Pain Management Treatments
Radiofrequency Ablation (Radiofrequency Neurotomy)
Benefits Include:
Non-surgical, minimally invasive but effective pain relief
Performed in an outpatient facility
No downtime; patients can resume normal activities in just a few hours
Provides a greater range of motion
Minimizes the need for pain medications
Long-lasting relief, up to 2 years
Improved quality of life
This minimally invasive outpatient procedure can provide long-lasting relief to those suffering from facet joint pain, chronic low back pain, and neck pain. Radiofrequency Ablation has proven to be a safe and effective way to treat some forms of pain. It is generally well-tolerated, with very few associated complications. Dr. Karan Johar is well-known for this treatment, attracting patients from all over New York.
The Radiofrequency Ablation Procedure
The radiofrequency machine uses electrical currents produced by radio waves to heat the nerves in the area of the patient’s pain to 80 degrees Celsius for one minute.
How to Prepare for a Radiofrequency Ablation Procedure
You will receive instructions from one of Dr. Johar’s specially trained nurses prior to your procedure day. Key preparation steps include:
Fasting: Do not eat or drink anything after midnight the day before the procedure.
Diabetic Patients: You may have additional instructions and might need to adjust insulin dosages on the day of the procedure. Bring your diabetes medication with you to take after the procedure.
Medications: Continue taking all other medications with a small sip of water. Do not discontinue any medications unless specified by your primary or referring physician.
Anesthesia: If you are having local anesthesia, bring someone with you to drive you home, and they must stay on the premises during the procedure. Do not drive or operate machinery for 24 hours after the procedure. If you opt not to have anesthesia, you may drive yourself home. Discuss all your options with Dr. Johar.
Dekompressor Discectomy
What is Dekompressor Discectomy?
Dekompressor Discectomy procedures aim to relieve symptoms of herniated discs in the spine. Conditions arise when spinal discs, which cushion the vertebrae, rupture and release their jelly-like substance into the spinal column. This rupture can cause pain, as the material places pressure on the nerve roots, leading to traveling pains and general weakness.
A general discectomy is a more invasive, open-back procedure. In contrast, Dekompressor Discectomy is a minimally invasive alternative that many patients prefer before considering more invasive options. This less-invasive procedure allows us to perform Dekompressor Discectomy on an outpatient basis.
Who is a Candidate for Dekompressor Discectomy?
If you’re suffering from disc issues and live in New York or the surrounding areas, our experienced physician, Dr. Karan Johar, can discuss this and other treatments to fit your current needs. At Park Avenue Medicine & Surgery, we believe in personalized patient care, developing treatment plans tailored to each individual’s unique situation.
How Does Dekompressor Discectomy Work?
Preparation: Patients take medication to relax before treatment begins. A local anesthetic numbs the area.
Procedure: Using X-rays or other imaging methods, the doctor locates the affected disc(s) and inserts a small needle into the area. Through this hollow needle, a tiny probe is inserted to remove portions of the damaged disc. Once completed, the needle is removed, and the insertion site is bandaged.
Recovery Time
Recovery time varies for each patient, but this procedure is performed on an outpatient basis and does not involve cutting into muscle or bone. As a result, recovery is less intense than other procedures that require opening the back.
Post-Procedure
The body’s natural healing processes absorb the displaced core of the disc, providing relief from symptoms. Patients typically begin to feel relief within days after treatment.
Dekompressor Discectomy Treatments in New York
If you think this might be a good fit for you and would like to speak to a doctor about it, get in touch with us today. Dr. Johar and his team are knowledgeable about this and many other treatments, ranging in invasiveness, to help you live a pain-free, healthy life. Please use the contact form on our website or call us today.
Lumbar Kyphoplasty
What is Lumbar Kyphoplasty?
Lumbar Kyphoplasty is a minimally invasive procedure designed to provide immediate relief and promote healing for patients experiencing significant back pain due to spinal fractures. These fractures are often caused by osteoporosis, trauma, or other spinal conditions that weaken the vertebrae.
