Chronic Pain Evaluations
It is essential to have the right diagnosis and the right treatment plan to achieve pain relief. This requires an appropriate history and physical examination, with possibly current laboratory tests, imaging and other diagnostic testing. The pain experts at Palo Brea Pain & Rehabiitation will take the time to arrive at the right diagnosis and the right treatment plan.
Interventional pain procedures
Epidural injections are a common treatment for low back and leg pain. The intention of the injection is used to provide pain relief and reduce inflammation, and is often used in conjunction with a rehabilitation program. Relief from pain may last months or longer.
The philosophy of our physiatrists is to prescribe medications conservatively and narcotic pain medications even more carefully. We use a trial period to see if a medication has an impact on the patient’s level of functionality and make adjustments from there.
Our medical goals include:
- Optimizing medication use
- Conservative medication management for both acute and chronic pain
- Multimodal polypharmacy when appropriate
- Minimal and controlled opioid administration
- Non-surgical procedures
- Functional restoration
- Random Urine Drug Screens as indicated
Nerve blocks is basically an injection used for pain treatment and management. The block is an injection of nerve-numbing medication into a specific area that is causing pain. There are a variety of different types of blocks for different body areas and serve different purposes.
Our vertebra each have tiny joints call facet joints. A facet injection places a combination of numbing medicine and a cortisone type medication into these joints under x-ray guidance. It can help with both pain and inflammation of the joints, as well as help improve the accuracy of the diagnosis.
Medial Branch Blocks
Small nerves that feed out from the facet joints are called medial branch nerves. A medial branch blocks involves placing numbing medication on the tiny nerves. The medial branch block temporarily interrupts the pain signal from the nerve. This determines if the facet joint is the cause of the pain. When the block is positive, it means the patient may be a strong candidate for an ablation procedure.
This is a minimally invasive procedure where high frequency energy is directed at an area surrounding nerve tissue decreasing the pain signals to the nerve. The pain relief can last six months or longer, but occasionally the procedure needs to be repeated. This procedure is also called:
- Radio frequency ablation
- Radio frequency procedure
- Radio frequency thermal ablation
- Radiofrequency ablation
- RFTC neurolytic ablation
Myofascial Pain (Trigger Points)
Myofascial pain involves the fascia which is connective tissue that covers muscle. The site of injury or strain can develop small contracted knots in your muscles. These are called trigger points. The pain can radiate throughout the affected muscle or can be in a different location. Myofascial pain doesn’t resolve in a few days like normal muscle pain. The pain persists or worsens.
Myofacial Release Therapy can be useful to help muscles relax. Trigger point injections are sometimes used to relax the painful areas of the muscles.
This is a diagnostic test used to verify disc problems. Discograms can precisely locate disc damage and pain. A tiny amount of special dye is injected into the injured disc or series of discs. A special x-ray shows the doctor if there is disc damage and if the patient feels pain, then that disc is the likely source of your pain. This test is also known as:
- Cervical discograms
- Lumbar discograms
Spinal Cord Stimulation
A spinal cord stimulation trial uses low voltage stimulation delivered through an electrode temporarily placed in the spine to block the feeling of pain. This trial lasts for a short period and might be recommended if the pain is coming from a particular nerve in the spine. If the trial relieves the pain, then permanent electrodes are then implanted.
Botulinum toxin (BOTOX®) works through relaxing your muscles by reducing the amount of neurotransmitters in your body. This can reduce painful muscle spasm. This reduction in spasm develops over 1-2 weeks and may last 3-4 months. The pain relief may last even longer. BOTOX® is a registered trademark owned by Allergan.
This is a Chinese medical procedure that consists of small needles being inserted into certain points on the body. It is an ancient art and has been successful in relieving headaches and pain in the back, joint, and neck.
We manage and treat neuropathy difficulties such as neuropathic pain, radiculopathy, and plexopathy.