Treatments

+ Facet joint injection / Medial branch blocks

A Facet Joint joins two vertebrae. It allows smooth movements in the spines. Arthritic joints may be the source of considerable back and / or neck pain. Rhizolysis involves administration of local anaesthetic around the nerves supplying these joints along with small amount of steroid. This is performes under X- ray or Ultrasound guidance with an appropriate needle. This is a day case procedure. Rhizolysis gives short term pain relief and has more to do with identifying the source of pain and planning definitive pain procedure in the future. This window of pain relief can be used to exercise and perform physiotherapy and the injection may have some long term positive effects.

+ Radiofrequency Ablation of medial Branch (Rhizotomy)

If medial branch nerve block (Rhizolysis-see information) proves successful and provides temporary relief, radiofrequency ablation is carried out. Drop of targeted radiofrequency generated heat is applied around each nerve under X-Ray guidance with appropriate sensory and motor testings. The nerve regrows over time, but if successful this procedure provides relief for 6 months to a year, sometimes even longer.

+ Epidural Steroid injection

Usually epidural injection is performed to provide pain relief for neck and back with our without radiation to the limbs and is mostly likely due to a slipped disc. It involves the injection of steroid into the epidural space (the space that surrounds the spinal cord and the nerves) in the back under X-ray or Ultrasound guidance. The steroid injection helps in calming the inflamed nerves. It gives short term pain relief of around 3 months in the majority of patients. But this window of pain relief can be used to exercise and perform physiotherapy and build up core muscles and the injection may have long term effect.

+ Dorsal Root Ganglion PRF

This treatment is an alternate option for nerve pain effecting the limb, commonly called “sciatica”, a frequent accompaniment to low back pain. It is due to irritation of the nerve root, most commonly by a "slipped" or "bulging" disc. Surgery is the last option for such pain and could result in more harm than benefit. Pulsed Radiofrequency (PRF) is a non-invasive treatment which aims to modulate the nerve’s function with electrical stimulation to the nerve station called Dorsal Root Ganglion (DRG) and so relieve pain. One or more levels may be treated as necessary. Studies have shown a benefit of up to a year in majority of the patients.

+ Rami communicans block

This procedure involves blocking a small twig of nerve from the main spinal nerve which supplies the disc and some vertebral structures. Indicated for midline disc related pain and also for vertebral compression fracture, a common complication of osteoporosis in the aging population. This is a X-Ray guided procedure; using a combination of local anaesthetic and steroid. This is a diagnostic block and is followed by more definitive procedure based on the initial response.

+ Spinal Cord Stimulation

Spinal Cord Stimulation is used to treat chronic nerve pain which is neuropathic, caused by direct or indirect injury to the nerves usually after spine surgery or trauma. It is not used for arthritis or muscle pain. It is recommended only for patients who have severe pain and disability and all other modalities of treatment have failed to make any impact. The Stimulation System consists of a chargeable or non-rechargeable battery implanted in the buttock and lead / leads going into the spine, precisely sited close to the spinal cord. Application of electricity through this novel system can result in a reduction of pain and can be controlled by the patient using a handheld controller. This therapy is also called neuromodulation. For some patients, low frequency stimulation in the form of tingling (paraesthesia) will be used and for others higher frequency stimulation, where nothing can be felt with achievement of pain relief and this mode is increasingly used now. In most cases a trial stage is used which will determine the success of permanent therapy.

+ Trigger point injection

Trigger points are tender points in the muscles secondary to spasm and these are sometimes felt like knots or bands. Injections are made into these points under image guidance using Ultrasound or X-Rays with local anaesthetic, often mixed with steroid and or botulinum toxins. Effects are shortlived but when combined with physiotherapy and exercises, patients could derive additional benefits and the therapy could facilitate faster rehabilitation. Normally two to three sessions are required to get optimal results.

+ COELIAC PLEXUS BLOCK

The coeliac (solar) plexus is a group of nerves in your belly. It sends pain messages to your brain from your Stomach, Pancreas, Liver, Kidneys, Gall bladder, Spleen and Intestines. Coeliac plexus block is indicated mostly for cancer pain and also for non-cancer pain. An injection is administered under X-Ray. Local anaesthetic is used for diagnostic block to confirm the source of pain followed by more definitive block using medical alcohol. Complications with definite block include rare chances of injury to major blood vessels and abdominal structures, partial collapse of lung, accidental injection of medication into a blood vessel and weakness in legs. Your pain specialist will always discuss these with you before your procedure.

+ SPLANCHNIC NERVE BLOCK

A splanchnic nerve block is an injection of medication that helps relieve upper abdominal pain, commonly due to cancer or chronic pancreatitis. The splanchnic nerves are located on both sides of your spine. They carry pain information to your brain from organs in your abdomen. Blocking these nerves can help stop the feeling of abdominal pain. Indications are the same as with Coeliac plexus block (information provided) but associated with less likelihood of complications and radiofrequency treatment including ablation is possible. Mostly used in non-cancer belly pain coming from internal organs.

+ HYPOGASTRIC PLEXUS BLOCK

The hypogastric plexus is a station of nerves near the lower spine and is located in front of major blood vessels. Blocking this plexus can help ease pelvic pain coming from distant colon, uterus, ovaries, prostate, testicles and other upper deep pelvic structures. It is used to treat both cancer and non-cancer pelvic pain. For the procedure, the patient lies on their stomach and X-Ray is used. The procedure is approximately 30 minutes in duration. Pain relief is experienced immediately after the injection, but pain may return a few hours later as the local anaesthetic wears off. Longer term relief usually begins in two to three days once the steroid begins to work. How long the pain stays away is different for each patient. For some, the relief lasts weeks. For others, the relief can last for months.