How Does Lumbar Kyphoplasty Work?
Preparation: The patient is given a local or general anesthetic to ensure comfort during the procedure.
Balloon Insertion: The doctor inserts a needle into the fractured vertebra and then guides a small balloon into the area.
Balloon Inflation: The balloon is gently inflated, creating space by elevating the collapsed vertebra. This process also compacts the inner bone, creating a cavity.
Cement Injection: The balloon is removed, and the cavity is filled with a special bone cement. This cement hardens quickly, stabilizing the vertebra and restoring its height.
Benefits of Lumbar Kyphoplasty
Immediate Pain Relief: Many patients experience significant pain relief soon after the procedure.
Minimally Invasive: The procedure involves small incisions, leading to a quicker recovery and less post-operative pain compared to open surgery.
Stabilizes Fractures: The bone cement used in kyphoplasty stabilizes the fractured vertebra, preventing further collapse.
Restores Vertebral Height: By restoring the height of the collapsed vertebra, kyphoplasty can improve posture and reduce spinal deformity.
Quick Recovery: Most patients can return to their normal activities within a few days.
Who is a Candidate for Lumbar Kyphoplasty?
Patients experiencing significant back pain due to vertebral compression fractures, particularly those caused by osteoporosis or trauma, may be good candidates for lumbar kyphoplasty. It is important to consult with a specialist to determine if this procedure is appropriate for your specific condition.
What to Expect After Lumbar Kyphoplasty
Recovery from lumbar kyphoplasty is generally quick, with many patients experiencing immediate pain relief. Post-procedure care may include:
Rest and Activity: Patients are encouraged to rest for a short period before gradually resuming normal activities.
Pain Management: Over-the-counter pain medications are usually sufficient to manage any discomfort after the procedure.
Follow-Up Care: Regular follow-up appointments with your doctor to monitor healing and ensure the success of the procedure.
Lumbar Kyphoplasty in New York
Dr. Karan Johar at Park Avenue Medicine & Surgery is experienced in performing lumbar kyphoplasty, offering this advanced treatment option to patients suffering from spinal fractures. Our team is dedicated to providing comprehensive care and personalized treatment plans to help you achieve pain relief and improved quality of life.
Intrathecal Pump
What is an Intrathecal Pump?
An intrathecal pump, also known as a "pain pump," is a unique method for administering medication directly to the spinal cord. This system involves a small pump that is surgically implanted beneath the skin of the abdomen. The pump is programmed to deliver a precise amount of medication through a catheter to the area near the spinal cord, similar to an epidural used during childbirth.
For patients who have not found relief through conventional methods, an intrathecal pump can be an effective alternative. By delivering medication directly to the spinal cord, the pump can control symptoms with much smaller doses compared to oral medication. The primary goal of a pain pump is to provide better pain management and reduce the need for oral medications, thereby minimizing their side effects.
Benefits of an Intrathecal Pump:
Effective Pain Relief: Provides targeted pain relief directly to the source.
Reduced Medication Dosage: Requires smaller doses of medication compared to oral administration.
Minimized Side Effects: Reduces the side effects associated with higher doses of oral medications.
Improved Quality of Life: Enhances the patient’s ability to manage chronic pain, improving overall quality of life.
Who is a Candidate for an Intrathecal Pump?
Candidates for an intrathecal pump typically include patients who have chronic pain that has not responded to other treatments. It is particularly beneficial for those with:
Chronic back pain
Cancer pain
Nerve pain
Spasticity from conditions like multiple sclerosis or spinal cord injuries
The Procedure:
Evaluation: A thorough evaluation by a pain specialist to determine if the intrathecal pump is appropriate.
Trial Period: A trial period may be conducted to assess the effectiveness of the pain pump.
