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P A I N
M A N A G E M E N T
1. The latest treatments. Starting with the least invasive, here's
the latest in pain procedures.
• Epidural steroid injections. Delivered in the lower back to treat lower
back and neck pain, the injections are often used in conjunction with
less-invasive modalities such as physical therapy. After injections,
patients will hopefully experience pain relief with rest for a week or 2
as the steroids decrease tissue inflammation around the injection area.
• Dorsal medial branch block. If steroid injections fail to control a
patient's pain, physicians can perform a dorsal medial branch block
— which involves injecting a local anesthetic along the spinal nerve
pathway — to determine if the patient would benefit from radiofrequency neurotomy. (If the local block relieves the pain, physicians
presume neurotomy would provide longer-term relief.)
• Radiofrequency neurotomy. This is at the forefront of pain management advances. Physicians insert a hollow radiofrequency needle near
the targeted nerve, then place a wired electrode through the needle to
denature proteins in the nerve's coverings, which impedes electrical
impulses that conduct down pain pathways. The technique targets a
nerve's sensory branch, not its motor branch.
The procedure, which is especially beneficial to patients suffering
from chronic discomfort, essentially stops impulses from moving
across the pain pathway for 12 to 18 months, until new tissue begins
to grow over the ablated portions of the nerve coverings. Patients may
have to repeat the procedure in a year or two, perhaps sooner.
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