+ GANGLION OF IMPAR BLOCK AND COCCYGEAL INJECTION

A ganglion impar block is a procedure for treating chronic lower pelvic or rectal pain by blocking nerve impulses. Pain around the genital or “seat” region, which is burning in character and frequently accompanied by sensations of urgency with urination and/or defecation can be treated by this simple procedure when other measures fail. The ganglion impar is a structure located at the level of the coccyx (tail bone). If the block is successful there is pain relief for a few hours, but it will typically return. it will improve over the next few days when the steroid takes effect. When supplemented by Pulsed Radiofrequency (PRF) treatment the duration of pain relief can be further prolonged but repeat injections are mostly necessary.

+ PUDENDAL NERVE BLOCK

Pudendal nerve block is indicated to treat a nerve pain called "Pudendal Neuralgia", a condition where a person experiences chronic pain in the distribution of the pudendal nerve which includes the skin from the clitoris (penis in males) to the anus. Pain could be secondary to trauma but mostly without apparent cause. The pudendal nerve travels from the lower back, along the muscles of the pelvic floor and towards the perineum (the skin between the tailbone and the pubic bone) and is targeted under image guidance (Ultrasound/X-Ray). The injection of local anaesthetic and steroid may provide temporary relief from pain but one should follow a regular gentle course of daily exercises, otherwise the pain will return.

+ IMAGE GUIDED TRIGGER POINT INJECTIONS

Spastic pelvic muscles could be the reason for chronic pelvic pain and is termed as myofascial pain. Injections are made into these points under image guidance using Ultrasound or X-Rays with local anaesthetic, often mixed with steroid and or botulinum toxins. Effects can be short term but when combined with physiotherapy and exercises, patients could derive additional benefits and the therapy could facilitate faster rehabilitation. Normally two to three sessions are required to get optimal results.

+ SACRAL NEUROMODULATION

Significant number of patients with chronic pelvic pain do not respond to conventional treatment and often no good alternative can be offered except extensive surgery like hysterectomy which might fail to resolve pain . Sacral neuromodulation or sacral nerve stimulation have also been suggested to be useful in the treatment of refractory chronic pelvic pain. Evidence is evolving and several studies have demonstrated promising results. It follows the same pathway for spinal cord stimulator for radicular spinal pain (Information provided).

+ INTERCOSTAL NERVE BLOCK AND ABLATION

Intercostal nerve blocks are used to manage thoracic and chest wall pain when conservative measures fail to make any impact. The chest wall consists of skin, muscles and bones which form a protective structure around vital organs. The intercostal nerves exit the spine and travel underneath the ribs to carry sensory information to the skin over the chest wall. These nerves could be irritated by surgical and non-surgical trauma or viral infection (Shingles, causing chest wall pain along with muscle spasm). These nerves can be temporarily blocked under image guidance (Ultrasound/X-Ray) to disrupt painful signals originating from the chest wall. Pain may return as the effects of local anaesthesia and steroid wear off. However, with radiofrequency or cryoablation, which involves heating/freezing the nerves longer lasting pain relief can be achieved.

+ IMAGE GUIDED TRIGGER POINT INJECTIONS

Spastic chest-wall muscles and localised inflammation such as costochondritis could be the reasons for chronic chest-wall pain. Injections are made into these points under image guidance using ultrasound or X-Rays with local anaesthetic, often mixed with steroid. Effects are short term but when combined with physiotherapy and exercises, patients could derive additional benefits and the therapy could facilitate faster rehabilitation. Normally two to three sessions are required to get optimal results.

+ IMAGE GUIDED TRIGGER POINT INJECTIONS

Trigger points are tender points in the muscles secondary to spasm, these are sometimes felt like knots or bands. Injections are made into these points under image guidance using ultrasound or X-Rays with local anaesthetic, often mixed with steroid and or botulinum toxins. Effects are short term but when combined with physiotherapy and exercises, patients can derive additional benefits and the therapy can facilitate faster rehabilitation. Normally two to three sessions are required to get optimal results.

+ PLATELETS RICH PLASMA (PRP) THERAPY

Platelet-rich plasma (PRP) injections help to heal an injury and subsequently provide pain relief. Patient’s own blood which is rich in platelets is separated using a centrifuge. Platelets are a type of blood cell that play a role in healing. This is administered into the target site under image guidance (Ultrasound/X-Ray). PRP injections usually take about 30 minutes. Platelets break down and release growth factors, which are components that help cells repair and renew. It is a very simple and safe procedure when carried out with all appropriate precautions.

+ PERIPHERAL NERVE STIMULATOR

Peripheral nerve stimulation is used to treat chronic nerve related pain following trauma to a nerve, amputation and complex regional pain syndrome. Unlike spinal cord stimulator, the effected nerve is targeted directly and is less invasive. The system involves the placement of a small diameter lead under ultrasound imaging and then connecting it to a stimulator inserted under the skin. After the lead is connected to the stimulator, the patient is able to adjust stimulation and customise its output remotely using a small Bluetooth enabled controller.