Surgical Implantation: If the trial is successful, the pump is surgically implanted under the skin of the abdomen.
Programming: The pump is programmed to deliver the precise amount of medication needed.
Recovery and Follow-Up:
Recovery from the implantation surgery is relatively quick. Patients will have follow-up appointments to monitor the pump’s performance and make any necessary adjustments to the medication dosage. Regular check-ups ensure that the pump is functioning correctly and that the patient’s pain is effectively managed.
Intrathecal Pump Treatment in New York:
Dr. Karan Johar at Park Avenue Medicine & Surgery offers comprehensive care for patients considering an intrathecal pump. With expertise in pain management, Dr. Johar provides personalized treatment plans to help you achieve optimal pain relief.
Endoscopic Discectomy
What is Endoscopic Discectomy?
Endoscopic discectomy is a minimally invasive surgical option for treating lumbar disc herniations that cause leg and lower back pain. This procedure offers an alternative to traditional open surgery, with the choice between the two primarily depending on the patient’s overall condition and the surgeon’s preference.
The Procedure
Endoscopic discectomy is performed through a small tube called a trocar, which is inserted into the patient's skin and directed towards the affected disc. The goal is to remove the herniated disc material that is pressing on the spinal nerves, thereby alleviating leg and lower back pain.
During the procedure, the surgeon uses an endoscope, a small camera with a light, to view a magnified image of the working area on a monitor. This visualization allows the surgeon to accurately remove the damaged tissue. The entire process is guided by fluoroscopy, which helps locate the herniated disc and ensures precise removal. Because the muscles are retracted rather than cut, the recovery time is significantly shorter.
How Endoscopic Discectomy is Performed
Preparation: The patient lies face down on the operating table and receives a mild sedative to help them relax.
Incision: A tiny incision is made over the affected disc area in the patient’s back.
Guidewire and Tube Insertion: A thin wire is inserted through the incision to the damaged section of the spine under fluoroscopic guidance. A tube is then inserted over the guidewire.
Removal of Herniated Disc: Micro-surgical instruments and the endoscope are placed in the tube to remove the herniated disc material compressing the nerves. Both fluoroscopy and the endoscope guide the surgeon throughout the procedure.
Completion: The endoscope and tube are removed, and the incision is closed.
What to Expect After the Procedure
Most patients are discharged on the same day as the surgery. A significant reduction in leg and back pain is typically felt shortly after the procedure, although tingling and numbness may take some time to fully resolve. Patients are advised to avoid lifting, twisting, or bending for several weeks following the surgery to ensure proper healing.
Endoscopic Discectomy at Park Avenue Medicine & Surgery
Dr. Karan Johar at Park Avenue Medicine & Surgery offers expertise in performing endoscopic discectomy, providing patients with a minimally invasive option for relieving pain caused by herniated discs. Our team is dedicated to offering personalized care and effective treatment solutions to help you achieve a pain-free life.
Muscle & Reflex Testing
What is Muscle & Reflex Testing?
Chronic back pain can arise from various conditions or injuries affecting multiple systems, including the central nervous system, skeletal system, and muscular system. To accurately diagnose the cause of chronic back pain, doctors perform various tests to identify weaknesses in these systems.
Muscle and reflex tests are crucial components of a physical exam. These tests help diagnose specific issues such as sciatica, herniated discs, pinched nerves, and other spinal conditions.
Common Reasons for Muscle & Reflex Testing:
During a physical exam, your doctor may ask you to perform the following activities:
Walk on the soles of your feet
Walk on your heels
Walk on your toes
These tests assess the strength of the muscles in your legs and help determine if there is any nerve damage from spinal degeneration.
Reflex Testing:
For reflex testing, the doctor will gently tap your knee and the back of your heel with a rubber hammer. Normal reflexes will cause a clear twitch in the leg being tested. Reflex tests evaluate general neural function and can reveal nerve damage.
