Ankur Manvar, MD

Products And Services

• Axial Injections

  The atlanto-axial joint is at the top of the cervical vertebrae in the upper neck area. Problems within this joint may result in scalp tenderness, neck pain and headaches. They may be the result of an injury to either the cartilage in the joint or its surrounding tissues. A diagnostic axial injection may be performed to determine the cause of pain in the region. The injection is a combination of local anesthetic and corticosteroid. The anesthetic provides immediate relief from pain, while the corticosteroid works to decrease inflammation and offer longer-term pain reduction. If the axial injection is effective in relieving pain and increasing motion in the joint, it can be used as a treatment method. Candidates for Axial Injections Patients who have chronic upper neck pain or headaches may be experiencing atlanto-axial joint pain. X-rays or MRI scans may not be able to identify the pain as being atlanto-axial joint pain, which is why the injection can be valuable as a diagnostic tool. The Axial Injection Procedure The procedure takes about 30 minutes. Local anesthesia is used for axial injections. Once the anesthetic has numbed the patient's skin, an imaging technique known as fluoroscopy will be used to insert a small needle into the spine near the axial joint. The medication is injected as soon as the needle is positioned properly. The patient is monitored for about 30 minutes after the procedure and sent home to rest. The patient can typically resume all normal activity the day after the procedure. Results of the Axial Injection There may be pain at the injection site from the needle. That pain is temporary and should disappear after a couple of days. Some patients experience permanent relief from their axial pain, with no further injections necessary. Others may experience relief for only a few weeks or months, requiring additional treatment.

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• Brachial-Plexus Nerve Block

  The brachial plexus is a nerve-fiber network that runs from the spine, through the neck and armpit region, into the arm. A brachial-plexus injury affects the nerves that send signals from the spine to the arms, shoulders and hands. It occurs when nerves are stretched, compressed or torn, often during contact sports. Minor brachial-plexus injuries can heal on their own, but more severe injuries can require surgery. A brachial-plexus nerve block provides pain relief via an injection of local anesthetic. Candidates for a Brachial-Plexus Nerve Block Although contact sports often cause brachial-plexus injuries, they also result from the following: Tumors Falls Congenital defects Stab or gunshot wounds Car accidents A patient with a mild brachial-plexus injury may experience weakness and numbness, or a burning sensation, in the arm; a patient with a severe brachial-plexus injury may experience loss of shoulder and elbow control, an inability to use the fingers, and inability to move or feel the arm. The Brachial-Plexus Nerve Block Procedure A brachial-plexus nerve block can be performed with a local anesthetic, although sedation or full anesthesia is an option if the patient desires. The procedure takes about 15 minutes, with a 30-minute recovery period. The injection site may be anywhere along the path of the brachial plexus; common injection sites include the base of the neck, the armpit, and the front of the shoulder. A local anesthetic is applied to the injection site, and the surrounding skin is cleaned. With the assistance of X-rays and contrast dye, a needle is inserted. Once the needle is situated properly, the medicine is injected. The patient's pain should be reduced almost immediately, but the length of time it lasts varies. Risks of a Brachial-Plexus Nerve Block Possible risks from a brachial-plexus nerve block are similar to those for most nerve-block procedures, and include the following: Soreness at the injection site Elevated blood sugar Bleeding Rare but serious complications include temporary or permanent nerve damage, convulsions and cardiac arrest

  Link: Brachial-Plexus Nerve Block

• Bursal Sac Injections

  A bursal sac is filled with fluid that provides a cushion between muscles/tendons and bones to decrease friction and irritation. There are bursal sacs around most of the body‘s joints. When a bursal sac gets infected or inflamed, it can lead to a painful condition called “bursitis.” Although often caused by repetitive movement or overuse of a joint during sports or intense physical activity, bursitis can also result from injury, or arthritis of a joint. The most common symptoms of bursitis are pain, stiffness, swelling and tenderness, usually in the joints of the elbow, shoulder, hip, knee or ankle. The heel and Achilles tendon can also be affected. Pain, which can develop gradually or be sudden and severe, may be accompanied by decreased mobility of the joint. If conservative treatment methods are unsuccessful in treating the pain and discomfort caused by bursitis, bursal sac injections can be an effective way of reducing inflammation and diminishing pain. Anti-inflammatory steroid medication is injected directly into the bursal sac; as inflammation decreases, pain and discomfort subside, often for a few weeks or months. In some cases, one injection may be sufficient to alleviate symptoms.

