Dr. Chou - Pacific Comprehensive Pain Management

 

PATIENT EDUCATION

Cervical epidural injection
The epidural is the space outside of the spinal canal. The spinal nerves come out the spinal cord, pass through the epidural space, and distribute to the body. Cervical epidural injection is injecting the anti-inflammatory agent in the epidural space in the neck region under X-ray guided. It helps neck pain and arm pain.

Occipital nerve block
The occipital nerves come out between the skull and the neck. Repetitive microtrauma from working can cause neck and head pain, also known as occipital neuralgia. Sometimes, the block is used to differentiate between occipital neuralgia and tension-type headache for diagnostic and therapeutic purposes.

Sphenopalatine ganglion block
Sphenopalatine ganglion block is used in the treatment of acute migraine headache, acute cluster headache, and some facial pain syndromes.

Cervical transforaminal injection
Cervical transforaminal injection is direct delivery of medication to the cervical nerve in the foramen of cervical spine. It is a selective nerve block. It has diagnostic and therapeutic function, and it is performed under X-ray guidance.

Cervical facet block
The facet (zygapophysial) joint is a small joint that connects the posterior portion of the adjunct vertebras. It is affected by inflammatory, degenerative processes and trauma. It is one of common causes of neck pain. Cervical intra-articular block could be both diagnostic and therapeutic.

Cervical medial branch block
The medial branch of the posterior nerve root is the small nerve supply the sensation of the facet joint. So, it is very effective to control the facet pain syndrome by blocking this nerve.

Cervical medial branch radiofrequency rhizotomy
The use of radiofrequency denervation of the medial branch achieves the long term control of the facet pain syndrome.

Stellate ganglion block
The stellate ganglion is the sympathetic nerve origin to supply the arm and face. Blocking this ganglion will decrease the sympathetic outflow to the distributed area. It is the therapeutic approach for the complex regional pain syndrome (Reflex sympathetic dystrophy) and acute vascular insufficiency.

Thoracic epidural injection
The epidural is the space outside of the spinal canal. The spinal nerves come out the spinal cord, pass through the epidural space and distribute to the body. Thoracic epidural injection involves delivery the medications or placement of a catheter in the epidural space for continuous infusion. Thoracic epidural injection is indicated for acute herpes zoster, postherpetic neurlgia, acute pancreatitis, pain from rib and vertebra fracture, herniated disk in the thoracic spine.

Thoracic medial branch block
The thoracic medial branch nerve supplies the sensation of the thoracic facet joint. By blocking this nerve, it will relieve the pain of thoracic facet syndrome.

Celiac plexus block
Celiac plexus is the network of tiny nerve fibers that transmit the pain signal from abdominal organs. The indications of this block are: acute and chronic pancreatitis, pancreatic cancer pain, abdominal angina associated with visceral arterial insufficiency.

Celiac plexus neurolytic block
Celiac plexus is the network of tiny nerve fibers that transmit the pain signal from abdominal organs. Celiac plexus neurolytic block is delivery the neurolytic agents, such as ethyl alcohol and phenol, in order to achieve the prolong pain relief. The indications of this block are: acute and chronic pancreatitis, pancreatic cancer pain, abdominal angina associated with visceral arterial insufficiency.

Lumbar sympathetic ganglion block
Lumbar sympathetic ganglions lie on the sides of lumbar vertebras. Blocking these ganglions will interrupt the transmission of the sympathetic nerves, which mediate the pain sensation in some pain disorders. The indications include: circulatory insufficiency in the leg, reflex sympathetic dystrophy, causalgia, pain from renal colic.

Lumbar epidural injection
The epidural is the space outside of the spinal canal. The spinal nerves come out the spinal cord, pass through the epidural space and distribute to the body. Lumbar epidural injection involves delivery the medications or placement of a catheter in the epidural space for continuous infusion. Lumbar epidural injection is indicated for the pain syndromes that caused by the lumbar disk, nerve root, muscle, ligament, fascia and facet joint.

Lumbar transforaminal injection
Lumbar transforaminal injection is the delivery of medication in the lumbar foramen through which the spinal nerve root comes out. It is a selective nerve root injection. The medication is delivered right on the target nerve. It is used for diagnostic and therapeutic purposes. The most common indication is radiculopathy.

Lumbar facet block
The facet (zygapophysial) joint is a small joint that connect the posterior portion of the adjunct vertebras. It is affected by inflammatory, degenerative processes and trauma. It is one of common causes of back pain. Lumbar intra-articular facet block could be diagnostic and therapeutic.

Lumbar medial branch block and radiofrequency rhizotomy
The medial branch of the posterior nerve root is the small nerve supply the sensation of the facet joint. So, it is very effective to control the facet pain syndrome by blocking this nerve. Radiofrequency denervation of the medial branch achieves the long term control of the facet pain syndrome.

