::::: DESERT PAIN MANAGEMENT MAHESH KUTHURU, MD :::::


	Interventional Pain Management:

	Severe, un-controlled pain can destroy a patient's quality of life, and thus our physician makes pain management a very high priority. Our primary focus is Interventional pain management and under the expert direction of Dr. Kuthuru this type of treatment has brought relief from pain to numerous patients.

	Nerve blocks, Epidural steroid injections and Radiofrequency nerve ablation are some non-operative forms of pain management. Therapeutic injections may be considered an adjunct to medication and physical therapy. Injection therapy may help control pain from Degenerative Disc Disease, Injury, Osteoarthritis and other disorders of the spine. Our Pain management techniques strive to relieve and control acute and chronic pain.

	Table 1: Types of Pain

	Type of Pain

	Acute Pain Severe, short-term pain, self-limiting Chronic Pain Consistent, not self-limiting Neuropathic Pain Burning, electric, shooting, tingling Nociceptive Pain Sharp, aching, throbbing, localized

	The following is a brief overview of different types of nerve blocks and Epidural Injections used to treat pain and discomfort caused by spinal disorders.

	• Nerve Blocks
	A nerve block is an injection of medication onto or near nerves. The injected medication may include a local anesthetic, steroid and narcotic or may involve more advanced modalities. Most injections are performed under fluoroscopic guidance and contrast enhanced for precise targeting / optional safety.

	• Facet Joint Block and Medial Blocks
	Joint inflammation between the spinal bones can cause back pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint. Medial block uses similar medication injected outside the joint space near the nerve that feeds that joint.

	• Peripheral Nerve Block
	Paresthesias are sensations described as numbness, tingling, or a ‘pins and needles' feeling. These sensations may be caused by a disturbance in the peripheral nervous system. The nerves outside of the brain and spinal cord are the peripheral nerves. Sensory peripheral nerves transmit information to the central nervous system. Motor peripheral nerves transmit information from the brain.

	• Selective Nerve Root Block (SNRB)
	Pain and discomfort from cervical or lumbar radiculopathy may be relieved by a SNRB. A radiculopathy is irritation and inflammation of a nerve root that serves a particular body part (e.g. arm, leg).

	• Sympathetic Nerve Block
	Sympathetic nerves regulate part of the autonomic (involuntary) nervous system. This includes such bodily functions as sweating and blood flow. Conditions causing chronic pain often involve the sympathetic nerves.

	• Epidural Steroid Injections
	The Epidural space is the space surrounding the membrane that covers the spinal cord and nerve roots. Disorders such as spinal stenosis and herniated disc can cause nerve irritation, inflammation and pain. An Epidural injection places anti-inflammatory medication (eg steroids) into the Epidural space. Epidural injections are performed in the cervical, thoracic and lumbar spine.

	• Sacroiliac Joint Injection
	The sacroiliac joint is the largest joint. It is located in the lower spine above the tailbone. Inflammation of the sacroiliac joint can cause low back and buttock pain. An injection of an anesthetic and steroid may help relieve joint pain.

	• Radiofrequency Nerve Ablation
	Facet joints are one source of back pain. Radiofrequency nerve ablation uses radio waves to produce heat directed at a specific facet joint nerve. The heat destroys the nerve and relieves pain.

	The ablation procedure is similar to a nerve block or spinal joint injection except that two needles are inserted; each facet joint has two nerves. Fluoroscopic guidance is used to correctly position each needle. Then Radiofrequency “radio waves” are directed through each needle. The ablation process takes about two minutes. The entire procedure usually takes about 2 hours.

	• Scope of the Problem
	Chronic pain is defined as pain that lasts for a long period of time or at least beyond the normal healing period. Seventy-five million Americans suffer from chronic pain and 50 million of them suffer with some degree of disability.

	Pain costs $120 billion each year. Unrelieved pain can lead to unemployment and decreased productivity. Unrelieved pain is associated with alcohol and medication abuse.