  Link: Bursal Sac Injections

• Celiac Plexus Block

  A celiac plexus block is an injection performed to relieve severe abdominal pain by blocking signals from the celiac plexus, a nerve bundle that supplies organs in the abdomen, including the stomach, intestines, liver, pancreas, adrenal glands and other organs around the midsection. The injection contains a local anesthetic or concentrated alcohol to produce immediate pain relief, as well as a medication such as a corticosteroid to provide longer-term respite from pain. Pain remedied by a celiac plexus block may be caused by conditions such as chronic pancreatis and cancer in other organs of the abdomen. The Celiac Plexus Block Procedure A celiac plexus block is generally conducted with the patient lying on his or her stomach. The skin surrounding the affected area will be cleaned and numbed with a local anesthetic. The patient may also receive a mild sedative through an intravenous line if needed. With the assistance of an X-ray and contrast dye, the needle is inserted. Once the needle is situated properly, the medicine is injected. The procedure typically lasts for 30 minutes. The pain the patient has been experiencing should be reduced almost immediately, but the length of time this relief lasts varies from patient to patient. Recovery From a Celiac Plexus Block The patient should arrange for a ride home after the procedure. In most cases, if there are no complications, the patient may go to work and resume most normal activities after a day or two. Some patients may be able to start physical therapy immediately, depending on individual recovery. Risks From a Celiac Plexus Block A celiac plexus block is relatively safe for most patients, but there may be soreness or bruising at the injection site. Low blood pressure or diarrhea may also occur. More serious complications, although uncommon, may include: Nerve damage Bleeding Pneumothorax (collapsed lung) Infection Bloody urine The patient's abdominal wall or leg may feel weak or numb, but that feeling typically disappears in a day or two.

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• Cervical Medial-Branch Block

  A cervical medial-branch block is an injection administered to diagnose and treat neck, upper-back, shoulder and facial pain, and headaches. The procedure is designed to both relieve symptoms and diagnose their source. By deadening pain signals in the medial-branch nerves (which transmit pain signals from the facet joints to the brain), it is possible to determine whether a particular facet joint (which connects two vertebra) is the source of the pain. The Cervical Medial-Branch Block Procedure During a cervical medial-branch nerve block procedure, an anesthetic and a corticosteroid are injected near small medial nerves connected to a specific facet joint. The anesthetic provides immediate but temporary pain relief; the corticosteroid provides long-lasting relief a few days later by reducing inflammation. The procedure is usually performed in an outpatient surgical center. A patient is given intravenous medication to help with relaxation. The skin on the back is cleaned, and a local anesthetic is applied. The targeted area is pinpointed using X-rays and contrast dye, and a small needle is inserted near the medial-branch nerve. Once the needle is situated properly, the injection is administered. It can take as much as a week for the injection to provide full pain relief. A patient can return to work or other normal activities the next day. Results of a Cervical Medial-Branch Block Results of a cervical medial-branch block vary. If the patient's pain is cut in half (or more), it is considered diagnostically significant because it indicates that the pain is being generated through the medial nerve. If this is the case, the patient may undergo radiofrequency ablation, which is helpful for a longer time, usually between 6 months and 1 year, than the injection. Side Effects/Risks of a Cervical Medial-Branch Block Common side effects of a cervical medial-branch block are pain and soreness at the injection site. And, although rare, a cervical medial-branch block does have some serious risks. They include bleeding, infection, bowel and/or bladder problems, nerve damage and sexual dysfunction.

