If it is determined that the patient is a suitable candidate for SCS, often the first step is to implant a device on a trial basis. During the SCS trial phase, a lead or leads are implanted temporarily and are connected to a trial spinal cord stimulator. The trial stimulator is programmed with one or more stimulation programs customized to the specific areas of the patient’s pain. The trial phase can be beneficial for the following reasons:

  1. It can help the patient/physician analyze whether SCS effectively relieves pain.
  2. It provides the patient/physician with an assessment period to determine which type of SCS technology works best.
  3. It enables the patient/physician to evaluate different stimulation settings and programs.

A radio frequency ablation (RFA) is a procedure that uses radio waves to stop the SI joint nerves or the lumbar medial branch nerve from transmitting pain signals from the SI joint or the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the nerves.

Applying RFA to the medial branch nerves that go to the facet joints may be a more permanent treatment for facet joint pain.

Applying RFA to the nerves that go to the sacroiliac joint may also be a more permanent treatment for SI joint pain

What will happen during the procedure?

  1. The procedure will take 30 to 45 minutes, with you lying on your stomach.
  2. The needle will be directed to its proper location using X-ray guidance.
  3. Once the needle and electrode are in the correct location, the nerve is heated with radio waves until that nerve is unable to pass pain signals to the brain.
  4. During the procedure, the doctor will ask you if you feel a tingling sensation or if you feel your muscle twitching. This will help ensure the electrode is in the proper place.
  5. You will be given local anesthesia. If needed, sedative medication may be given to reduce discomfort. You will be awake during much of the procedure.

A medial branch block is an injection of anesthetic medication onto the nerves that transmit pain information. The nerves that transmit pain for the facet joints are called medial branch nerves. For this reason, the procedure is called a medial branch block. The goal of the shot is to relieve pain in your lower back or neck caused by the facet joints.

An epidural steroid injection (ESI) is an injection of a small dose of anti-inflammatory medication (called a glucocorticoid) into the lower back or neck to relieve pain in your legs/arms or lower back/neck. The medication is injected into an area of fatty tissue surrounding the spinal nerves called the epidural space. By reducing inflammation, an ESI can help reduce your pain. An ESI can be both a treatment and a way to diagnose a specific nerve root problem when there is a question.

EMG/NCS is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).

Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets.

An EMG uses tiny devices called electrodes to transmit or detect electrical signals.

During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle.

Nerve Conduction Study
A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.

EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.

Your doctor may order an EMG if you have signs or symptoms that may indicate a nerve or muscle disorder. Such symptoms may include:

  • Tingling
  • Numbness
  • Muscle weakness
  • Muscle pain or cramping
  • Certain types of limb pain

Migraines can cause nausea, sensitivity to light and significant pain for hours to days, keeping you from performing daily tasks and participating in activities you enjoy. For those who experience chronic migraines at least eight times a month, Botox injections can block pain-causing chemicals in the nerves and bring relief.

Spasms or muscle stiffness and tightness that interfere with voluntary movement can affect those who have brain or spinal cord injuries or conditions like cerebral palsy, multiple sclerosis, or strokes. These painful spasms and jerky or repetitive involuntary movements can significantly impact daily activity. Botox injections – similar to those used in cosmetic procedures – can help relieve spasticity symptoms for some patients.

Good candidates for Botox treatments typically have spasticity in only a few muscle groups. Initial treatment for spasticity includes rehabilitative stretching and exercise programs. These regimens should be continued during Botox treatments to ensure maximum treatment effectiveness.

Small doses of Botox injected into a muscle block the release of a neurotransmitter chemical known as acetylcholine, which transmits messages from the brain through the nerves to tell a muscle to contract. When acetylcholine is blocked, the muscle relaxes.

Suboxone/Buprenorphine treatment is treatment for Opioid addiction.