Discography is the injection of a dye into the disc. Discography is used to determine which disc level(s) is painful, and is usually used as a diagnostic tool for your surgeon. A minimum of two discs will be injected. If you have x-ray findings of disc problems at many levels additional injections may be necessary.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

The main risk of the procedure, though it happens less than 1% of the time, is discitis.  Discitis is an infection in the disc that can lead to an infection in the spine.  Every effort is made to prevent this from occurring; for example, antibiotics are administered before the procedure and use of sterile technique.

There is also a chance of what is called a paresthesia; a shooting, “electric-shock” type pain.  This generally occurs when the medicine is injected into the disc and more pressure is put on the nerve.  This usually passes quickly but on rare occasion it can continue.

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.  However, these are extremely rare.

Some short-term side effects may occur.  If local anesthetic spreads to nearby nerves you may have weakness or numbness that can last for several hours.  If this happens you may have to stay in the Pain Management Center until the condition subsides.  You may have increased pain for a few days after the injection, including localized pain at the injection site.

There will be an anesthesiologist present during the procedure.  The anesthesiologist will administer medications to make you relaxed.  Your skin will be numbed with a local anesthetic.  This is usually felt as a stinging/burning sensation.  The anesthesia will be allowed to wear off after the needles are in the discs.  Once the dye is injected you may experience discomfort. 

After signing a consent form, an intravenous catheter will be started.  You will then be escorted into the fluoroscopy (x-ray) room.  You will be asked to lie on the table face down.  An antiseptic solution is used to sterilize your back.  At this point the anesthesiologist will administer medication to help you relax.  Sterile drapes are placed.  The skin is then anesthetized (numbed) with a local anesthetic.  Using x-ray guidance the needle is advanced into the disc.  During the injection of the dye your response will be recorded; specifically, whether or not this represents your usual pain.  The needle will then be removed.  This process will be repeated at as many levels as needed.  Your skin will be cleaned and bandages will be applied.  The bandages can be removed the following day.  Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

It is not unusual to feel sore after the injection. Your usual pain may be somewhat increased after the discography is done. You may experience muscle soreness in your back from the needle placement. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure, plus any new medication your physician prescribes. Based on the findings of the examination your doctor may prescribe extra pain medication for a few days.

In most instances, after the injection you will have to undergo a computed tomography (CT) scan. This will be arranged by the Pain Management Center.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call (702) 798-0111.

An epidural steroid injection is an injection of local anesthetic and steroid deposited into the epidural space. The epidural space is a space located in the spine just outside of the sac containing spinal fluid. The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. An epidural steroid injection will not correct the preexisting medical problem (i.e. spinal stenosis, herniated or bulging disc, arthritis, etc.) but may improve the level of pain. It is not unusual for someone to need more that one injection to achieve long term benefit. The injections are done in a series of three injections approximately one month apart, if needed. If the pain is significantly improved no further injection is needed unless the pain begins to come back.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

The main risk is a dural puncture; however, this occurs at a rate of approximately less than 1%. This rate is higher in patients who have had previous back surgery. A dural puncture occurs when the needle is unintentionally advanced one layer beyond the epidural space and punctures the membrane that surrounds spinal fluid. If this occurs there is a risk of developing a spinal headache, which may be severe and may last for days. There is a procedure (epidural blood patch) that can treat this headache if it occurs and does not improve sufficiently in 48 hours.

Other risks are remote but include bleeding, infection, nerve injury and allergic reaction to the medication.

Some short-term side effects may occur. If local anesthetic spreads to nearby nerves you may have weakness or numbness that can last for a few hours. If this happens you will have to stay in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection. Diabetics may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for 1-2 weeks.

An anesthesiologist will provide sedation for your comfort. You will not feel any pain or discomfort during the procedure.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize your back. At this point the anesthesiologist will administer medication to make you sedated. You will not feel any pain or discomfort. Sterile drapes are placed. A needle is used and then advanced into the epidural space. Once in the epidural space the medication is injected and the procedure is complete. Your skin will be cleaned and a bandage will be applied. The bandages can be removed the following day. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

Most people don’t feel any different immediately after the injection though the pain may be temporarily improved or worsened. The steroid takes about two days to produce an effect in most people and peaks in about one to two weeks. Therefore, it may be awhile before you feel a change in your pain. You may feel some relief from the local anesthetic, but this will wear off. Some local tenderness may be experienced for a couple of days after the injection. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure. It is important that you keep track of the amount of pain relief you experience as well as how long the relief has lasted.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.

