Interventional Pain Procedures

Interventional pain management consists of minimally invasive procedures to reduce pain.

Epidural steroid injection

An epidural steroid injection (ESI) involves injecting medications (steroid and anesthetic) along the nerve roots, which are attached to the spinal column. When one of the spinal cord nerve roots becomes compressed and irritated, it can produce neck and/or back pain along with numbness, tingling and occasionally extremity weakness. If the injection provides pain relief for the patient, it can help identify the specific source of pain. This is a safe procedure performed by a fully trained and qualified physician utilizing fluoroscopic guidance.  The procedure can be both diagnostic and therapeutic, helping surgeons identify the source of pain while at the same time affording relief.

Facet Injection

This injection can also be both therapeutic and diagnostic. There are a pair of facet joints at each vertebral level which allow movement of the spine and provide stability. When people have significant back pain with sitting, it is usually indicative of facet joint inflammation. Steroid and an anesthetic agent are injected into the facet joint space to reduce inflammation and decrease pain. These injections are typically done in combination with physical therapy for maximum benefit.

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Medial Branch Blocks

Medial branch blocks help to diagnose and relieve back pain from degenerative and painful facet joints. The medial branch is a nerve that carries pain signals from the facet joint to the spinal cord. Each joint gives pain signals to the medial branch located above and below the joint. A local anesthetic medication is injected over two medial branches to block the pain signals from a facet joint.

Radiofrequency Ablation

After a Facet Joint Injection or a Medial Branch Block has been performed to diagnose the exact source of pain, a radiofrequency ablation (RFA) may be performed on the same nerve roots. Radiofrequency waves treat the nerve that is causing the pain using heat, minimizing the transmission of pain signals to the brain. It can provide longer lasting relief for people with chronic pain, especially in the back and neck. This is a safe procedure performed by a fully-trained and qualified clinician in our office, and requires the use of flouroscopy. The procedure takes less than 20 minutes. The results after receiving an RFA vary with each individual. After 1 week most people feel less pain than before their procedure. Overall healing time is typically 4 weeks, due to the residual effects of the procedure and muscle spasm. The duration of pain relief from this procedure varies from person to person, but typically lasts between 6 and 12 months.

Sacroiliac Joint Injection

Sacroiliac joint (SI joint) dysfunction is a common diagnosis. The sacroiliac joints are located in the back where the lumbosacral spine joins the pelvis. An inflamed SI joint will usually give patients the feeling that the hip is giving out. An SI joint injection is also both diagnostic and therapeutic. These injections eliminate pain temporarily by filling the SI joint with a combination of steroid and anesthetic medication that numbs the joint, ligaments, and joint capsule around the SI joint.


When you have a therapeutic injection performed at DOC, we use a real time X-ray machine called a fluoroscope. It can be adjusted in several different directions and angles, during the procedure, in order to see the same location from a different perspective. We take a series of images as we insert and guide the needle to the exact place. Having our own fluoroscope allows us to perform almost all our interventional procedures right in our office. This can save you thousands of dollars versus going to a surgery center.

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