What Muscle & Reflex Testing Reveals:
Reflexes can be exaggerated or depressed, indicating nerve dysfunction. For example, an exaggerated response might point to spasticity caused by a central nervous system injury. Difficulty walking on your heels or toes, or a lack of reaction during the test, may indicate nerve damage or a compressed nerve root from a bulging or prolapsed disc.
Every nerve root in your spine consists of two fibers: a motor fiber and a sensory fiber. The motor fiber controls muscle movement, while the sensory fiber delivers sensation to specific skin areas (dermatomes). The muscle group supplied by the same nerve root is known as a myotome. If your doctor finds weakness in a particular myotome, it could indicate damage to the corresponding nerve, often due to a disc injury compressing the nerve root.
Importance of Muscle & Reflex Testing:
These tests are essential for pinpointing the source of pain and nerve dysfunction, enabling accurate diagnosis and effective treatment planning. If you experience chronic back pain, consult with Dr. Karan Johar at Park Avenue Medicine & Surgery for a comprehensive evaluation and personalized treatment plan.
Fluoroscopy in Pain Management
Advanced technology has significantly contributed to modern interventional pain management. Fluoroscopy, a type of imaging method that utilizes X-rays to obtain real-time moving images of a patient's internal structures, is one such advancement. A fluoroscope, essentially a box or tube fitted with a screen coated with fluorescent material, allows for the viewing of deep structures within the body.
How Fluoroscopy Works
Fluoroscopy enables precise needle placement and opens up new treatment possibilities in pain management. During procedures, doctors like Dr. Karan Johar can inject a contrast substance to determine the exact location of the needle in real-time, rather than relying on conventional X-rays.
Advantages of Fluoroscopy
Research has shown that epidural injections done without fluoroscopy have a 30-40 percent miss rate, highlighting the importance of this technology in ensuring accurate treatment. Many pain physicians now consider fluoroscopy a standard tool during epidural injections, as it helps achieve the best possible care and results for patients.
Applications of Fluoroscopy
Fluoroscopy has significantly benefitted several procedures developed over the past decade, including:
Minimally Invasive Lumbar Discectomy
Vertebroplasty
Spinal Cord Stimulators
When working in difficult or awkward areas, dye injections under fluoroscopy can confirm accurate needle placement, saving time and ensuring precise delivery of medication. Fluoroscopy also allows the doctor to see in real-time if the needle is appropriately located within a vascular structure.
Flexibility and Precision
Fluoroscopes can move in many directions, which is particularly useful for patients with scoliosis or other irregular anatomies. The intensity of fluoroscopy can be adjusted, which is helpful for patients with excess tissue to penetrate. Advanced fluoroscopes enhance image quality, even as patient size increases.
Conclusion
Fluoroscopy technology and its increased precision have revolutionized pain management, making procedures more accurate and efficient. The use of fluoroscopy is comparable to the convenience and utility of a cell phone in modern life.
Transforaminal Injections
What is a Lumbar Transforaminal Epidural Steroid Injection?
A lumbar transforaminal epidural steroid injection involves administering a long-term steroid injection into an opening on the side of your spine where a key nerve root exits, known as a foramen. This area includes a small sleeve of epidural space that extends beyond the nerve root, located just outside the spinal canal.
These steroid injections are beneficial for treating back and lower back pain, particularly by relieving inflammation associated with herniated discs, thereby facilitating quicker healing.
Procedure
This outpatient procedure generally does not require an overnight stay and is typically not painful, so sedation is unnecessary. You will lie face down on an x-ray table, and the skin above the treatment area will be numbed using a local anesthetic, similar to what is used in dental procedures.
A needle is then inserted into the skin, guided by a fluoroscope when needed to ensure precise placement. These injections are sometimes referred to as root sleeve blocks, transforaminal epidural blocks, or root blocks.
