Pain

An epidural steroid injection (ESI) is an injection of steroid into the epidural space of the vertebral column as a means of treating pain caused by the irritation of the spinal nerves. The injection helps to reduce inflammation of the nerve roots as they exit the spine. By decreasing this inflammation it can help to alleviate pain in the neck, back, and/ or limbs. An ESI will not cure arthritis or heal a herniated disc, but it may be a useful tool to manage or cure your pain.

You will be positioned lying face down on an X-ray bed. The area of the injection will be prepped with antiseptic solution. The skin and deeper tissues are anesthetized with a local anesthetic using a small needle. Once the skin is numb, an x-ray machine will be used to help guide the needle into the epidural space. When the needle is in the epidural space x-ray contrast is injected to ensure correct placement. A local anesthetic and a steroid will then be injected into the epidural space. This procedure can take approximately 15 minutes.

After the procedure is complete you will be taken over to recovery area and observed for 30 minutes before being discharged home with aftercare instructions. An ice pack will be provided for you to be placed over the injection site. Our pain clinic staff will contact you in a week for a follow up call. Should you have any questions or concerns we can be reached at (406) 237-5945.

Selective Nerve Root Block and Transforaminal Steroid Injection

A nerve root block is an injection into the sheath surrounding a nerve root in the spine to temporarily decrease pain and to define the location of your pain more precisely. The procedure uses a mixture of local anesthetic and steroid to decrease pain and inflammation. These injections provide important information to your physician. ft serves to prove which nerve is causing the pain allowing for proper treatment.

You will be positioned face down on an X-ray table. The area of the injection will be prepped with an antiseptic solution. The skin and deeper tissue will be anesthetized with a local anesthetic using a small needle. An x-ray machine is used to help guide the needle into the correct location, a small amount of x-ray dye is injected to confirm placement. Once the needle is in the correct location a mixture of local anesthetic and steroid is injected. This procedure will take approximately 15 minutes.

After the procedure is completed you will be taken over to the recovery area and observed for 30 minutes before being discharged with aftercare instructions. An ice pack will be provided for you to be placed over the injection site. Our pain clinic staff will contact you in a week for a follow up call. Should you have any questions or concerns we can be reached at (406) 237-5945.

Sacroiliac Joint Injection

The sacroiliac joint (ST joint) is a large joint in the region of your back and buttocks. The SI joint is formed by the connection of the sacrum with the ilium. When this joint becomes painful it can cause pain into your groin, abdomen, leg or lower back. This injection helps confirm or deny that the SI joint is a source of pain as well as serve to reduce any presumed inflammation within the joint.

You will be placed on an X-ray table lying face down. The skin is then prepped with an antiseptic solution. Next, the physician will anesthetize a small area of skin with a local anesthetic. Using x-ray guidance, a needle is inserted into the SI joint. To ensure the needle is in the joint, a small amount of x-ray dye is injected to confirm placement. Once the needle is in the correct location a mixture of local anesthetic and steroid is injected. The procedure will take approximately 15 minutes.

After the procedure is completed you will be taken over to the recovery area and observed for 30 minutes before being discharged home with aftercare instructions. An ice pack will be provided to be placed over the injection site. A staff member from our pain clinic will follow up with you a week after your injection. Should you have any questions or concerns we can be reached at (406) 237-5945.

Occipital Nerve Block

An Occipital Nerve Block is an injection that can be used to treat occipital neuralgia or irritation of the occipital nerve. A physician will inject a combination of a local anesthetic and steroid into the back of the head around the greater and/or lesser occipital nerves to help with the treatment of chronic headaches.

You will be positioned sitting on a stool facing the bed. The physician will assist you in leaning over the bed resting your arms and forehead on a pillow. The back of your head will be prepped with an antiseptic solution. The physician will then inject a mixture of local anesthetic and steroid around the occipital nerve(s).       When the procedure is complete you will be taken to the recovery area and given an ice pack for your injection site. You will be observed for 30 minutes and then discharged home with aftercare instructions. A staff member from our pain clinic will follow up with you a week after your injection. Should you have any questions or concerns we can be reached at (406) 237-5945.