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• Epidural Steroid Injections

  By reducing inflammation, epidural steroid injections (ESIs) are used to temporarily relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura). As a result, they provide more effective and faster pain relief than oral medications. Candidates for Epidural Steroid Injections Candidates for epidural steroid injections have back pain, and/or pain radiating down the arms and legs. Pain relieved by ESIs can be the result of many conditions, including the following: Lumbar-disc herniation Degenerative disc disease Lumbar spinal stenosis Vertebral compression fractures Cysts in a facet joint or nerve root Annular tears Epidural steroid injections can be used alone to provide pain relief, or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection can last from 1 week up to 1 year; a typical positive response lasts for 1 month. If helpful, injections can be repeated at 2-week intervals, but usually no more than 3 or 4 times per year. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist a physician in developing an appropriate treatment plan. The Epidural-Steroid-Injection Procedure Epidural steroid injections are administered by many types of physicians, including anesthesiologists, orthopedists, physiatrists, pain-management specialists and neurologists. Typically, they are administered in an outpatient facility, under the guidance of fluoroscopy, to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although a patient may feel pressure at the injection site. The injection procedure takes only a few minutes. In most cases, the patient experiences immediate pain relief due to the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation, the patient should feel a significant, if not total, alleviation of pain. The patient can usually resume normal activities the day after the procedure. Risks of Epidural Steroid Injections Epidural steroid injections are a safe form of treatment, although, in rare instances, they can cause headaches, bleeding, infections, nausea or vomiting, allergic reactions or nerve damage. Patients who are pregnant, have infections, or suffer from chronic bleeding disorders are not candidates for epidural steroid injections. ESIs can temporarily elevate blood pressure and blood sugar, and cause mood swings, so patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment.

  Link: Epidural Steroid Injections

• Facet-Joint Injections

  Facet-joint injections are both a minimally invasive treatment for back pain caused by inflamed facet joints, and a diagnostic tool for determining whether facet-joint inflammation is a source of pain. Four facet joints connect each vertebra to the vertebra above and below it. A facet-joint injection, administered into either the joint capsule or its surrounding tissue, combines a long-lasting steroid and a local anesthetic. Although the anesthetic provides only temporary pain relief, the steroid reduces inflammation, and can relieve pain for anywhere from a few days to a few years. Lasting pain relief is diagnostically significant because it confirms that the pain originated in the joint that received the injection. Facet-joint injections can be repeated up to 3 times a year for those who have successful but short-term pain relief. Candidates for Facet-Joint Injections Patients with back pain (or pain thought to originate in the back) are candidates for facet-joint injections. Facet-joint pain can be the result of injury, spinal stenosis, sciatica or osteoarthritis. Although pain typically appears in the lumbar region, it can occur anywhere in the spine. When facet joints are inflamed, depending on the location of the inflammation, pain can be experienced in the following regions: Groin Buttocks Hips Shoulders or neck Legs or arms Facet-joint injections are often recommended after anti-inflammatory medication, a back brace or other conservative methods have failed to alleviate symptoms. A patient who is pregnant, has an infection, or suffers from a chronic bleeding disorder is not a candidate for facet-joint injections. The Facet-Joint-Injection Procedure During the procedure, the injection site is first numbed with an anesthetic. The needle is then inserted directly into the facet joint through the back; fluoroscopy, an imaging technique, is used to ensure precise placement. Once the needle is correctly positioned, a combination of anesthetic and cortisone is injected into the targeted joint. The procedure takes less than 30 minutes to perform. There is immediate pain relief from the anesthetic used in the injection, but it takes several days to determine whether the cortisone has had an effect. There may be mild pain at the injection site; it can be managed by taking Tylenol and applying ice. Recovery from Facet-Joint Injections A patient can return home shortly after receiving an injection(s), and can resume regular activities the next day. A follow-up visit to the doctor takes place in about a week; an evaluation is made of how effective the injection has been in lessening symptoms. Results of Facet-Joint Injections Results of facet-joint injections vary widely. Some patients experience long-term, even permanent, pain relief after one injection, whereas others may need additional treatment within a few weeks or months. Risks of Facet-Joint Injections Although considered safe, there are risks involved with facet-joint injections. In rare cases, they can cause infection, allergic reaction, bleeding or nerve damage.

