Botulinum Toxin Therapy (onabotulinum toxin A) - for Chronic Migraine
Chronic Migraines are characterized by significant pain that can last for
hours or even days. Preceding a migraine, individuals may often times experience
flashes of light, blind spots, or tingling in the limbs. Individuals may
also experience nausea, vomiting, and extreme sensitivity to light. Botox
is the first and only preventive treatment approved by the FDA for adults
with Chronic Migraine with its potential for reducing the number and frequency
of headaches. Botulinum toxin is administered as an injection every 3 months
in our office by our experienced Pain Management Physicians.
Epidural Steroid Injections (ESI)
Using x-ray fluoroscopy to guide the needle directly into the neural foramen;
the point where the affected nerve root exits the spinal canal. Injections
of steroids into the lumbar epidural space are particularly useful to alleviate
pain that radiates from the lower back into a leg. This pain may be caused
by disc herniation or spinal stenosis, which triggers nerve root irritation,
inflammation, and pain. Similarly, ESIs are used to treat neck pain that
extends into the arms.
Facet Joint Injections involve the injection of steroid
medication into the affected spinal facet joint (fah-set joint) to reduce
inflammation and pain. Injections into these joints or blocks of the nerves
that feed the facet joints can often be very helpful to relieve pain.
Nerve Blocks are injections of medication onto or near
nerves. The medications that are injected include local anesthetics, steroids,
and opioids. Blocks are used to control acute pain. Blocks can provide periods
of dramatic pain relief, which can help reduce nerve and joint inflammation,
and the abnormal triggering of signals from injured nerves.
Occipital Nerve Block
An occipital nerve block is the injection of local anesthetic around the
occipital nerves, which are located in the back of your neck near the base
of the skull. This may be useful in the diagnosis and treatment of headache
and jaw pain. A needle is inserted around your occipital nerve and a local
anesthetic or local anesthetic steroid solution is injected.
Osteopathic Manipulative Therapy
OMT involves using the hands to diagnosis and treat illness or injury. Gentle
pressure and resistance is used to move your joints and muscles.
Peripheral Nerve Blocks affect the peripheral nerves; nerves
beyond the brain and spinal cord. These nerves transmit sensation and motor
A facet ablation destroys facet nerve(s) either in the lower back (lumbar)
or the neck (cervical) region, using radiofrequency (heat) waves. This procedure
is done if you have pain due to disease in the facet joints of your spine,
and you have had pain relief from your facet nerve blocks.. Fluoroscopy
is used to guide the placement of the needle probe to the area of the facet
nerve. Radiofrequency waves are transmitted to lesion (destroy with heat)
the involved nerve(s). This temporarily stops sensation from that area,
which may last for an average of 6 months or more.
Sacroiliac (SI) Joint Injections
An SI joint injection is the injection of medication into the sacroiliac
joint in your buttock region. This may be done if you have a certain type
of low back/buttock pain. Fluoroscopy will be used to guide placement of
a needle into the SI joint, and inject a local anesthetic or local anesthetic/steroid
Spinal Cord Stimulator Trials
Spinal cord stimulation always involves a short, 5-7day trial conducted
with a temporary stimulator to determine whether or not spinal cord stimulation
will provide the patient with adequate pain relief. This is unlike many
other forms of pain treatment. The spinal cord stimulator for the trial
period is implanted during an outpatient visit. Placement of the trial stimulator
generally takes about 10 to 20 minutes, and the patient can go home soon
after the leads have been inserted. Preset programs are used to emit electrical
currents in a pattern designed to target the areas of pain. If the patient
experiences significant relief from pain during the trial, a complete system
with a generator can then be implanted. Medtronic YouTube Video
Trigger Point Injections are muscle blocks. Muscles chronically
tense or in spasm become tender and painful. The pain triggers more spasm
that can develop into a vicious cycle. Injections into the muscle can help
to break the cycle.