Injection Based Programs
Injection-based programs include diagnostic procedures and medication administration to relieve chronic pain and inflammation. The following injection therapies are offered at Advanced Diagnostic.
Lumbar Mapping (Spinal Facet Mapping)
Lumbar mapping is a diagnostic procedure that allows a doctor to determine the source of a patient’s pain. Between two vertebrae is a joint called the facet joint. This joint provides stability and guides spine mobility. When these joints become inflamed, they may cause pain in the lower back, buttocks, groin or legs. The amount of immediate pain relief the patient experiences after the facet injection will help confirm or deny the source of the pain.
Radiofrequency ablation (RFA) is a non-surgical technique initially introduced in 1974 for treatment of chronic spine pain. Radiofrequency energy is used to produce heat to create a lesion—an interruption at the nerve “tail.” This blocks the pain signal from reaching the brain. The nerve itself is not damaged and eventually grows a new “tail.” The amount of time that an individual experiences pain relief differs, but in general the pain will return after two years. When the pain recurs, radio frequency ablation can usually be repeated and there is no limit to the number of times it can be repeated in a lifetime.
Cryotherapy, also called cryoablation, is a procedure performed with image guidance, using a needle-like applicator called a cryoprobe. Carbon dioxide gas is used to create intense cold and when applied to a malfunctioning sensory nerve interrupts the nerve’s ability to send pain signals to the brain where all pain is ultimately experienced. This provides pain relief often providing a permanent cure. While cryoablation can be applied to various organs and tissues and is used in a variety of medical specialties, it is primarily used to treat peripheral nerve pain.
Diagnostic discography, or a discogram, is a preoperative study used to determine if an intervertebral disc is a pain generator. A needle is placed into the center of a disc and a solution of sterile contrast dye is injected. The patient’s response to the injection is important to the diagnosis—if the injection reproduces the usual daily pain, it is called concordant pain. The patient participates by rating and describing their pain during the procedure, which helps determine the diagnosis and whether surgical disc replacement or obliteration (fusion) of the pain generator(s) is a possible treatment.
Trigger Point Injections
Trigger points are painful areas of muscle that form when muscles do not relax. These knots of muscle can irritate surrounding nerves and cause “referred pain,” or pain that is felt elsewhere in the body. Trigger point injections (TPI) may help alleviate this pain. During a trigger point injection, a small needle containing a local anesthetic or saline is inserted into the trigger point. The needle may also contain a corticosteroid. The injection of the medication relieves the pain and multiple treatments may provide sustained relief. Trigger point injection can be used to treat many muscle groups especially in the arms, legs, lower back, and neck. The procedure is done in the office and takes just a few minutes.
Joint injections provide temporary relief to joint pain caused by various conditions. The injection includes an anesthetic to numb the injection site and a corticosteroid, which helps reduce inflammation. Pain relief usually occurs quickly and can last from days to year. While it is not a cure and is only a temporary fix, it can make it possible for the patient to improve with physical therapy and exercise. Injections are made in the facet joints of the spine, sacroiliac joint and coccyx, hip, shoulder, elbow, hand, knee, ankle and foot. It is a minimally invasive procedure that can be done in the office.
Among others, some of the joint injection treatments we use at Advanced Diagnostic include:
Synvisc-One (hylan G-F 20) is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen. For more information visit: https://www.synviscone.com
DUROLANE is a single injection treatment to relieve the pain of osteoarthritis (OA) in specific small and large joints. For more information visit: https://www.durolane.com/en/what-is-durolane/
Nerve block injections (transforaminal epidural steroid injection or TFESI) may help decrease inflammation or turn off a pain signal coming from a specific area of the body. An anesthetic or anti-inflammatory drug is injected at a targeted location. Guided imaging such as fluoroscopy is used to ensure the needle is placed where the patient will receive the maximum benefit from the injection. Pain relief is temporary, but may allow the damaged nerve time to heal or help diagnose the source of pain. During the injection the doctor may ask the patient questions and monitor how they respond in order to determine the source of the pain and advise on further treatment.
Epidural Steroid Injections
The epidural steroid injection (or interlaminar ESI) is minimally invasive and can help reduce inflammation providing relief from pain in the neck, arm, back and leg caused by spinal stenosis or disc herniation. Medicine is injected into the epidural space (between the bone and the protective sac of the spinal nerves). The goal of ESI is to reduce pain so the patient can be as functional as possible and participate in physical therapy and exercise to improve the underlying condition. Pain relief may last for several day to several years.
Botox for Cervical Dystonia and Migraines
BOTOX® is a prescription medicine that is injected into muscles and used to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older.
BOTOX® is also used to treat patients with 15 or more migraine days a month, each migraine lasting 4 hours or more. It is not approved for 14 or fewer headache days a month. For more information please visit the links below.
More info on BOTOX® for Cervical Dystonia: https://www.botoxmedical.com/CervicalDystonia/PatientMaterials
More info on BOTOX® for Migraines: https://www.botoxchronicmigraine.com
Xeomin for Cervical Dystonia
XEOMIN® is a prescription medicine used in adults treat the abnormal head position and neck pain with cervical dystonia (CD). In adults with cervical dystonia, nerve signals tell the muscles to contract when they shouldn’t. This can lead to abnormal head positions, uncomfortable movement, and pain. XEOMIN is injected into muscles to help block these signals. This can help decrease muscle activity and neck pain. Some muscles may still contract, but less severely. Results may differ for each individual.
For more information visit: http://www.xeomin.com/cervical-dystonia/about-xeomin/
Small Fiber Biopsy
Skin biopsies are used to diagnose small fiber neuropathy, a condition that occurs when small fibers of the peripheral nervous system are damaged causing symptoms such as pain, burning, and tingling. These symptoms often start in the feet and move up the body from there and may become more severe over time. The procedure is only mildly invasive and involves taking a few tiny skin samples, usually from several locations on the legs, which are then examined under microscope for signs of the condition.
Ketamine is a medication administered intravenously (IV) in our office that works by blocking certain pain receptors in the brain. For some people, ketamine may also help reduce reliance on opioids or other pain relief medications. Ketamine might be recommended to patients with neuropathic pain, CRPS, fibromyalgia, spinal cord injury pain, cancer-related back pain, depression caused by chronic pain, and certain kinds of nerve and back pain. Ketamine may not be appropriate for people with high blood pressure, head injury, or a history of seizure. Ketamine is a controlled substance due to its potential for abuse and addiction. Patients undergoing Ketamine treatment are closely monitored by our physicians.