Procedures

Just as there are many medical conditions that cause pain, there are many procedures and treatments that can be used to diagnose and treat pain. The physician anesthesiologists at the UCLA Comprehensive Pain Centers work with each patient to design a treatment program that determines the cause of the pain and how best to treat it. Often, conservative treatment with non-narcotic pain medications, physical therapy, and other noninvasive techniques will be sufficient. But our pain medicine physicians have a full array of diagnostic and therapeutic procedures to offer when needed.

In this section:

• Nerve Block
• Epidural Injections
• Other Nerve Blocks
• Joint Injections

• Sympathetic Blocks
• Implantable Pumps
• Other Techniques

Nerve Blocks

Nerve blocks are procedures that can help diagnose or manage many different types of pain. Often, a local anesthetic (numbing medication) is injected to block pain caused by specific nerves. The block can be used as a diagnostic tool to determine exactly where the source of the pain is located. Steroid medications can be used in nerve blocks to decrease inflammation.

Epidural Injections

Watch epidural video

Perhaps the most common type of nerve block is an epidural injection. Many people have heard of epidural anesthesia because it is commonly used to ease the pain of labor, and for anesthesia during cesarean section or other types of surgery.

Epidural injections may be performed at the level of the cervical spine to treat neck pain, the thoracic spine to treat upper/mid back pain, and the lumbar spine or caudal area to treat low back pain. Diagnostic epidurals involve injecting a local anesthetic (numbing medication) into the epidural space near nerve roots to identify and pinpoint the underlying cause of pain. Whether the injection provides immediate relief will help determine whether this type of injection is the best treatment option. Dr. Jakun Ing explains more about the different types of medications that may be used in an epidural in this video.

If the patient obtains good relief from the initial epidural block, the physician may inject a steroid solution into the epidural space to reduce inflammation and provide long-lasting pain relief.

To learn more about epidural steroid injections, see these videos:

• Cervical epidural steroid injection
• Thoracic epidural steroid injection
• Lumbar epidural steroid injection
• Caudal epidural steroid injection

Other Nerve Blocks

Watch medial branch block video

• Intercostal nerve blocks may relieve the pain of rib fractures, a shingles (herpes zoster) infection in the chest area, or an incision after chest surgery
• Medial branch blocks may help in the management of spine facet joint pain
• Occipital nerve blocks may be used in the treatment of occipital neuralgia
• Pudendal nerve blocks can help in the diagnosis of chronic pain conditions such as vaginal pain, penile pain, scrotal pain, or perineal pain

Joint Injections

Watch hip joint injection video

Steroid joint injections are used to temporarily relieve pain caused by an inflamed joint, which is common in conditions such as arthritis or bursitis. Diagnostic injections involve injecting local anesthetic into the joint that is the source of pain. If it provides good pain relief, the physician will inject both a steroid and a local anesthetic into the capsule of the painful joint, to relieve pain and reduce inflammation. To learn more about injection into different joints, see these videos:

• Facet joint injection
• Hip injection
• Knee injection
• Sacroiliac joint steroid injection
• Shoulder injection

Sympathetic Blocks

Watch celiac plexus block video

Sympathetic nerve blocks target a part of the nervous system that is different from the nerves that control movement and sensation. These nerves control involuntary body functions such as blood flow and digestion, and are involved in several chronic pain syndromes that can be treated with sympathetic nerve blocks.

• Celiac plexus block may be performed to reduce abdominal pain caused by conditions such as cancer or pancreatitis. The celiac plexus is a group of nerves that surround the aorta, the major artery in the abdomen.
• Hypogastric plexus block may be performed to manage pelvic pain, which may come from the colon, bladder, uterus, prostate, or other parts of the pelvis.
• Stellate ganglion block involves injection of local anesthetic into the sympathetic nerve chain on either side of the neck. This block is used to diagnose and treat pain in the head, neck, chest, or arm.

Sympathetic blocks are usually done under X-ray or ultrasound guidance. These blocks may take a few days to become fully effective, and may need to be repeated more than once.

Implantable Pumps

Watch intrathecal pump implant video

Medication delivered continuously via an implanted pump can help control severe chronic back and abdominal pain, and it can also lessen muscle rigidity and spasms in the arms and legs. The pump is about the size of a hockey puck, and is surgically implanted under the skin of the abdomen. Medication is slowly released over time into the fluid-filled area around the spinal cord, which is called the “intrathecal” space. When the pump’s storage reservoir is empty, it can be refilled by inserting a needle through the skin into the fill port on top of the reservoir.

Other Techniques

Watch discography video

Botulinium toxin, or Botox®, may be helpful in the treatment of chronic migraine headaches. It may also be used in the treatment of the overactive muscle contractions, called “spasticity”, that may cause pain in patients with cerebral palsy, multiple sclerosis, or a history of stroke.

Discography is a diagnostic procedure that uses fluoroscopy (a type of X-ray) to determine whether back pain is caused by one or more spinal disks. If the pain is reproduced by injecting a sterile liquid into the disk, then the disk is the likely cause.

Kyphoplasty is a procedure used to treat painful compression fractures in the spine. The goals are to stabilize the fractured bone, reduce pain, and restore some of the height that is lost when the vertebra collapses. A hollow needle is inserted through the back and into the fractured vertebra under X-ray guidance. A type of cement then is injected into the vertebra. Dr. Jakun Ing explains more about kyphoplasty in this video.

In a neurolytic block, the nerves involved in the perception of pain are permanently destroyed. This type of block is reserved for severe pain, such as cancer pain, that has not responded to other treatments. First, a block such as a celiac plexus block is done with local anesthesia to confirm the source of the pain. If pain relief is achieved, the block is repeated using an agent such as ethyl alcohol that will destroy the specific nerves involved in causing the pain.

Radiofrequency neurotomy or rhizotomy is a procedure that uses radio waves or electric current to semi-permanently block the nerves that carry pain impulses. Relief may be long-lasting, though sometimes the nerve may recover function. Dr. Parisa Sadoughi explains more about radiofrequency ablation in this video.

Watch spinal cord stimulator implant video

Spinal cord stimulation is a technique used to treat chronic back or limb pain. It uses a low-voltage electric current to the spine to block the feeling of pain. This is done via a spinal cord stimulator system, with a pulse generator that is surgically implanted under the skin of the abdomen. When turned on, it creates a pleasant sensation that blocks the brain’s ability to sense the pain. Patients can learn to control the stimulation and adjust it to their pain levels. Dr. George Pan explains more about spinal cord stimulators in this video.

Trigger point injection reduces the pain from small, tender knots that can form in the muscles or deeper fascial tissues.