A facet block is an injection of local anesthetic and steroid into a joint in the spine. A medial branch block is similar but the medication is placed outside the joint space near the nerve that supplies the joint called the medial branch (steroid may or may not be used). You may require multiple injections depending upon how many joints are involved.

Facet blocks and medial branch blocks are typically ordered for patients who have pain primarily in their back coming from arthritic changes in the facet joints or for mechanical low back pain.

A facet block or medial branch block may be therapeutic and/or diagnostic. One of three things may happen:

A. The pain does not go away; which means that the pain is probably not coming from the blocked facet joints; this has diagnostic value.

B. The pain goes away and stays away for a few hours but the original pain comes back and doesn’t get better again; this has diagnostic value. The pain is probably coming from the joints, but the steroid was not of benefit.

C. The pain goes away after the block. The pain may come back later that day, but then the pain will lessen over the next few days; this has therapeutic value. The steroid had a long lasting effect on the pain.

If you get good, lasting benefit from the injections, the block may be repeated. If you experience good, short-term benefit, another procedure (radiofrequency lesioning) may be done which may provide pain relief anywhere from 8-14 months.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Some short-term side effects may occur. If local anesthetic spreads to nearby nerves you may have weakness or numbness that can last for several hours. If this happens you may have to stay in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for 1-2 weeks.

An anesthesiologist will provide sedation for your comfort. You will not feel any pain or discomfort during the procedure.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize your back. At this point the anesthesiologist will administer medication to make you sedated. You will not feel any pain or discomfort. Sterile drapes are placed. Using x-ray guidance, the needles are advanced to the appropriate location (in to the joint or along the medial branch nerve). Once the needles are in the proper location local anesthetic, with or without steroid, are injected and the needles are then removed. Your skin will be cleaned and bandages will be applied. The bandages can be removed the following day. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

Most people don’t feel any different immediately after the injection though the pain may be temporarily improved or worsened. The steroid takes about two days to produce an effect in most people and peaks in about one to two weeks. Therefore, it may be awhile before you feel a change in your pain. You may feel some relief from the local anesthetic, but this will wear off. Some local tenderness may be experienced for a couple of days after the injection. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure. It is important that you keep track of the amount of pain relief you experience as well as how long the relief has lasted.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.

An intercostal nerve block is an injection of local anesthetic with or without steroid injected just under the rib where the intercostal nerve lies. An intercostal nerve block is typically ordered by your doctor for pain in the area of your ribs that comes after having surgery in that area, a rib fracture, herpes zoster (shingles) or an intercostal nerve entrapment.

An intercostal nerve block may be diagnostic and/or therapeutic. One of three things may happen:

A. The pain does not go away, which means that the pain is probably not coming from the nerve(s) at the level(s) of the injection. This has diagnostic value.

B. The pain goes away and stays away for a few hours but the original pain comes back and doesn’t get better again; this has diagnostic value. The pain is probably coming from the nerve(s) at the level of the injection(s), but the steroid, if used, was not of benefit.

C. The pain goes away after the block. The pain may come back later that day, but then the pain will lessen over the next few days; this has therapeutic value. The steroid had a long lasting effect on the pain.

If you get good, lasting benefit from the injections, the block may be repeated. If you get good, short-term benefit another procedure (radiofrequency lesioning) may be done which may provide pain relief anywhere from 8-14 months.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

As the rib cage is designed to protect the lungs, there is a risk of collapsing the lung if the needle penetrates the lung. If severe, this could require the placement of a chest tube to reinflate the lung. As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.

An anesthesiologist will provide sedation for your comfort. You will not feel any pain or discomfort during the procedure.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize your back. At this point the anesthesiologist will administer medication to make you sedated. You will not feel any pain or discomfort. Sterile drapes are placed. Using x-ray guidance, the needles are advanced to the appropriate location. Once the needles are in the proper location local anesthetic, with or without steroid, are injected and the needles are then removed. Your skin will be cleaned and bandages will be applied. The bandages can be removed the following day. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

After the local anesthetic takes effect, you will feel numb in a band-like fashion that follows the rib(s). You may feel lightheaded from the local anesthetic. This is usually short-lived. The steroid takes about two days to produce an effect in most people and peaks in about one to two weeks. Therefore, it may be awhile before you feel a change in your pain. Some local tenderness may be experienced for a couple of days after the injection. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure. It is important that you keep track of the amount of pain relief you experience as well as how long the relief has lasted.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.

