MRA now also offers a full spectrum of services for the optimal long term management of acute and chronic pain in a state-of-the-art procedure suite, including:
- Epidural Steroid Injections
- Facet Blocks
- Radiofrequency Neurolysis
- Diskography
- IntraDiscal ElectroThermal Therapy (IDET)
- Percutaneous Disk Decompression
Emerging evidence indicates that the problem of benign chronic pain can be optimally managed by agressive, active treatment programs that include (as needed):
- early diagnosis and workup
- active physical rehabilitation
- ergonomic modification
- judiciously chosen interventional pain techniques
Our experience has shown that care of pain conditions is often fragmented and typically lacks specific patient education regarding the nature of the illness, its chronicity and potential for recurrence. Too frequently the patient's symptoms and radiological findings become one and the same entity.
Which patients are candidates for interventional pain procedures?
The use of interventional procedures is limited to patients who do not respond to more conservative measures. Typical indicators would be
- a need for escalating doses of pain medication
- lack of progression in a therapeutic exercise program
- the need to identify the pain generators more specifically when imaging/exam do not suffice
What is the rationale for the use of interventional pain procedures?
The goal is to break the pain cycle and avoid chronic pain syndromes and the usual circuitous route of drug dependence, disuse, disability and further depression.
The use of fluoroscopic guidance allows greater specificity during diagnostic and treatment injection procedures than was previously available. Chronic pain syndromes of the neck and low back can be more specifically diagnosed and treated using techniques such as:
- Medial branch blockade for diagnosis of facet disease
- Transforaminal epidural injections for the treatment of acute and chronic radiculopathies
- Radiofrequency neurolyses for a variety of disorders including chronic facet arthropathy and sympathetically maintained pain
- Diagnostic lumar diskography for the evaluation of painful symptomatic intervertebral disk disease, conducted with strict consideration to technique, standardization and data reliability.
Why are behavioral/pyschological and therapeutic services commonly utilized in conjuction with spinal injection treatment?
- Chronic pain patients are actively involved with these interventions in order to further facilitate the goal of improved activity and improved quality of life
- In cases where a "cure" is not possible, significant improvements in strength, endurance and coping skills can be attained.
- The management of chronic pain requires a compassionate, competent and integrated approach that provides patients with achievable long term goals and coordinated care.
What information is given to patients before receiving interventional injections?
- Patients are educated extensively about the goals of the injections, as well as their limitations.
- Patients are made to understand quite clearly that the injections are not meant to be curative in all instances, but are meant to facilitate increases in activity or decreases in opiod use.
What services are required prior to scheduling a patient for an interventional procedure?
- Physical Medicine Consultation to determine medical indication and selection of appropriate initial procedur
- Pre-procedure instructions concerning diet and need for a designated driver on the procedure date
- Instructions regarding discontinuance of anticoagulant medications five days prior to procedure. Patients on Coumadin require INR monitoring by their primary care physician prior to the intervention
What side effects are commonly encountered following an interventional procedure?
- A temporary increase in post-proedure discomfort
- Mild corticosteroid side effects such as warmth and flushing
- A very small risk of spinal headache is possible with some epidural procedures
Is sedation required during interventional procedures?
- Sedation is not routinely used or necessary for most procedures
- Sedation is offered to very anxious patients or during longer, more invasive procedures such as IDET and diskography
Our goal at MRA is to avoid the ill-advised iatrogenic interventions that typically occur in the management of benign pain including:
- over emphasis on passive care after injury
- over emphasis on psychogenic diagnoses in patients with actual, discernible pathophysiology
- over emphasis on structural diagnosis involving imaging studies