Precise techniques are performed to establish what structure(s) are causing the pain and which nerve(s) are transmitting the pain impulses into the nervous system. These techniques are very minimally invasive, performed under fluoroscopic guidance, and safely performed.
In order to establish which structures are involved in chronic pain, precise injection of local anesthesia can temporarily anesthetize the structure itself or its nerve(s) to see if the pain temporarily stops. With the injection of x-ray contrast more structural information is obtained which cannot be seen with any other method. The injection of a potent anti-inflammatory steroid also provides information about the chemistry of the pain and may actually provide long lasting pain relief!
Spinal Diagnostic Injections
Examples of Diagnostic Technology
Selective Spinal Nerve Blocks
One location where we know that a nerve is located is where it exits from the side of the spine between each vertebrae. The exiting spinal nerve can be anesthetized to determine if it is transmitting the pain signal or if it is structurally compromised by surrounding structures.
Intra-articular Facet Joint Injections and Medial Branch Blocks
The joints between the vertebrae frequently become a source of neck or back pain. Precise anesthesia of these small joints or their nerve supply can identify if they are the source of pain. Once definitively identified, direct treatment is possible.
Direct evaluation of individual discs’ structural integrity and potential for pain generation is possible with provocation discography. Diagnosing if one or multiple discs are the source of back or neck pain is possible. This information contributes to what treatment options are possible.
Sympathetic Nerve Blocks
Some pain syndromes are associated with parts of the nervous system that are usually not involved in the transmission of pain impulses. The sympathetic nerves normally have no pain transmission function. In Complex Regional Pain Syndromes (aka Reflex Sympathetic Dystrophy), these nerves transmit pain and can be diagnosed by sympathetic nerve blocks.