Recovery Process
After the procedure, you will be monitored for about half an hour to ensure there are no adverse reactions to the medication or needle placement. You will be advised not to drive for the rest of the day, as the local anesthetic can temporarily dull reflexes and response times.
You should be able to return to normal activities the following day. Some soreness or tenderness around the injection site is common and can be relieved with an ice pack. Pain relief typically begins within 2-3 days.
What to Expect from Transforaminal Injections
The injection involves inserting a needle through the skin into the deeper tissues. Although you may experience some discomfort, the doctor will numb both the deeper tissues and the surrounding skin with a local anesthetic before inserting the needle. Once the area is numb, the injection needle is inserted, usually causing a sensation of pressure rather than sharp pain.
Some patients opt for intravenous sedation instead of a local anesthetic to make the process more comfortable, while others undergo the injection without any sedation and do quite well.
Immediately following the injection, your leg or arm may feel numb or slightly heavy, depending on the injection site and the amount of local anesthetic used. Most patients can still move their limbs normally despite the numbness. This temporary effect is due to the concentration of the anesthetic. Many patients experience significant pain relief shortly after the injection, but this immediate relief typically lasts only a few hours. Some soreness may persist for a few days due to the needle insertion and initial irritation from the medications. Substantial pain relief usually begins around the third day.
Transforaminal Injections at Park Avenue Medicine & Surgery
If you are considering a transforaminal injection for pain relief, Dr. Karan Johar at Park Avenue Medicine & Surgery provides comprehensive care and expertise in this procedure.
Non-Surgical Pain Treatments
Dr. Karan Johar believes that the most effective way to improve chronic pain conditions is through a multidisciplinary approach and non-surgical interventional procedures. He understands that pain can significantly impact an individual’s quality of life, affecting them functionally, emotionally, and socially.
By using conservative and interventional procedures, Dr. Johar aims to:
Minimize dependence on opioids
Improve quality of life
Enhance functionality
Develop pain coping skills to help patients adapt to daily activities and regain normal function
Non-Surgical Pain Treatment Options
Physical Therapy: Helps restore movement and function.
Occupational Therapy: Assists patients in performing daily activities.
Advanced Manual Therapy Techniques: Includes various hands-on techniques to alleviate pain.
Joint Mobilization: Improves joint movement and reduces pain.
Trigger Point Therapy and Myofascial Release: Targets muscle knots and tightness.
Platelet Rich Plasma (PRP): Uses the patient’s own blood to promote healing.
Electromyography: Diagnoses muscle and nerve conditions.
Joint Fluid Replacement: Provides lubrication to joints to reduce pain.
Muscle Energy Techniques: Uses muscle contractions to improve mobility.
McKenzie Exercise Programs: Focuses on spinal exercises to reduce pain.
Postural Training: Corrects posture to alleviate pain.
Balance/Proprioception Training: Improves stability and coordination.
Post-Operative Rehabilitation: Aids recovery after surgery.
Modalities (Mild Electrical Stimulation and Ultrasound): Uses technology to relieve pain.
Cold Laser Therapy: Reduces pain and inflammation.
Therapeutic Exercise, Aerobic Exercise, Massage, Stretching: Enhances overall well-being.
Home Exercise Programs: Encourages ongoing self-care at home.
Dr. Johar focuses on helping patients return to their daily lives, often without requiring surgery. In fact, nine out of ten patients recover with non-surgical pain treatments. He offers multifaceted pain management, quality service, and extensive knowledge. Specializing in the non-surgical treatment of intractable pain, Dr. Johar provides thorough evaluations, treatment recommendations, coordinated care, and alternative approaches when conventional options fail.
Epidural Steroid Injections
What are Epidural Steroid Injections?
Epidural steroid injections (ESIs) are minimally invasive procedures designed to relieve pain in the neck, back, legs, and arms caused by inflamed spinal nerves. ESIs are often used to alleviate pain due to conditions such as disc herniation, spondylolysis, or spinal stenosis. The medication is delivered directly to the spinal nerve via the epidural space, which lies between the vertebrae and the spinal cord’s protective covering. Although the effects of ESIs are generally temporary, pain relief can last from several days to several years. The primary goal is to reduce pain enough to allow patients to resume normal activities and improve their quality of life.
