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Types of Pain
Treatment options
Procedures

 

Patient information

 

 

spinal pain

Procedures

The majority of procedures performed in Dr Munglani's pain clinics are injections. These can be to provide short-term relief in the form of steroids or long-term relief in the form of specialised injections that use heat to densensitise ligaments or cut the pain signals along nerves. Where appropriate Dr Munglani uses a relatively new procedure called pulsed radiofrequency that uses an electrical current without high temperature to desensitise the nerve.

Dr Munglani also performs nucleoplasty, in cases where an intervertebral disc is persistently painful, and prolotherapy, a procedure that encourages new tissue growth and repair.

 

Injections within a treatment programme

Dr Munglani recommends injections be combined with a number of complementary approaches to managing pain.

Post-injection physical rehabilitation may involve simply increasing the amount of walking one does, exercise such as swimming, attending a physical therapist or enrolling in a Pain Management Programme.

Risks from injections

Overall the risks of injections around the spine are very small indeed. The chances of a minor reaction such as infection are 1 in 5,000 and the chances of a major problem such as paralysis range from 1 in 100,000 to 1 in 300,000 or less. It is important however to have the injections performed by or under the supervision of a consultant experienced in performing them under x-ray control.

Summary information on procedures

Dorsal Root Ganglion Injections
These procedures are performed to help reduce pain, particularly where the source of the pain is thought to be arising from the nervous system, particularly the nerves that carry sensation. These nerves come out of the spinal cord and branch out to the different parts of the body. The dorsal root ganglion is a little swelling on the nerve at the place where it joins the spinal cord. It is the place where impulses from the nerves are transmitted through to the spinal cord. This injection is called an epidural because it is inserted into the epidural space which is a specific space found in your back.

Facet or sacroiliac (SI) Joint Injection

Facet or SI joint injections are used to test whether pain is coming from the joints of the spine. The little joints that link each vertebra together are known as the facet joints. They help stabilise the spine and allow movement.

Facet joints occur in pairs along the length of the spine. The ones that most often cause problems are in the neck (cervical facet joints) or the lower back (lumbar facet joints). There may be a problem with more than one set of joints due to wear and tear, injury, inflammation or previous disc problems. If inflammation of the facet joints is causing pain, then this may, partly or fully, respond to an injection.

The sacroiliac joint is where the spine joins to the hips. Inflammation may occur due to a variety of reasons causing pain just off the centre of the base of the spine. Inflammation of the SI joint or of the overlying ligament may also irritate the sciatic nerve as it exits the spine to travel down the leg.

A facet joint injection is an injection of local anaesthetic and steroid either directly into the joint or to the path of the small nerve which supplies sensation to the joint. A sacroiliac injection is an injection of local anaesthetic and steroid either into the joint itself or around the joint and ligament.

Radiofrequency Denervation

A denervation is a procedure that aims to permanently stop a nerve transmitting pain. The nerve is destroyed by heating it with an electrical current from a special device called a radiofrequency machine.

This treatment is usually done after procedures such as facet joint or sacroiliac injections have been effective.

Pulsed Radiofrequency Denervation is a similar procedure to the above with the same outcome but the electrical current does not heat the nerve.

Nucleoplasty
When surgical approaches are not appropriate or merited and an intervetebral disc continues to cause pain nucleoplasty is an option that may be considered. It is a patented procedure developed by Arthocare and uses a plasma laser to core out material from the inside of the disc thus reducing pressure.

Prolotherapy
Prolotherapy is defined as injection of growth factors or growth factor stimulants to help production of normal cells or tissue. An example of the former involves, for example, the injection of blood concentrates (which have growth factors in them). The second involves the injection of irritant/stimulant solutions (e.g. Dextrose, Phenol, Sodium Morrhuate) that initiate production of growth factors by the body and thereby encourages new tissue growth and repair.

Injections treating dysfunctional nerves
These injections, sometimes called Sympathetic Blocks, are used to treat nerve pain, which may be caused by nerves, not normally used, to carry pain messages. Occasionally these nerves may alter in function and become pain-carrying nerves. Pain, which occurs in the face, arms, chest, abdomen, back, pelvic region or legs may sometimes be caused by these conditions. Often this type of pain is accompanied by intense sensitivity of the skin, occasionally changes in skin colour, and changes in the temperature of the skin. Local anaesthetic and, in some cases, steroids are used for these procedures.

Therapeutic use of Botox as muscle relaxant
Patients with persistent back or neck pain linked to with muscle spasm often respond to treatment with botulinum toxin when they have failed to respond to back surgery or interventional pain procedures such as epidurals, lumbar or cervical facet denervation.

You can read a case study of one of Dr Munglani's recent patients here: Case Study PDF