Lumbar diskography
Diskography (disk picture) involves the infection of contrast medium into the nucleus pulposis of the intervertebral disk to study its internal morphology. The provocation diskography elicits patient’s pain during the injection, which is specific for the diagnosis of the causes of the back pain.

Percutaneous disc decompression
Percutaneous disc decompression is a minimally invasive procedure for the treatment of some herniated dick diseases. A small decompression device is introduced in the dick under x-ray. It relieves the pressure inside the disk and lessens the herniated disk compression on the nerve root.

Intradiscal electrothermal therapy
Intradiscal electrothermal therapy is a minimally invasive procedure. It involves placement of a tiny electrothermal device in the defective disk under x-ray. The device will seals off the fissures with thermal energy, destructs the nociceptive nerve ingrowths, and stabilizes the collagen and biomechanics of the disk.

Caudal epidural block
Caudal epidural block is the injection of medication in the epidural space inside the sacral vertebrates (lower portion of the spine). It can be used as a diagnostic tool to evaluate pelvic, bladder, perineal, genital, rectal and lower extremity pain. It may be used to palliate acute pain emergencies in adults and children-postoperative pain, acute low back pain, acute radiculopathy, pain secondary to pelvic and lower extremity trauma, pain of acute herpes zoster, acute vascular insufficiency of the lower extremities and cancer-related pain.

Hypogastric plexus block
Hypogastric plexus lies on in front of the lower lumbar vertebras and upper sacrum. It supplies the sympathetic innervation to the pelvic viscera and vasculature. It is useful in the evaluation and management of sympathetically mediated pain of the pelvic viscera, including pain secondary to malignancy, endometriosis, reflex sympathetic dystrophy, causalgia, porctalgia fugax, acute herpes zoster and postherpetic neuralgia in the sacral dermatomes.

Ganglion of impar block
Ganglion of impar (Ganglion of Walther) lies in front of the sacro-coccygeal junction and provides sympathetic innervation to the pelvic viscera and genitalia. This technique is primarily used in the treatment of pain secondary to endometriosis, reflex sympathetic dystrophy, proctalgia fugax and radiation enteritis.

Lysis of epidural adhesions, Racz technique
Lysis of epidural adhesions is developed to break down scar formation, deliver site-specific corticosteroids and local anesthetic drugs directly to the target, and reduce edema with hypertonic saline. It is indicated in post-laminectomy pain syndrome, disk disruption, metastatic carcinoma of the spine leading to compression fractures, multilevel degenerative arthritis, facet pain, spinal stenosis, pain unresponsive to spinal cord stimulation and spinal opioids.

Spinal cord stimulator implant
Spinal cord stimulation implant is based on the “gate control theory”. Large myelinated A-beta fiber stimulation could “close the gate” in the spinal cord and manipulate the pain signals carried by C-fibers and A-delta fibers. It involves the placement of stimulating leads in the epidural space and the implant of a pulse generator. The indications include post back surgery pain syndrome, complex regional pain syndrome and peripheral ischemia.

Intrathecal infusion pump implant
Intrathecal infusion pump implant involves the placement of a catheter in the spinal cannel and implantation of an infusion pump. It provides an access to deliver the medication in the spinal cannel continuously. It could be used in spasticity condition and intractable cancer pain and non-malignant pain.

Vertebroplasty
Vertebroplasty is a minimally invasive procedure and for the treatment of painful vertebral compression fractures. A needle is placed in the fractured vertebra under x-ray guided. Bone cement (polymethylmethacrylate ) is injected through the needle and stabilizes the fractured vertebra.

Continuous peripheral nerve infusion
Continuous peripheral nerve infusion is mostly used for acute pain management. A small catheter is placed by the peripheral nerve under ultrasound. Continuous infusion with local anesthetic blocks the nerve transmission to palliate the pain. Different pain syndromes require different peripheral nerve infusions, such as interscalene, infracavicular, axillary, femoral, sciatica, popliteal.

Acupuncture
The history of acupuncture spans thousands of years. It is one of the traditional Chinese medicines. Disposable needles are inserted in the body according to the acupuncture points and meridians. Acupuncture is recognized by the World Health Organization as an effective treatment of pain. Several evidenced-based studies have demonstrated the efficacy of acupuncture in treating pain. Acupuncture is not a stand-alone treatment but should be considered as part of multidisciplinary approach, especially in patients who wish to explore non-pharmacologic strategies.

Headache
Occipital Neuralgia
Cervical facet syndrome
Cervical radiculopathy
Cervical strain
Fibromyalgia
Postherpetic neuralgia
Chronic pancreatitis
Pancreatic cancer pain
Lumbar radiculopathy
Spinal stenosis
Chronic low back pain
Herniated disc pain
Facet syndrome
Sacroiliac joint pain
Post laminectomy pain syndrome
Chronic pelvic pain
Coccydynia
Phantom limb pain
Complex regional pain syndrome (Reflex sympathetic dystrophy)
Causalgia
Acute and postoperative pain