What is an ESI (Epidural Steroid Injection)?
An ESI consists of a combination of an anesthetic numbing agent (such as bupivacaine or lidocaine) and a long-lasting corticosteroid (such as betamethasone or triamcinolone). These medications are injected into the epidural space of the spine, an area filled with tiny blood vessels and fat, between the bony vertebrae and the spinal cord’s protective covering (dura).
Corticosteroids work to reduce acute inflammation and are particularly effective when delivered directly into the affected area. Although ESIs do not reduce the size of a herniated disc, they effectively target the spinal nerves to provide pain relief, allowing patients to improve their spinal health through physical therapy and exercise programs.
Who is a Good Candidate for ESI?
Patients suffering from chronic pain in the neck, lower back, arm, or leg (sciatica) may benefit from ESIs, especially those with the following conditions:
Herniated Disc: When the gel-like substance inside the disc ruptures or bulges through a weak area in the annulus, causing swelling, pain, and irritation.
Sciatica: Intense pain along the sciatic nerve in the buttocks and down the leg, typically due to compression of the 1st sacral or 5th lumbar spinal nerve.
Spinal Stenosis: Narrowing of the nerve root canal and spinal canal, causing significant leg and back pain, especially when walking.
Degenerative Disc Disease: Aging or breakdown of the intervertebral disc, leading to disc space collapse, bone spur growth, and annulus tears.
Spondylolysis: Fracture or weakness between the lower and upper parts of a vertebra, causing the vertebra to slip forward and compress the nerve roots.
Why are ESIs Limited?
ESIs are generally limited to a few per year because the steroids can weaken nearby muscles and spinal bones, not because of the needle itself. The more ESIs a patient receives, the higher the risk of these side effects. ESIs mimic the effects of hydrocortisone and cortisone, temporarily reducing inflammation and pain when injected near irritated nerves. However, repeated steroid injections can disrupt the body's natural hormone balance, so spacing out injections allows the body to return to normal.
It’s important to weigh the potential risks and benefits of long-term ESIs. If pain persists between injections, discuss alternative treatment plans with your doctor.
How Often can ESIs be Performed?
There is no definitive research dictating how often a patient should receive ESIs for leg or lower back pain. Some patients may receive up to three ESIs within a six-month period, but the frequency should be tailored to each patient's specific condition and in consultation with their doctor.
Selective Nerve Root Blocks
What are Selective Nerve Root Blocks?
Selective nerve root blocks (SNRBs) involve injecting a local anesthetic along a specific nerve root to alleviate pain. Along your spine are several foramina, or openings, through which nerve roots exit. These openings can become partially closed due to vertebral misalignment, bone spurs, or bulging discs, leading to nerve root compression. This compression often causes intense, radiating pain along the affected nerve root. In an SNRB procedure, a doctor injects medication next to the nerve root using a small needle inserted into the foramen.
Spinal Nerve Inflammation
Spinal nerve inflammation can occur from compression due to bone spurs or damaged discs. Depending on the nerve's location, this can cause pain, tingling, or numbness in various parts of the body. For example:
Cervical Spine: Pain, numbness, or tingling in the shoulder, arm, or neck.
Thoracic Spine: Pain in the upper back or near the ribs and chest wall.
Lumbar Spine: Pain in the lower back, buttocks, hips, or legs, along with numbness or tingling.
How Selective Nerve Root Blocks are Performed
The procedure is generally performed with the patient lying on their side for a neck injection and on their belly for a back injection. Throughout the procedure, the patient's oxygenation and blood pressure are monitored. In addition to the doctor and X-ray technician, a nurse is present to assist and address any needs.
