment can be appropriately directed. Rather than just prescribing medication or only recommending physical therapy, an interventional pain management specialist utilizes all sources of treatment to reduce pain in the fastest and most effective way possible for each individual patient, while assessing the risk and benefit of each modality.

    What kind of symptoms does a pain management specialist treat?

    We treat symptoms closely related to pain of all levels and duration. These can range from discomfort, difficulty sleeping, soreness, and tightness, to burning, aching, or electrical feelings. Treatments can help relieve pain related to arthritis spinal disease, radiculopathy, neuropathy, headaches, bone pain, back pain, and muscle pain.

    How do you diagnose the source of pain?   

    Pain specialists are not only experts at treating pain, but also help to diagnose the source of pain. We will conduct a thorough history and physical examination, as well as review any previous medical records. If not already completed, additional diagnostic studies will be ordered to further define diagnosis of the patient’s chronic pain. Based on these data, diagnostic injections can be further utilized to determine the source of pain, helping establish a more focused treatment plan.

    When should I seek advice/treatment from an interventional pain management specialist?

    Interventional pain management is generally used when pain is significant enough to interfere with day-to-day activities. Earlier interventional therapies are generally more successful, and thus patients are encouraged not to delay treatment.

    What types of treatment do interventional pain management specialists provide?

    Interventional pain management specialists provide a wide range of treatments including epidural steroid injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, facet joint injections, lumbar sympathetic plexus blocks, and trigger joint injections. All procedures are done on an outpatient basis.

    If I undergo an interventional pain management treatment, are there any limitations to my activities?

    If you have received a sedative for your procedure, you are required to have someone (relative, friend, etc.), available to drive you home afterwards. We recommend that a patient who has received an interventional pain management treatment take it easy immediately following the procedure. In most cases patients may return to pre-procedure activity the following day without restriction.

    Are interventional pain management treatments effective?

    Yes, they are successful for most patients. Some patients will have pain following a treatment, but this pain resolves quickly. Based on the severity of your pain, further treatments may be required for effective results and significant pain reduction.

    Does interventional pain management involve the use of medication?   

    Interventional pain management treatment utilizes a multi-disciplinary approach to alleviate pain without an emphasis on prescription medications. The majority of pain sufferers will have pain relief by this multi-disciplinary approach; however, prescribed pain medications do have their roles in chronic pain management. Risk and benefits of these medications will be reviewed with each patient.

    What role do opiates play in pain relief?

    Opiates are derived from the poppy plant and are among the oldest drugs known to humankind. They include codeine and perhaps the most well known opiate of all, morphine, as well as many other newly synthesized opiates (oxycodone, hydrocodone, fentanyl, hydromorphone, methadone, etc.). Opiates are effective in treating acute pain and in some clinical situations, can assist in the management of chronic pain conditions. However, this class of medication carries a significant risk profile that must be addressed with every patient deemed an appropriate candidate for their use. Opiates are NOT the first line of treatment for chronic pain management.

    What are the risks of opiates?

    Patients who take opiates (short- or long-term), can develop:

    • Pharmacological dependency (development of withdrawl symptoms and/or the failure of the medication to work at continued dose)
    • Opiate use disorder (inability to abstain from drug use leading to physical, emotional, and mental detriment to the patient)
    • Temporary withdrawal symptoms with the discontinuation of the drug
    • Accidental overdose (from central nervous system respiratory depression), leading to death

    Long-term opiate therapy can also lead to immunological and/or hormonal dysfunction, as well as worsening depression and depressive symptoms. Patients must be aware of these risks prior to initiating therapy, and that these complications can occur anytime during treatment.  Risk/benefit analysis with the use of these medications will be determined by the physician.

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