Intra-articular Peripheral Joint Injection
Intra-articular peripheral joint injections provide physicians with an effective modality to help treat inflammatory conditions, such as chronic joint pain, degenerative musculoskeletal diseases, and rheumatoid arthritis.
The physician injects powerful anti-inflammatory corticosteroids into the aggravated joint that will help to alleviate inflammation and pain. The physician may rely on fluoroscope guidance to help with accurate needle placement into the affected joint. The physician may also use a local anesthetic along with the steroid injection to help with the pain-relieving effects of the treatment.
This non-invasive procedure is performed in an outpatient setting with a relatively short treatment time. The effects of intra-articular peripheral joint injections are typically seen within two days following the procedure. Relief can be long lasting and may provide long-term therapeutic benefits. When effective, the injections may be part of an ongoing chronic pain treatment program. In many cases, intra-articular peripheral joint injections have allowed for enhanced mobility and substantial improvement to a patient’s quality of life. Intra-Articular Peripheral Joint injections are often used successfully to enhance physical therapy.
Epidural Steroid Injection
Epidural Steroid Injections are a standard tool for treating non-surgical, early disc herniations and inflamed nerve roots. The fluoroscopic-guided injection of long lasting steroids and local anesthetic into the epidural space acts to decrease inflammation and reduce nerve irritation, allowing for quick recovery from debilitating pain and an early start to rehabilitation.
Depending on the location of your pain, the epidural steroid injection can be given in the neck or back. Epidural steroid injections are done on an ambulatory basis, with or without conscious sedation. Patients can expect minor discomfort from the needle puncture, with beneficial effects beginning as early as 24-48 hours after the procedure.
Trigger Point Injection
Trigger Point Injections are 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.
The physician will insert a small needle into the patient’s trigger point. The injection contains a local anesthetic or saline, and may include a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in the office and usually take just a few minutes. Several sites may be injected in one visit. In cases where trigger point injections do not offer sustained pain relief, botox injections may offer longer lasting results.
Epidural Lysis of Adhesion
Epidural Lysis of Adhesions is an advanced type of epidural steroid injection for patients suffering from chronic low back pain and radicular pain (pain that shoots down the thigh, calf, and sometimes into the foot). Adhesions may form after back surgery or from leakage of disc material into the epidural space. Oftentimes, the adhesions and disc material surround a nerve root, causing inflammation and severe pain.
The physician will inject a local anesthetic into the skin. An epidural needle is inserted and a catheter is advanced to the injection site. The movement of the catheter is continuously monitored with fluoroscopy to assure safe and effective positioning. The physician will inject contrast material to see an outline of the epidural space on the monitor. This is commonly known as an epidurogram. It allows the physician to identify the exact location of the adhesion and direct medication onto the inflamed area and nerve root. The physician will then inject fluids that may include steroids, anesthetic agents, enzyme and hypertonic saline that work to relieve pain, dissipate scar tissue and reduce inflammation.
Epidural Lysis of Adhesions is indicated only after conservative treatments such as medication and epidural steroid injections have failed to relieve pain. This procedure is commonly used for spinal stenosis and post spine surgical patients where standard epidural injections may no longer be possible.
Transforaminal Injections are used to reduce inflammation and swelling of spinal nerve roots and tissues surrounding the spinal nerve root. These injections are commonly referred to as nerve blocks.
The physician will inject a long acting steroid into the opening at the side of the spine where the nerve roots exits. This opening is known as a foramen. The medication will travel into the epidural space from the side. The advantage of a transforaminal injection over an epidural steroid injection is that transforaminal allows for a more concentrated delivery of steroid medication directly on to a nerve root.
The procedure will help to reduce pain, tingling, numbness and other symptoms caused by inflammation, irritation or swelling. Transforaminal Injections are done with either light or conscious sedation.
Transforaminal Radiofrequency Nerve Reprogramming
Transforaminal Radiofrequency Nerve Reprogramming uses a computer generated-pulse radiofrequency signal to reduce nerve pain. By placing a special computer probe onto the painful nerve or on the dorsal root ganglion (DRG), a reduction in pain can be achieved. The procedure has been very effective in the treatment of neuromas, diabetic neuropathy, HIV neuropathy, sciatica, reflex sympathetic dystrophy, nerve injury, and ischemia.
Stellate Ganglion Block
The Stellate Ganglion Block is an injection procedure used to block or decrease pain located in the head, neck, chest, or arm. It may also help increase circulation. The stellate ganglion is a group of nerves located in the upper neck and is part of the sympathetic nervous system. After an injury or illness, the sympathetic nervous system may not function properly, causing pain.
The number of blocks you will need depends on how long you experience pain relief between injections. Generally, more and longer pain relief is achieved after each injection.
Radiofrequency technology can be used to block sympathetic nerves that are conductors of pain. The procedure is done using a small insulated needle guided through the skin with fluoroscopy. The needle is directed to the chain of sympathetic nerves and a dose of heat energy is precisely delivered. This causes a sympathectomy or blocking of the sympathetic nerves in patients suffering from pain that is transmitted to the brain via these nerves. Examples of sympathetic mediated pain are some neuropathies and complex regional pain syndrome. A sympathectomy may also be used for individuals with peripheral vascular disease as it helps to improve blood flow and promote healing in cases such as extremity ulcers and Raynaud’s disease.