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• Lumbar Epidural Steroid Injection

  A lumbar epidural steroid injection is a minimally invasive procedure for treating leg, buttock and lower back pain originating from the epidural space. The epidural space surrounds the dura, a membrane which protects the spinal cord and its nerves. The primary reasons for pain in this area are herniated or ruptured discs, stenosis, or sciatica all of which result in nerve compression. The pain may originate in any part of the lumbar region of the spine, including the coccyx, or tailbone, where it is referred to as caudal. A lumbar epidural steroid injection is usually administered in an outpatient surgical setting under local anesthetic. After the local anesthetic has numbed the skin, a small needle is inserted into the epidural space with the assistance of an imaging technique known as fluoroscopy. Once the targeted area is pinpointed, the medications, which include an anesthetic and a corticosteroid, are injected. After a lumbar epidural steroid injection, most patients return to work the next day. They normally experience immediate pain relief for a few hours after the procedure as a result of the injected anesthetic, although there may be some irritation at the injection site. In a few days, the original pain may worsen again as the anesthetic wears off. This is completely normal. In about a week, the corticosteroids will take full effect, reducing inflammation and significantly reducing pain. Depending on the patient‘s response, the doctor may administer as many as three epidural injections spaced several weeks apart. The effectiveness of a lumbar epidural steroid injection varies. Some patients experience long-term, or sometimes even permanent, pain relief after one injection, requiring no further treatment. Others may require additional treatment a few weeks or months later. The exact effectiveness of a lumbar caudal epidural steroid injection depends on the individual patient‘s condition.

  Link: Lumbar Epidural Steroid Injection

• Lumbar Sympathetic Nerve Block

  A lumbar sympathetic nerve block is administered to both diagnose and treat pain in the lumbar (lower) region of the spine. It is used to determine whether the lumbar sympathetic nerves, which carry pain impulses from the lower extremities, are the cause of the pain, and, in some cases, serves to eliminate that pain altogether. During the procedure, medication is injected into or around the lumbar sympathetic nerves on one side of the body. Underlying conditions for which a lumbar sympathetic block may be considered include the following: Complex regional pain syndrome Herpes zoster (shingles) Neuropathy Peripheral vascular disease When successful, the injections reduce pain, inflammation, abnormal skin color and sweating, and improve the patient‘s mobility. Lumbar Sympathetic Nerve Block Procedure Receiving a lumbar sympathetic nerve block injection takes only a few minutes, although the patient will likely spend a few hours in an outpatient surgical setting or doctor‘s office. These hours include the time needed for preparation, positioning and recovery. During the procedure, the patient lies facedown, and a local anesthetic is administered. In most cases, patients are also sedated to minimize anxiety. Once the local anesthetic has numbed the skin, the injection is administered. The injection contains an anesthetic to numb the inflamed area. Sometimes it also contains a corticosteroid to reduce inflammation, or clonidine, a hypotensive agent. These medications are added to provide long-lasting pain relief. Immediately after receiving an injection, a patient may experience warmth in the leg, but the sensation disappears quickly. Risks of a Lumbar Sympathetic Nerve Block Although receiving a lumbar sympathetic nerve block is a safe, there is a risk of complications, which includes infection at the injection site, nerve damage, bleeding, or leakage of spinal fluid. Recovery from a Lumbar Sympathetic Nerve Block After a lumbar sympathetic nerve block procedure, a patient usually returns home after a few hours, and is able to return to work the next day. The effectiveness of a lumbar sympathetic nerve block varies. Some patients experience permanent relief, whereas others experience relief for only a few weeks or months, and require additional treatment. If the block relieves the patient‘s pain, a series of injections may be administered to provide long-lasting relief. If the block does not relieve pain, radiofrequency ablation may be considered.