An I.V. Lidocaine infusion is an infusion of Lidocaine (local anesthetic) into the bloodstream by way of an intravenous line. It is typically ordered by your doctor for neuropathic (nerve) pain or central pain syndromes that have not responded to other treatments. If effective in treating your pain it is likely the process will be repeated to obtain long-term benefit. If short-term benefit is obtained but not maintained with repeat infusions, a pill form (Mexiletine) may be prescribed after an EKG is ordered.
Note: The procedure can not be performed if you have an active infection, flu, cold, fever, or very high blood pressure. Please make your doctor aware of any of these conditions. This is for your safety!

The risks of the procedure, though infrequent and generally dose related, include irregular heart rhythm, seizure, coma, and death. There is also a low risk of allergy to the medication.

It is not unusual to experience lightheadedness, dizziness, and slurred speech during the infusion. The duration of these sensations are temporary and will resolve quickly when the infusion rate is decreased or stopped.

The only discomfort associated with the procedure is the start of the intravenous line. Local anesthetic is used to numb the skin before the I.V. line is placed. The anesthetic stings/burns when injected.

After signing a consent form and checking your blood pressure, an intravenous line will be started. You will be asked what your pain score is on a scale of 0–10. The procedure will be performed with you lying or sitting on the stretcher (whichever is more comfortable). The Lidocaine mixture will run in over approximately 30–60 minutes (depending on your tolerance). You will be asked to let us know if you are lightheaded, have ringing in your ears, slurred speech, visual changes, dizziness, or changes in your pain during the infusion. The infusion rate will be adjusted if needed. You will be asked at different times during the infusion to rate your pain on the 0–10 scale. Your blood pressure and pulse will be monitored during the infusion. At the end of the infusion you will be asked to rate your pain again.

When the effects of the Lidocaine have diminished, your intravenous line will be removed. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

Immediately after the infusion you may feel a little “drunk”. These effects will wear off quickly. The duration of pain relief will vary. It is important that you keep track of the amount of pain relief you experience as well as how long the relief has lasted.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

Any “side-effect” you may get from Lidocaine will be gone before you leave the Pain Center. The half-life of Lidocaine is quite short. Fortunately, the pain relief frequently outlasts the life of the medication.

A lumbar sympathetic block is an injection of local anesthetic into the back (under x-ray) that is typically ordered by your doctor for pain that is located in the buttocks and/or legs caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), or herpes zoster (shingles). Lumbar sympathetic blocks are also used to see if blood flow can be improved in circulation problems (vascular insufficiency).
Lumbar sympathetic blocks may be therapeutic and/or diagnostic. One of three things may happen:
A. The pain does not go away and there is evidence of sympathetic block; which means that the pain is not responsive to sympathetic blocks; this has diagnostic value.

B. The pain does not go away and there is not good evidence of a sympathetic block, the block is a technical failure. stays away for a few hours but the original pain comes back and doesn’t get better again; this has diagnostic value. The pain is probably coming from the joints, but the steroid was not of benefit.

C. The pain goes away after the block and stays away longer than the life of the local anesthetic; this has therapeutic value. The steroid had a long lasting effect on the pain. The procedure will most likely have to be repeated to get long lasting benefit. The spacing of injections will be based on how long the pain relief is between injections (usually you will get longer benefit after each injection).

It is expected that the leg of the side being injected will have a temperature increase that will last the life of the local anesthetic (about 4–6 hours).

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

TThe risks of the procedure, though infrequent, include allergy to medication, hypotension (a drop in blood pressure), weakness or numbness in legs (lasts the life of the local anesthetic, approximately 4-6 hours), anesthetic toxicity, nerve damage, and hematoma (blood collection).

An anesthesiologist will provide sedation for your comfort. You will not feel any pain or discomfort during the procedure.

