Specialty Pain Management Center
Specialty Pain Management
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Dr. Jeff Calava
Procedures

TREATMENTS OR PROCEDURES

Caudal Epidural Steroid Injection
Cervical, Thoracic & Lumbar Discography
Cervical, Thoracic, and Lumbosacral Medial Branch Block
Cervical & Lumbar Sympathetic Nerve Block
Intrathecal Pain Therapy
Lumbar, Cervical or Thoracic Epidural Steroid Injection
Lumbar Facet Joint Injections
(RFTC) Radio Frequency Thermal Coagnlation Rhizotomy
Sacroiliac Joint Injections
Spinal Cord Stimulator
Stellate Ganglion Block
Trigger Point Injections


>Caudal Epidural Steroid Injection
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your neck, shoulders, and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing.
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>Cervical, Thoracic & Lumbar Discography
Discography helps confirm or deny the disc(s) as a source of your pain. This procedure utilizes the placement of a needle into the discs themselves and injecting contrast (dye). CT and MRI scans only demonstrate anatomy and cannot absolutely prove your pain source. In many instances, the discs may be abnormal on MRI or CT scans but not be a source of pain. Only discography, can tell if the disc itself is probably a source of your pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Discography is usually done only if you think your pain is significant enough for you to consider surgery.
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>Cervical, Thoracic, and Lumbosacral Medial Branch Block
What is a nerve root and why is a selective nerve root block helpful?

Nerve roots exit the spinal cord and form nerves that travel into the arms or legs. These nerves allow movement of the arms, chest wall, and legs. These nerve roots may become inflamed and painful due to irritation, for example, from a damaged disc or a bony spur.

A selective nerve root block provides important information to physicians but is not a primary treatment. It serves to prove which nerve is causing pain by placing temporary numbing medicine over the nerve root of concern. If your usual pain improves after the injection, that nerve is most likely causing the pain. If the pain remains unchanged, that nerve is generally not the reason you may be experiencing pain.

By confirming or denying the exact source of pain, it provides information allowing for proper treatment, which may include additional nerve blocks and /or surgery at a specific level.
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>Cervical & Lumbar Sympathetic Nerve Block
A sympathetic nerve block involves injecting medicine around the sympathetic nerves in the lumbar or cervical area. By doing this, the system is temporarily blocked in hopes of reducing or eliminating your pain. If the initial block is successful, then additional blocks are generally repeated in 7-10 days and repeated again until your pain diminishes.
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>Intrathecal Pain Therapy
Intrathecal pain therapy works by delivering small doses of analgesic directly to the pain receptors in the spinal cord, blocking the message to the brain. Because the doses are small and applied directly at the site of pain receptors, the entire body is not flooded with medications, and therefore negative side effects such as grogginess, confusion, and over sedation are usually avoided.

A surgically implanted pump delivers medication in small, regular doses. The medication goes through a catheter to the intrathecal space around the spinal cord where it most effectively blocks pain signals. Exact dosages and frequency of delivery are determined by the physician.
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>Lumbar, Cervical or Thoracic Epidural Steroid Injection
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your neck, shoulders, and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing.
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>Lumbar Facet Joint Injections
Lumbar facet joints are small joints a little larger than the size of your thumb nails located in pairs on the back of your spine. They provide stability and guide motion in your low back. If the joints become painful they may cause pain in your low back, abdomen, buttocks, groin or legs.

A facet joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. Additionally, the temporary relief of the numbing medicine may better allow a chiropractor or physical therapist to treat that joint. Also, time release cortisone (steroid) will help to reduce any inflammation that you may have within your joint(s).
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>(RFTC) Radio Frequency Thermal Coagnlation Rhizotomy
This procedure is done to treat pain caused by the facet joints by creating a lesion or burn in the pain fibers to the facet joint also known as the Medial Branch of the posterior primary ramus.

The purpose of RFTC of the medial branch is to decrease pain and improve function. This is done only if pain is relieved temporarily by facet joint injections and then by medial branch nerve blocks.

>Sacroiliac Joint Injections
A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. Additionally, the temporary pain relief of the numbing medicine may better allow a physical therapist or chiropractor to treat the joint. Also, time release cortisone will serve to reduce any presumed inflammation within your joint and further assist the physical therapist or chiropractor, if necessary. It is possible to obtain relief from the injection alone without follow-up physical therapy or chiropractic care.
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>Spinal Cord Stimulator
It is a therapy that uses electrical impulses to block pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation.

Who is a good candidate for a Spinal Cord Stimulator?
Doctors will generally consider the following:

* Conservative treatments have been tried and failed.
* Treatment is most effective when pain is in one or both arms or legs, or for low back pain that persists after surgery.
* Further surgery is not likely to help.
* The patient has no untreated drug addictions.
* The patient has had a psychological evaluation.
* The patient does not have a pacemaker or other contraindications.
* The patient has had a successful SCS trial.
* The patient is willing to play an active role in establishing and maintaining increased quality of life.
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>Stellate Ganglion Block
The stellate is a group of nerves in the neck area. A stellate ganglion block is an injection of a local anesthetic (pain-relieving medication) around this group of nerves to relieve pain. The pain relief will affect one side of the head and neck, the upper arm and the upper part of the chest on the same side of the body.
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>Trigger Point Injections
Trigger points are commonly defined as areas of taut muscle bands or palpable knots of the muscle which are painful. Often these trigger points can cause localized pain and even referred pain patterns that can even mimic the pain people feel from nerves being pinched in their neck or low back.

Common medications used in trigger point injections can include local anesthetic, normal saline, and small doses of steroid medications.

Utilizing a local anesthetic to numb the region of pain can help break the cycle of pain. A small dose of steroid medication at the site can help decrease inflammation of muscles as well.
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