  Link: Lumbar Sympathetic Nerve Block

• Myofascial Release

  Myofascial release is a form of therapy designed to relieve chronic and acute pain through special, targeted massage that aims to reduce tightness within the fascia, a sheet of connective tissue below the surface of the skin. Tightness within the fascia can restrict a patient‘s range of motion or cause the patient to favor one side of the body. The goal of myofascial release is to relieve pain and allow the patient to regain range of motion. Candidates for Myofascial Release Myofascial release is often effective in treating chronic pain caused by conditions that include carpal tunnel syndrome, fibromyalgia and temporomandibular joint (TMJ) disorder; it is also effective in treating acute pain caused by trauma. Some patients experience myofascial pain in the form of headaches or lower back pain. Myofascial release may be recommended in combination with traditional pain-relief treatments, including anti-inflammatory medications, heat and ice application, and stretching exercises. The Myofascial Release Procedure Myofascial release is performed by chiropractors, sports medicine specialists, physical therapists and massage therapists trained in myofascial release. It typically takes place in a health center or outpatient clinic. After an initial consultation in which the location of the affected fascia is determined, the medical professional typically applies gentle pressure to the affected area or guides the patient through prolonged, low-load stretching. Sessions usually last 30 minutes to an hour, and are performed, depending on the severity of the patient‘s condition, every day or every few days.

  Link: Myofascial Release

• Pain Medication

  A number of different types of medications may be used to reduce pain in various parts of the body. Any of the medications described below may be helpful in relieving pain, depending on the medical condition of the patient and the severity of the pain being experienced. Over-the-Counter Medications Over-the-counter medications are frequently helpful in relieving symptomatic pain that is mild to moderate. Such medications may include analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen. It is important for patients to consult with their physicians regarding appropriate dosages and to avoid possible interactions with prescribed medications or over-the-counter preparations they may be already taking. Opioids For severe or post-operative pain, opioids, sometimes known as narcotics, may be necessary. These may include codeine, propoxyphene (Darvocet), hydrocodone (Vicodin) and oxycodone (Percocet, Oxycontin). While these drugs can be extremely effective against pain, they tend to be addictive. Ultram (Tramadol), a prescribed medication called an opioid analgesic, is somewhere between an over-the-counter medication and a narcotic and may be habit-forming. Muscle Relaxants Muscle relaxants can also help to relieve symptoms of pain, particularly when such symptoms are associated with muscle spasms. Examples of commonly used muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol (Soma) and diazepam (Valium).

