MultiCare Health System

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Pain Management

FAQ

What is pain?
Pain is a legitimate medical syndrome that is associated with an unpleasant sensation and the emotional response to that sensation. Pain can be caused by any number of events, such as an auto accident, work or sports injury, surgery, or infection. Your response to a painful sensation is as individual as you are.

What can the Interventional Pain Management Program do for my pain?
The goal of the pain program is to use safe, effective, and minimally invasive diagnostic and therapeutic procedures to decrease painful sensations, improve function and mobility, and decrease reliance on pain medications.

What kind of pain syndromes can be treated at the Pain Management Program?
The most common types of pain are:

   1. Spine pain (low back pain or neck pain)
   2. Pain from damaged or pinched nerves (sciatica or radiculopathy)

Call us or ask your doctor if your pain syndrome merits an evaluation at the pain clinic.

What are some of the procedures performed at the Pain Management Program?
These procedures include:

   1. Epidural steroid injections in the cervical, thoracic, and lumbar regions
   2. Transforaminal steroid delivery and Selective Nerve Root blockade
   3. Facet joint and Medial Branch nerve injections
   4. Lumbar Provocative Discography
   5. Radiofrequency Neuroablation
   6. Sympathetic plexus blockade
   7. Spinal Cord Stimulation
   8. Celiac Plexus Block

What is an Epidural steroid injection?
An Epidural steroid injection is among the most common interventional pain management procedures. The procedure takes just a few minutes to perform and the purpose is to deliver powerful anti-inflammatory steroids around the source of nerve irritation or painful disc. Nerves that are pinched or chemically irritated can be exquisitely painful, and the relief provided by the steroids can allow them to heal and repair themselves, while at the same time allowing you to return to many of your normal activities. It is often necessary to perform an initial series of several epidural steroid injections separated by a few weeks.

What is Radiofrequency Neuroablation?
This procedure is used to deactivate small pain transducing nerves around the spine.  For example, if facet joints are causing your pain syndrome, the small pain nerves that serve the facet joints can be turned off with the Radiofrequency Neuroablation procedure. Relief may last for months to years.

What is a facet joint?
Facet joints are arranged in the back part of your spine from the base of your neck all the way down to your low back. They are involved in “whiplash” injuries of the neck and arthritis or degeneration in the low back. These joints may cause pain in and around the spine and can markedly limit how you use your neck or back. When facet joints are painful, it can be difficult to bend the spine backward. Each facet joint is served by medial branch nerves, and if these nerves are blocked with local anesthetic, the pain from the joints will stop, telling the doctor where the pain is coming from.

What is Provocative Lumbar Discography?
When pain in the low back does not respond to the basic treatments it may be necessary to investigate the intervertebral discs as possible pain generating structures.  Painful discs can be bulging or have tears, but often discs that look normal on X-rays may be painful. The procedure usually takes about 30 minutes. A small needle is guided into the center of the discs and dye is injected while X-rays are being taken.

What is Spinal Cord Stimulation (SCS)?
This procedure is for patients with spine and extremity pain that has not responded to other treatments. SCS is a technique that uses tiny electrical leads to block pain signals.  These leads are placed over the spinal cord where the pain signals are converging.  Temporary leads are placed initially, and a permanent system can be implanted if the temporary leads result in significant relief over a three to five day trial period.

Can I have a procedure on the same day as my evaluation?
Sometimes, but it can take time to check with your insurance carrier and secure authorization before scheduling the procedure. The pain clinic staff will work as quickly and efficiently as possible so that you can have your procedures in a timely manner.  You can help this process by making sure that your insurance information is updated.

What should I do before my procedure?
Your stomach must be empty for the procedure, since anxiety and sedation can cause some people to be nauseous. Please don’t eat for four hours before your appointment. However, you can take your usual medications with sips of water.

Does it matter if I take blood thinners, such as aspirin or Coumadin?
Yes. It is very important to notify the physician that is prescribing the blood thinners that you are going to have a procedure. This doctor will instruct you about when to stop taking the medication. Sometimes your blood will be checked on the day of the procedure to make sure it is okay to proceed.

How long do the procedures take?
Most procedures take less than 10 minutes to perform. You will be asked to arrive a little early in order to fill out any necessary paperwork, and you will stay in the recovery area of our facility for about 20 – 30 minutes after your procedure. Since you will have received sedation for the procedure, you will need a driver to take you home.

How does the doctor know where to perform the procedure?
The vast majority of the procedure will take place under fluoroscopic guidance, which is a way to use low intensity X-rays to show the outlines of bone structures. Your doctor knows where the needles need to be in relation to these structures and will even use a very small amount of dye to confirm that the medications are flowing precisely to where they need to go in order to achieve a good result.

What can I expect after the procedure?
Plan to relax for the rest of the day.  If you receive a steroid injection you may be uncomfortable until the medicine begins to take effect (one to two days). If your doctor used local anesthetic to block nerves, such as facet joint nerves, the local medicine will wear off in about four to six hours. Generally, it is safe to resume your normal activities the next day, including going to work.