Radiofrequency Facet Ablation is a minimally invasive procedure used to reduce pain caused by arthritis in the spine. The physician will place a small radiofrequency probe at the location of the arthritis. Fluoroscopy is used for guidance in properly targeting and placing the probe. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
The injection may cause minor discomfort and spasm at the treatment location for a couple of weeks. After approximately one month, prolonged relief is usually achieved. The degree of pain relief varies, depending on the cause and location of the pain. Pain relief can last from 6 to 12 months and in some cases, relief can last for years.
Alpha Stim-Cranial Electrotherapy Stimulation (CES)
Alpha-Stim uses microcurrent electrical therapy to provide relief for patients suffering from acute, chronic or post-traumatic pain and uses cranial electrotherapy stimulation to treat anxiety, insomnia and depression.
The Alpha-Stim electrodes will deliver low level electrical current that has been proven to effectively reduce symptoms. Both pain control and anxiety reduction are usually experienced during a single treatment, but may occur hours after the treatment or after a series of treatments. Insomnia is usually improved after a single treatment but may require up to three weeks of treatments. Depression typically takes three weeks or more of daily treatment to experience significant relief.
Matrix therapy uses pleasant, externally applied, computer-generated electromedical treatment to reduce pain, relax spasms and improve blood flow. Matrix therapy is often combined with massage, acupressure, and holistic modalities to bring relief and healing.
Severe spasm not responsive to other treatments such as physical therapy, muscle relaxants, and trigger point injections are often responsive to Botulism toxin injections. This small injection inactivates the ACh receptor on the muscle causing prolonged muscle relaxation. After approximately four weeks, the pain that is caused by muscle spasm improves. Side effects are rare and can include temporary dry mouth, pain on injection site, swallowing difficulty, and muscle weakness. Botox injections have also been found to be effective for headaches, sweating, torticolis, muscle twitches, and cosmetic wrinkles.
Spinal Cord Stimulation
Spinal Cord Stimulation is the electrical neuroaugmentation of the spinal cord. The physician will place an electrode percutaneously into the epidural space and stimulate the dorsal columns with a high frequency, low amplitude signal to block pain. The procedure involves an initial trial, followed by permanent implantation of a pacemaker-size generator, which is adjusted via a remote, hand-held controller. Spinal cord stimulation has been found to be useful for intractable pain due to reflex sympathetic dystrophy, arachnoiditis, failed back syndrome, radiculopathy, peripheral vascular disease, phantom limb pain, and deafferentiation pain.
Ketamine is an intravenous anesthetic agent that has very different properties than the conventional drugs used for anesthesia. It blocks N–methyl–D–aspartate (NMDA) receptors that are located on nearly all neurons and works to block that nerves ability to conduct pain signals to the brain. As a result, many clinical disorders that have failed conventional therapy can be treated in this manner. Ketamine can also be effective for treatment resistant depression and many neuropathic disorders. The physician will place a small IV in the patient’s arm and the drug is infused over a 45 minute period. A typical dose is 40-50 mg.
Osteoarthritis of the knee is usually caused by excess wear on the knee joints as a result of aging or a joint injury. Hyaluronic acid, the normal knee shock absorber, breaks down over time causing cartilage to wear away and the bones to rub against each other. This results in increased pain and swelling.
Orthovisc/Synvisc/Supartz/Hyalgan are FDA approved nonsurgical treatment injections that replace the knees natural joint fluid. These viscose supplementations are injected into the knee joint once a week for 3-4 consecutive weeks. The injections can be done with ultrasound to facilitate proper placement. They effectively help regenerate cartilage, lubricate and cushion the knee joint and can provide pain relief for up to 6 months. Although individual results vary, some patients will feel relief after the first injection.
Pulsed Electromagnetic Frequency Therapy
Pulsed electromagnetic frequency therapy (PEMF) delivers beneficial health enhancing electromagnetic energy to cells and organs in need of healing. Using PEMF therapy accelerates the healing process by increasing tissue oxygenation and nutrient delivery by up to 200%. In doing so it stimulates the production of ATP and other hormones thereby boosting the immune system and energizing the body. PEMF is FDA approved to reduce pain, fuse broken bones and reduce tissue swelling.
The procedure is done while the patient relaxes in a chair. The machine will be placed on the injured area and will deliver pulsing sensations. The patient may experience slight discomfort during the treatment.
Greater Occipital Nerve Block
Greater Occipital nerve blocks are used to help reduce headache pain caused by occipital neuralgias. The physician will insert a small needle where the occipital nerve originates at the base of the skull. A typical injection includes local anesthetic and steroids.