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• Radiofrequency Neurotomy

  Radiofrequency neurotomy is a treatment designed to provide relief from severe pain in the back or neck. It uses the heat generated by radiofrequency waves to interfere with the nerves‘ ability to send out pain signals. The heat generated by these waves is delivered to targeted nerve areas through special needles that are inserted, just above the spinal area, through the skin. Radiofrequency neurotomy does not usually provide permanent pain relief; its goal is to significantly decrease neck or back pain. Patients who have been previously unresponsive to more conservative methods of treatment, such as physical therapy or pain medication, are often candidates for this procedure. Candidates for Radiofrequency Neurotomy People experiencing chronic back or neck pain are considered good candidates for radiofrequency neurotomy. Patients who are taking blood-thinning medications are generally not good candidates because blood thinners can cause adverse reactions when mixed with the medication that is administered during radiofrequency neurotomy. A series of diagnostic tests are performed to determine whether radiofrequency neurotomy will be beneficial for the patient. The diagnostic testing process begins with the injection of a small amount of numbing medication into the area where the pain is located. The areas of the body that have been numbed by the medication are the locations where the radiofrequency needles are placed. Once the needles have been inserted, the patient‘s pain level is tested. If the pain gradually lessens, the patient is a good candidate for radiofrequency neurotomy. The Radiofrequency Neurotomy Procedure Radiofrequency neurotomy is performed as an outpatient procedure in a doctor‘s office, and is usually completed within an hour. The procedure begins with the placement of an intravenous (IV) line into the patient‘s arm or hand. The IV is used to administer medication that keeps the patient comfortable and relaxed during treatment. A specialized X-ray machine, known as a fluoroscope, provides information that allows for the most accurate positioning of the radiofrequency needles. This ensures that only the targeted nerve tissues are affected, and that the healthy surrounding nerve tissues remain undamaged. Risks of Radiofrequency Neurotomy The risks of radiofrequency neurotomy vary. Some patients experience mild and temporary discomfort/reactions, while other patients experience serious and long-term pain or discomfort. Complications include the following: Temporary pain/numbness where the needles were placed Persistent numbness that cannot be resolved with medication Paralysis Another possible complication of radiofrequency neurotomy is bowel or bladder incontinence. Recovery from Radiofrequency Neurotomy Patients can return home immediately following radiofrequency neurotomy. The recovery process varies from patient to patient, though most patients need only a few days to recover. One of the most commonly reported side effects of the procedure is mild, temporary soreness throughout the body; it is typically treated with rest, or over-the-counter pain medication. Results of Radiofrequency Neurotomy Radiofrequency neurotomy is more successful in some patients than others. The relief the procedure provides is only temporary, and lasts anywhere from just a few months to up to 2 years. Radiofrequency neurotomy can be repeated if pain recurs.

  Link: Radiofrequency Neurotomy

• Sacroiliac-Joint Steroid Injections

  Sacroiliac-joint steroid injections help to diagnose and relieve lower-back pain caused by problems with one or both of the sacroiliac joints, which connect the spine‘s base (sacrum) to the pelvis‘s ilium bones. If one or both of the sacroiliac joints is inflamed (sacroiliac-joint dysfunction), a patient can experience pain in the buttocks and lower back that worsens when running or standing. Sacroiliac-joint dysfunction can be caused by osteoarthritis, traumatic injury, pregnancy, inflammatory joint disease, or underlying structural abnormalities. Reasons for Sacroiliac-Joint Steroid Injections A sacroiliac-joint steroid injection is used to confirm a diagnosis of sacroiliac-joint dysfunction. If the injection provides pain relief, it establishes the joint as the pain‘s source, and, at the same time, acts as a treatment. Corticosteroids, along with a local anesthetic and saline solution, are injected directly into the sacroiliac joint, reducing swelling and pain for, possibly, several months. As with other spinal blocks, a sacroiliac-joint injection can be repeated up to 3 times a year. Spinal injections only provide temporary relief from pain; they are not a cure. For that, surgery may be necessary. The Sacroiliac-Joint-Steroid-Injection Procedure To make sure the injection is placed in the correct spot, the procedure, which takes less than half an hour, is performed using imaging guidance and a contrast dye. The patient lies facedown on a surgical table, and the skin on the lower back is cleansed with an antiseptic solution. A local anesthetic is given to reduce discomfort from the injection, which contains steroid medication, saline solution and anesthetic. When the procedure is complete, the injection site is covered with a small bandage. The anesthetic in the injection provides immediate pain relief, and the steroid medication reduces inflammation within 24 to 48 hours. Recovery from Sacroiliac-Joint Steroid Injections In some cases, a patient‘s legs are affected by the anesthetic, causing numbness or weakness that can make walking difficult until the anesthetic wears off. Injection-site tenderness and swelling can occur, but they are usually mild, and can be minimized by applying ice. Normal activities can be resumed the next day. Only moderate exercise is allowed, but it can be increased in duration and intensity during the following 1 to 2 weeks. Risks of Sacroiliac-Joint Steroid Injections Although sacroiliac-joint steroid injections are considered safe, there are risks; they include infection, excessive bleeding, adverse reaction to medication, and damage to adjacent tissue. Post-injection, a diabetic patient may have temporary spike in blood sugar levels, and a patient with bipolar disorder may have a manic episode, making careful monitoring essential in these instances.