The skin on the neck or back is thoroughly cleansed with antiseptic before starting. While the injection itself takes only a few minutes, it’s best to allocate about an hour for the entire procedure.
What to Expect
After numbing the skin, you might feel some pressure from the needle at the injection site, though it should not be painful. Given that the nerve root is already irritated and sore, you may temporarily feel some aching along the nerve root as the local anesthetic is injected. This sensation typically subsides as the anesthetic takes effect, usually within about 15 seconds. These sensations are normal and should be expected.
Trigger Point Injections
What are Trigger Point Injections?
Trigger point injections (TPIs) are an effective treatment option for patients suffering from muscle pain. TPIs target specific areas of muscle that contain knots, or trigger points, which develop when muscles do not relax. These knots can often be felt just beneath the skin and can irritate nearby nerves, causing referred pain in other parts of the body.
How Trigger Point Injections Work
During a TPI, the doctor inserts a small needle into the trigger point of the patient's muscle. The injection may contain saline, a local anesthetic, and sometimes a corticosteroid. This injection renders the trigger point inactive, alleviating the pain. Often, a short course of TPIs provides long-lasting pain relief. The procedure takes only a few minutes and is typically performed in a doctor’s office. Multiple trigger points can be treated in one visit. For patients allergic to certain medications, a dry-needle technique can be used, involving no medication.
When are Trigger Point Injections Used?
TPIs are used to treat various muscle groups, especially in the neck, lower back, legs, and arms. They are also effective in treating tension headaches and fibromyalgia. Additionally, TPIs can be used to manage myofascial pain syndrome when other treatments have failed, though their overall effectiveness for this condition is still being researched.
How a Trigger Point Injection is Performed
TPIs are usually administered in a doctor’s office with the patient either sitting or lying on their belly on the exam table. The doctor locates the trigger point and marks the site, often without the need for ultrasound guidance. The skin is thoroughly cleaned with alcohol or another cleanser like betadine. To minimize pain, ethyl chloride is often used to numb the skin before the injection. If the injection site is tender or sore afterward, applying ice or heat and taking over-the-counter pain relievers like Tylenol or Advil is usually recommended.
Spinal Injections
Millions of people experience back pain every day, and even mild cases can significantly impact their quality of life. Severe back pain can halt daily activities and diminish the pleasure of living.
Spinal Injections
Spinal injections are typically administered as part of a larger, comprehensive pain treatment program. This program often includes a sensible exercise regimen to maintain or improve spinal mobility through stretching exercises and enhance stability through strengthening exercises.
How a Spinal Injection is Performed
Spinal injections are guided by a type of X-ray known as fluoroscopy to ensure accurate placement and safe administration of the medication. Initially, a liquid dye is injected to confirm the correct flow to the target area. If the dye does not flow correctly, the needle is repositioned, and more dye is injected until the proper flow pattern is achieved. Medication is administered only after confirming the precise dye flow.
Medications
Spinal injections typically involve a local anesthetic, such as Xylocaine or Lidocaine, injected into a specific area of the spine. Lidocaine acts quickly but wears off within a few hours, making it more suitable as a diagnostic tool than a long-term pain reliever. Bupivacaine (Marcaine) is another anesthetic used in spinal injections; it acts more slowly but provides longer-lasting pain relief.
A powerful anti-inflammatory steroid, cortisone, is often injected alongside the local anesthetic to reduce inflammation in the target area. Cortisone is slow-releasing and provides long-term pain relief, though it typically begins to work several days after the injection and can last for several months. In some cases, a narcotic like Fentanyl or Morphine is combined with cortisone and a local anesthetic to enhance pain relief.
What to Expect
The most common side effect of a spinal injection is a temporary increase in pain for the first 2 or 3 days after the procedure. This occurs because the injected substances can initially aggravate the inflamed area. However, these symptoms usually diminish with each passing day, leading to improved pain relief.