Median Nerve Block
The dorsal median nerves are small nerves that innervate the facet joints of the spine. The facets are synovial joints that are between the bones of the spine that over time can become arthritic and be a source of pain. By using a small needle under local anesthesia the nerve can be directly injected with a long acting anesthetic. If after the injection there is prolonged relief of pain a radiofrequency procedure to the same nerves can be performed which can offer long lasting pain relief.
An opiate regimen may be prescribed for patients whose acute or chronic pain has not responded to more conservative treatments such as non-opioid medications, heating pads, ice and physical therapy. Opiates may also be indicated for patients who cannot tolerate oral anti-inflammatory agents due to a drug allergy or side effects like nausea, vomiting or gastritis.
The goal of an opiate regimen is to improve function by decreasing pain and allowing a return to normal daily activity and exercise. In addition, patients may be referred for physical therapy or receive injections that will aid in reducing pain and keeping the opiate dose to a minimum.
Patients on an opiate regimen will be closely monitored with frequent reevaluation and urine toxicology.
Buprenorphine is a partial opioid agonist that has been used for standard pain management for many years. It was released in 2000 for the treatment of opiate dependence in a private office setting. Many patients with legitimate causes of pain have problems overtaking pain medication due to previous dependency issues, depression, and anxiety disorders. Suboxone has the special advantage of being a strong pain medication, resistant to patient escalation of dose, beneficial ceiling effect, less sedation, and minimal street resale value. Patients that have opiate dependency issues or legitimate pain and opiate overuse issues may be good candidates for treatment with Suboxone.
Intrathecal Pump Infusions – Refills and Maintenance
Fully implantable drug delivery systems are now available for infusing opioids and baclofen into the intrathecal space. This is very effective for the treatment of syndromes that are unresponsive to more conservative measures including spinal cord injuries, multiple sclerosis, cancer, and chronic painful conditions where patients are unable to tolerate systemic opioids.
Medical Marijuana Therapy
Medicinal marijuana has been approved in New York State for treatment of many disorders and symptoms. Approved disorders in NY include cancer, HIV, ALS, Parkinson’s disease, multiple sclerosis, damage to the spinal cord, spasticity, epilepsy, inflammatory bowel disease, neuropathies and Huntington’s disease. Symptoms typically treated are severe pain, nausea, seizures or persistent muscle spasms. Medicinal marijuana has two main components; THC (tetrahydrocannabinol)and CBD (cannabidiol). There are various concentrations and ratios of THC and CBD. Depending on the type of pain, the physician will determine the appropriate ratio of drugs. Medical marijuana can be taken as a pill, in liquid form or inhaled as a vapor. The patient must be certified by our office with New York State prior to receiving a registry ID card.
Platelet Rich Plasma (PRP)
The use of Platelet Rich Plasma has shown great success in promoting the healing of injured tendons, ligaments, muscles and joints. This non-surgical procedure relieves pain with an injection produced from the patient’s own blood. Platelets and the liquid plasma portion of blood that make up PRP are a concentrated source of growth factors and cellular signaling factors that play a significant role in the biology of healing.
A blood sample is obtained from the patient and the Platelet Rich Plasma is separated out through the use of a centrifuge and is injected into the affected area. Ultrasound guidance assists in the precise placement of PRP. The concentrated platelets promote the natural healing of damaged joints and soft tissues and assist with improved function and decreased pain.
Intravenous vitamin infusion therapy can be used to holistically treat chronic pain disorders. A vitamin cocktail is formulated for the individual patient and can include vitamin B complex, vitamin B-12, vitamin C, pyridoxine, calcium chloride, magnesium sulfate, lidocaine and glutathione. The concentrations and variations in the formulation will depend on the underlying condition. Intravenous vitamin infusion can be very effective for fibromyalgia, chronic fatigue syndrome, neuropathic syndromes, chronic headaches and muscular spasm. Infusions typically take less than one hour and can be repeated every 2-4 weeks.
Physical Therapy Modalities and Massage
Using specialized medical massage techniques with spine stretching and a home restorative exercise program, patients can become active participants in recovery from injury and spine degeneration.
Energy Therapy or “laying-on-of-hands” healing is the ancient art and science of transmitting energy through a trained practitioner to a patient in order to reduce or eliminate pain. Energy Therapy uses life-force energy by transferring energy to the patient to enhance the body’s natural ability to heal itself. Energy Therapy helps to restore and balance life-force energy within the body. By using light touch, energy transmission and energy adjustments, while a person is fully clothed, the healer is able to re-align and re-tune the body between the physical, emotional, mental and spiritual energy fields leaving the patient’s energy system recharged, unblocked and re-balanced.
As we age, our bodies produce less of the proteins and fibers that retain moisture in the skin and provide volume and structure. This depletion results in wrinkles and hollows. While this occurs naturally, some factors like sun exposure or smoking accelerate the aging process, especially in the face.
Botox and dermal fillers can be a great option for patients seeking to replace lost volume, fill in wrinkle lines, or restore youthful facial contours. Fillers are FDA-approved compounds that are injected beneath the surface of the skin and are a safe way to achieve a youthful look. They are an excellent alternative to more invasive cosmetic procedures, such as facelifts.