  Link: Sacroiliac-Joint Steroid Injections

• Spinal Cord Stimulation (SCS)

  Spinal cord stimulation (SCS) typically involves implanting an electronic device in the body to help relieve chronic back and leg pain. The device, called a "spinal cord stimulator" or "dorsal column stimulator," sends electrical impulses through wires/electrodes placed near the spinal cord; the impulses block pain signals from reaching the brain. SCS does not cure chronic pain, but usually lessens it by 50 percent and more by replacing a patient's feeling of pain with a tingling sensation. Before implantation, a patient is asked to go through a trial period with an external device; this allows pain levels to be evaluated, and determine whether they decrease when the device is used. Candidates for Spinal Cord Stimulation Not everyone is a candidate for SCS. It is an option only for those who have tried, but been unsuccessful with, conservative treatments; will likely not be helped by surgery; are not addicted to drugs; have been psychologically evaluated; do not have pacemakers; and have undergone trials with an external spinal-cord stimulator. The Spinal-Cord-Stimulation Implantation Process Implantation of a spinal cord stimulator is a two-step process that involves first implanting the stimulator, and then a pulse generator to power it. To implant the stimulator, an incision is made in the patient's back; the wires with electrodes on the end are fed through and positioned on the spinal cord. Exact placement depends on the area of pain. To implant the pulse generator, an incision is made in the buttocks or abdomen, and the generator is placed between layers of skin and muscle. An extension wire is run from the spine to whichever area the generator is placed in. Incisions are closed with either staples or sutures. The procedure takes 3 or 4 hours, and the patient usually goes home on the same day. Recovery from the Spinal-Cord-Stimulation Implantation Process Pain from SCS implantation is treated with prescription medication and/or over-the-counter painkillers. A patient should refrain from lifting, bending, twisting and stretching during the healing process, which can take 6 to 8 weeks. Risks and Complications of Spinal Cord Stimulation In addition to the risks associated with any surgical procedure, those related to SCS include spinal-fluid leakage and paralysis. Complications related specifically to the stimulator include the following: Device works only intermittently or stops Device causes over-stimulation, or unpleasant sensations Stimulation occurs in the wrong place Device causes an allergic reaction It is also possible that the device's wires could shift or become damaged, which might require surgical intervention. The pulse generator's battery, if it is a standard one, needs to be surgically replaced every 2 to 5 years, although there are generators that run on rechargeable batteries that can last up to 10.

  Link: Spinal Cord Stimulation (SCS)

• Sympathetic Ganglion Block

  A sympathetic ganglion block is a type of nerve block used in the treatment of severe or chronic pain. It involves the injection of an anesthetic medication that will numb the affected bundle of nerves, a cluster known as a ganglion. These nerves help the body react to stress and are responsible for the fight-or-flight response, a physiological reaction to situations perceived as being dangerous. If the nerves are damaged or compressed in any way, they can produce pain and other symptoms. Part of the sympathetic nervous system, a stellate ganglion transmits signals to the upper body, including the face, neck, arms and chest area. A lumbar ganglion, on the other hand, sends signals to parts of the lower body, such as the leg or lower back. Damage to the ganglion nerves can result in pain in one or more of these regions. A sympathetic ganglion block involves the injection of a medication to numb the nerve and interrupt the pain signals it sends to the brain. It can be used in a diagnostic capacity to determine whether the source of the discomfort is due to damage to the ganglion nerves, as well as to effectively treat pain. The Sympathetic Ganglion Block Procedure Taking place in the doctor's office, a sympathetic ganglion block is generally completed within 30 minutes. A local anesthetic or mild sedative may be provided to patients to prevent any discomfort from the procedure. During a stellate ganglion block, an anesthetic medication, in combination with a corticosteroid, is injected into the nerve tissue of the neck. During a lumbar ganglion block, the medication is injected into a ganglion in the lower spine. This provides immediate relief from pain caused by a problem within the ganglion. Following the procedure, patients are typically restricted from driving home. However, recovery time is minimal, and most patients can return to their normal activities the next day. Sympathetic ganglion nerve blocks used to treat chronic pain can provide significant relief to many patients for up to several months, and they can safely be repeated as necessary. Risks of Sympathetic Ganglion Block While sympathetic ganglion blocks are common, minimally invasive procedures that are considered to be safe for most patients, they do carry a slight risk of complications. These risks may include: Soreness at the injection site Infection Headache Bleeding Other side effects may include drooping of the eyelid and hoarseness, though these effects are usually temporary and last just a few hours.