After signing a consent form and checking your blood pressure, an intravenous will be started. Skin temperature monitors will be placed on both your feet. You will be asked what your pain score is on a scale of 0–10. The procedure will be done with you lying on your stomach in the fluoroscopy (x-ray) room. Your back will be cleaned with an antiseptic soap. Sterile drapes are placed. The skin is anesthetized (numbed) with a local anesthetic. Using x-ray guidance the needle(s) are advanced to the appropriate location. A dye will be injected at this point to confirm correct needle placement. Once placement is confirmed local anesthetic is injected through the needle(s) and the needle(s) is removed. The medicine can take 10–20 minutes to take effect. You will be watched during that time. Your doctor will be checking to see if your leg warms up as well as to see what effect if any there is on your pain. Your pulse and blood pressure will be checked. If all is well, your intravenous will be removed. Your doctor will authorize your discharge when you’re ready and your ride is present.

Your pain may be improved immediately after the injection. You may have some weakness/numbness in your leg. If you have difficulty walking due to this, you will be asked to stay in the Pain Center until this improves. You may have some local tenderness in your back for a couple of days after the injection. Using an ice pack three or four times a day will help this. You may take your usual pain medication as well after the injection. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted. .

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

You may take your medications as usual with a sip of water but do not eat or drink before the procedure. Please follow the above instructions unless told differently by your doctor.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.

After two successful facet blocks, radiofrequency ablation of the medial branch nerve is carried out. This procedure is very similar to the medial branch nerve block with the exception that the ablation provides pain relief anywhere from 8 to14 months. A modified needle is utilized to generate a current. This current causes the surrounding tissue around the needle tip to heat up. Essentially, heat will cause cell death, thus destroying the nerve.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.

You may have increased pain for up to two weeks after the injection, including localized pain at the injection site.

The pain you will feel will only be slightly more intense than the existing level. This is due to the nature of the procedure. The purpose of the stimulation is to reproduce a painful sensation in order to localize a specific nerve position. An anesthesiologist will administer light sedation in the beginning to provide comfort. Optimal benefit can be obtained with your cooperation. Thus, it’s important to know you will be coherent enough throughout the process to answer questions.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize your back. At this point the anesthesiologist will administer medication to provide light sedation. Sterile drapes are placed. Using x-ray guidance, entry points are identified. Local anesthetic is used to numb your skin. This will feel like a bee sting. Radiofrequency needles are then advanced to the appropriate locations along the medial branch nerve. Once the needles are in the proper location, confirmation of exact location is determined by electrical stimulation. At this point you will be asked to report the intensity or severity of your pain with increasing stimulation. Next, muscular stimulation is carried out. You will feel contraction of your back muscles. It’s important your leg muscles are not contracting. Local anesthetic is injected through the needle and the needle is then activated. Each ablation takes approximately two minutes. While one level is being ablated, needles are placed in a different level. After the ablation is completed, the needles are then removed and your skin will be cleaned and bandages will be applied. The bandages can be removed the following day. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

Your back pain may be improved immediately after the injection from the local anesthetic. The local anesthetic will wear off after several hours. You may have increased pain for up to two weeks after the injection, including localized pain at the injection site. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure. In addition your physician will prescribe extra medication if deemed appropriate. In some cases your doctor will place a catheter attached to a bag and a pump which administers local anesthetic to alleviate your pain. This device is utilized for approximately three days. You cannot shower or take a bath with the device. You will also have to take antibiotics for several days with the device.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.

Stimulation is achieved by the use of pulsed electrical energy near the spinal cord to cover your pain. The trial involves implantation of these electrodes, usually two of them, in the epidural space. A DVD is provided by your physician, which will describe the process in more detail.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Infection is the most common complication reported; however, the incidence is less than 3%. The risk of infection is minimized by following strict guidelines. These include taking antibiotics, keeping the site dry and limiting overall strenuous activities.

During this procedure you have to be awake in order to report if the stimulation covers your painful areas. At the beginning of the procedure an anesthesiologist will provide light sedation for your comfort. However, you will not be fully sedated.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize an area on the back. At this point the anesthesiologist will administer antibiotics and medication intravenously to provide light sedation. Sterile drapes are placed on the back. Entry points for the needles are then numbed with local anesthetic. This will cause some discomfort, but it will not last as the skin will be numbed very quickly. Using x-ray guidance, the needles are advanced to the appropriate location. During needle placement you will feel pressure, but you should not feel any pain. Once the needles are precisely situated, the leads are then threaded into the appropriate location. At times, during lead placement you might feel an electric shock down one leg. If this occurs the lead will be adjusted. At this point the leads are then connected to a power source and activated. Next you will report if the electrical stimulation, “buzzing sensation”, covers your painful areas.

