Corvallis Pain Management Videos
This section includes helpful links to various videos regarding pain management. To learn more click on the video links below.
Preparing to Receive an Epidural Steroid Injection
Patients may be asked to change into a hospital gown, which allows for access to clean the injection area and to allow the physician to easily visualize the injection site. An epidural steroid injection usually takes between 15 and 30 minutes and follows a relatively standard protocol:
- The patient lies flat on an X-ray table or with a small pillow under their stomach to slightly curve the back. If this position causes pain, the patient can be allowed to sit up or lie on their side in a slightly curled position.
- The skin in the low back area is cleaned and then numbed with a local anesthetic similar to what a dentist uses.
- Using fluoroscopy (live X-ray) for guidance, a needle is inserted into the skin and directed toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space, as controlled studies have found that medication is misplaced in many (> 30%) of epidural steroid injections that are done without fluoroscopy.
- Once the needle is in the proper position, contrast is injected to confirm the needle location. The epidural steroid solution is then injected. Although the steroid solution is injected slowly, most patients sense some pressure due to the amount of the solution used (which in lumber injections can range from 3mL to 10mL, depending on the approach and steroid used). The pressure of the injection is not generally painful.
- Following the injection, the patient is monitored for 15 to 20 minutes before being discharged home.
Radiofrequency Ablation is a minimally invasive procedure that is usually performed with local anesthetic and mild sedation. As with many spinal injections, radiofrequency neurotomy is best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve or other injury). The neurotomy or ablation procedure includes the following steps:
- An intravenous (IV) line is often started so that relaxation medicine (sedation) can be given.
- The patient lies on a procedure table and the skin over the neck, mid-back, or low back is well cleaned.
- The physician numbs a small area of skin with numbing medicine (anesthetic), which may sting for a few seconds.
- The physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial or lateral branch nerves.
- A small amount of electrical current is often carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the neck or back.
- The targeted nerves will then be numbed to minimize pain while the lesion is being created.
- The radiofrequency waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve's ability to send pain signals.
- This process will be repeated for additional nerves.
Trial of Spinal Cord Stimulation
Unlike many other forms of pain treatment, spinal cord stimulation always involves a short trial (lasting a week) conducted with a temporary stimulator to determine whether or not spinal cord stimulation will provide the patient with adequate pain relief. The spinal cord stimulator for the trial period is implanted in an outpatient visit, during which:
- The patient's skin is numbed with a local anesthetic
- Leads are placed under the skin and attached to a small generator that the patient carries (much like a pager or cell phone)
- Using pre-set programs, electrical currents are emitted in a pattern to target the areas of pain, with the goal of giving the best pain relief possible.
- Placement of the trial stimulator generally takes about 10 to 20 minutes, and the patient can go home soon after the leads have been inserted. Preset programs are used to emit electrical currents in a pattern designed to target the areas of pain.
- If the patient enjoys significant relief from pain during the trial, a complete system with a generator can then be implanted.
Other Injection Videos
- Cervical Epidural Steroid Injection Video
- Cervical Facet Radiofrequency Neurotomy Video
- Cervical Transforaminal Epidural Steroid Injections Video
- Costovertebral Block Video
- Epidural Steroid Block Video
- Epidural Steroid Injections for Back Pain and Leg Pain Video
- Facet Joint Blocks Video
- Facet Joint Injections Procedure Video
- Lumbar Radiofrequency Neurotomy Video
- Lumbar Sympathetic Block Video
- Medial Branch Block Video
- Sacroiliac Joint Block Video
- Sacroiliac Joint Radiofrequency Rhizotomy Video
- Sacroiliac Joint Steroid Injection Video
- Trigger Point Injections Video
- Types of Spinal Injections Video