Epidural Blood Patch

When headaches occur due to a leakage of spinal fluid this is called a spinal headache. Epidural blood patches are a treatment option for managing this pain and to seal the leak. This involves injection of your own blood into the epidural space which closes the opening through which the leak is occurring. This can provide you with immediate relief.

A sterile IV will be placed in the pre op area before coming into the procedure room. Once in the procedure room you will be positioned lying face down on an X-ray bed. The physician will prep your back with an antiseptic solution. X-ray guidance will be used to determine proper needle placement in the epidural space. Once in the epidural space X-ray dye will be used to confirm placement. The nurse will then withdraw blood from your IV using sterile technique.

The physician will then inject this blood into the epidural space. It is not know exactly how it works but it is 85-90% effective in relieving headaches. The blood clots and the increased volume restores the pressure and seals the hole. The procedure takes approximately 15 minutes.

After the procedure is complete you will be taken over to recover area on a bed lying flat on your back and observed for 30-45 minutes. The nurse will gradually elevate the head of your bed as tolerated into a sitting position before being discharged home with aftercare instructions. Our pain clinic staff will contact you the following day to determine if your headache has resolved. Should you have any questions or concerns we can be reached at (406) 237-5945.

Medial Branch Nerve Block

A Medial branch nerve block is a procedure in which an anesthetic is injected around a nerve that innervates, or supplies sensation to specific facet joints to diagnose pain originating from that vertebral level. If you get relief immediately after the injection, then that facet joint is deemed the source of your pain.
This is a diagnostic procedure, meaning that if you get the appropriate amount of pain relief after the Medial branch block, then you may benefit from a Radiofrequency ablation of those nerves which would provide longer lasting relief (6-18months). Note: The pain may return because the nerves regrow.

You will be positioned lying face down on an X-ray table. The physician will use x-ray guidance to direct the needles alongside the nerves that supply the facet joints. The physician will then inject the anesthetic. When complete, you will be taken to the recovery area and observed for 30 minutes then discharged home with aftercare instructions.

A Medial Branch Nerve Block is a diagnostic block to determine pain relief. After discharge we ask that you try to recreate your pain to detennine if the local anesthetic is helping. You will also be sent home with a pain diary to document your pain relief for the first 4-6 hours. Our pain clinic staff will call you the following day to inquire about your pain relief from the day of the injection. Should you have any questions or concerns we can be reached at (406) 237-5945.

Radiofrequency Ablation

A Radiofrequency Ablation is a minimally invasive procedure that destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints. During the Radiofrequency ablation, also referred to as a rhizotomy, heat is used to reduce or stop the transmission of pain. This is done with radio frequency waves that ablate, or “bum”, the nerve that is causing the pain. If you received the appropriate amount of pain relief from your diagnostic medial branch block injections then you may benefit from a Radiofrequency. The benefits of this procedure include avoiding surgery, pain relief, decreased use of pain medications, improved function, and a quicker return to work or other activities.

You will be positioned lying face down on an X-ray table. The physician will use x-ray guidance for proper needle placement. The skin will be cleansed with an antiseptic solution and then anesthetized with a local anesthetic medication. After the skin is anesthetized, needles are then placed near the targeted nerve. The patient experiences minimal discomfort throughout the procedure and remains awake and aware. Once the needle is in place a radiofrequency current is passed through the hollow needle to create a small and precise bum, called a lesion, about the size, of a cotton swab. The current destroys the portion of the nerve that transmits pain and disrupts the pain-producing signal. The bum takes approximately 90 seconds for each site and multiple nerves can be burned at the same time . This procedure can be performed on your lumbar, thoracic or cervical regions. A mild sedative is typically used for your comfort however you will be awake and aware during the procedure to provide feedback to the physician.

After the procedure is complete you will be taken over to the recovery area and observed for 30 minutes before being discharged home with aftercare instructions. You may experience pain from the procedure for up to 14 days, but this is generally due to the residual effects of the nerve ablation or muscle spasm. Relief of pain can vary from patient to patient. It may be immediate for some patients and others it may take up to three to four weeks. You will receive a follow up call from our pain clinic staff at 2 weeks, 6 weeks, and 6 months after the ablation. If you have any questions or concerns we can be reached at (406) 237-5945.

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