  Link: Sympathetic Ganglion Block

• Sympathetic-Nerve Blocks

  The sympathetic nervous system is responsible for regulating involuntary body functions, including blood flow, heart rate, digestion and perspiration. Sympathetic nerves spread outward from the spine, and, when compromised, can cause pain in various parts of the body. A sympathetic-nerve block is an injection of medication into whichever of these nerves is causing the pain. It works by numbing the nerve, which interrupts the pain signals the nerve is sending to the brain. It is used both to diagnose damage of and treat pain caused by the sympathetic nerves. Uses for Sympathetic-Nerve Blocks There are a number of uses for sympathetic nerve blocks; two of the most common are therapeutic and diagnostic. A therapeutic nerve block is used to treat pain; it typically contains a local anesthetic. Nerve blocks used to treat chronic pain can work for up to 6 to 12 months, and can be repeated as needed. A diagnostic nerve block is designed to determine the cause of pain; an anesthetic is injected only for the amount of time it takes to pinpoint the area causing the issue. Sympathetic-Nerve-Block Treatment Areas Injections of sympathetic nerve blocks are given near various areas of the spine. Types of blocks include stellate blocks, which target the upper spine‘s sympathetic nerves, including those that run to the chest, arms, neck and head; lumbar blocks, which target the lower spine‘s sympathetic nerves, including those that run to the legs and feet; and thoracic-region blocks, which target the mid-spine‘s sympathetic nerves, including those that run to the abdomen.

  Link: Sympathetic-Nerve Blocks

• Trigger-Point Injections

  Trigger-point injections treat pain in areas that have developed trigger points, which are knots of muscle that form when muscles contract and but cannot relax. Trigger points are caused by injury to or overuse of the affected muscle; they can also be caused by stress and anxiety. They can irritate the nerves around them, which causes pain in other areas of the body. The chronic pain brought on by trigger points can also decrease the affected muscle‘s range of motion. Candidates for Trigger-Point Injections Trigger-point injections are typically used to treat pain in the neck, lower back, arms and legs. They can also be effective for tension headaches, temporomandibular joint (TMJ) pain or fibromyalgia, and for myofascial pain syndrome, a chronic pain condition in which trigger points develop in certain muscles, and cause pain when touched. Patients with this condition often experience deep, aching pain in the affected muscle that worsens over time, as well as muscle and joint stiffness, and difficulty sleeping. Symptoms can significantly affect a person‘s quality of life, and should be addressed if they do not subside. Over time, patients with untreated myofascial pain syndrome can develop muscle weakness or fibromyalgia. The Trigger-Point Injection Procedure A needle containing a local anesthetic, and, sometimes, a corticosteroid to reduce inflammation, is inserted into the trigger point to make it inactive and, therefore, alleviate the pain. The procedure typically takes between 15 and 20 minutes, and is done in a doctor‘s office. If necessary, multiple sites can receive trigger point injections in one appointment. Risks of Trigger-Point Injections Trigger-point injections are considered safe, and have few side effects. The patient may feel sore around the injection site for up to 2 days, but applying ice usually helps. In most cases, normal activities can be resumed the next day. Trigger-point injections not only relieve pain, they loosen the muscles that are responsible for the pain, which facilitates the rehabilitation process.

  Link: Trigger-Point Injections