If all your painful areas are covered then the placement is finished. However, if there are large regions not covered, the leads will have to be adjusted. Once you and your physician are satisfied with the coverage, the leads are then secured to your skin with sutures. Dressing is then applied and the leads are connected to an external battery pack. After a final blood pressure check and the doctor authorizing your discharge, you will be allowed to leave with your pre-arranged transportation.

Some local tenderness may be experienced for a couple of days after the injection. You may take your usual pain medications after the procedure. It is important that you keep track of the amount of pain relief you experience. A representative from the stimulator company will teach you how to use the device.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the duration of the trial. The area where the dressing is located must be kept dry. You will have to take antibiotics for ten (10) days.

If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call (702) 798-0111.

A nerve root block is an injection of local anesthetic and steroid injected under x-ray guidance into the area where the nerve exits the spinal column. A nerve root block is usually ordered by your doctor for pain in the arm or leg that follows the path of a single nerve.

A nerve root block may be diagnostic and/or therapeutic. One of three things may happen:

A. The pain does not go away; which means that the pain is probably not coming from the nerve at the level of the injection; this has diagnostic value.

B. The pain goes away and stays away for a few hours but the original pain comes back and doesn’t get better again; this has diagnostic value. The pain is probably coming from the nerve at the level of injection, but the steroid was not of benefit.

C. The pain goes away after the block. The pain may come back later that day, but then the pain gets better again over the next few days; this has therapeutic value. The steroid had a long lasting effect on the pain.

If you get good, lasting benefit from the injection, the block may be repeated. Sometimes your surgeon will ask that the block be done to help identify whether or not surgery maybe beneficial.

Note: The procedure can not be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. The usage of Coumadin (warfarin) should be stopped 5 days prior to your injection and a blood test will to be performed before your injection. Plavix (clopidogrel) should be discontinued for 7 days.

As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.

Some short-term side effects may occur. You should get some numbness that follows the path of the nerve that was blocked. You may get some weakness as well. If you get weakness that interferes with your ability to walk, you will have to remain in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for 1-2 weeks.

An anesthesiologist will provide sedation for your comfort. You will not feel any pain or discomfort during the procedure.

After signing a consent form, an intravenous catheter will be started. You will then be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table face down. An antiseptic solution is used to sterilize your back. At this point the anesthesiologist will administer medication to make you sedated. You will not feel any pain or discomfort. Sterile drapes are placed. Using x-ray guidance, the needles are advanced to the appropriate location. Once the needles are in the proper location local anesthetic and steroid are injected and the needles are then removed. Your skin will be cleaned and bandages will be applied. The bandages can be removed the following day. Your blood pressure will be checked and you will be allowed to leave with your pre-arranged transportation after the doctor authorizes your discharge.

Most people don’t feel any different immediately after the injection though the pain may be temporarily improved or worsened. Some numbness and or weakness may be present after the procedure, this is due to the local anesthetic and it will wear off in a few hours. The steroid takes about two days to produce an effect in most people and peaks in about one to two weeks. Therefore, it may be awhile before you feel a change in your pain. You may feel some relief from the local anesthetic, but this will wear off.

Some local tenderness may be experienced for a couple of days after the injection. This is helped by using ice packs three or four times a day. You may take your usual pain medications after the procedure. It is important that you keep track of the amount of pain relief you experience as well as how long the relief has lasted.

Do not eat or drink anything prior to the procedure except for sips of water to take your usual medications.  No food for eight (8) hours prior to the injection.  You may drink CLEAR LIQUIDS (water, apple juice, non-carbonated soda, pulp-free juices, clear tea, and black coffee) up to three (3) hours before the procedure.  Please follow these instructions unless told differently by your doctor.

You may not drive for the remainder of the day after your procedure.  An adult must be present to drive you home or to go with you in any form of public transportation.  The procedure will be cancelled if you don’t have a responsible adult with you!!  This is for your safety.

No heat is to be used in the injected areas for the remainder of the day.
No soaking in water (i.e. bathtub, pool, Jacuzzi, etc.) for the remainder of the day.

If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call (702) 798-0111.