Glossary of Procedures and Treatments
The Pain Medicine Clinic at the University of Chicago Medicine is designed to help patients overcome pain and improve their quality of life. Our specially trained physicians may recommend one or more of the following interventional procedures:
- Epidural steroid injections
- Selective nerve root blocks
- Trigger point injections
- Facet joint injections
- Radiofrequency treatments
- Epidural scar tissue lysis
- Sympathetic nerve blocks
- Joint injections
- Spinal cord stimulation
- Spinal medication infusions
- Peripheral nerve blocks
- Botox® injections
- Minimally invasive lumbar decompression (MILD)
An epidural steroid injection (ESI) may be performed to relieve neck, back, arm and leg pain caused by spinal stenosis (a narrowing of the spinal column), spondylolysis (stress fractures), disc herniation or other conditions. During this minimally invasive procedure, medication is injected into the spinal nerve through the epidural space (the area between the protective covering of the spinal cord and vertebrae). While the effects of an epidural steroid injection are temporary -- lasting anywhere from several days to several years -- the goal is to help patients resume their daily routine and begin a physical therapy program, if recommended.
If a nerve root becomes compressed, it may cause inflammation and pain. When an imaging study does not clearly show which nerve is responsible for the pain, the selective nerve root block (SNRB) procedure may be used to identify the source. In addition to this diagnostic function, a selective nerve root block may provide therapeutic relief of low back pain and/or leg pain, and also can treat far lateral disc herniation (a disc that ruptures outside the spinal canal).
Trigger points -- also known as muscle knots -- are distinct spots located in a taut bundle of fibers within the skeletal muscles. These points can cause local pain and often are associated with musculoskeletal conditions. A trigger point injection (TPI) aims to alleviate pain through a shot of a corticosteroid that inactivates the trigger point. The physician may inject multiple sites in one office visit. One treatment session usually brings sustained relief.
Facet joints are small joints, located at each segment of the spine, that provide stability and enable the vertebrae to bend and twist. Degeneration of these lubricated connections can occur from everyday wear and tear, arthritis of the spine, a back injury or other stress to the back, and can cause pain in the spinal cord. Injection of a steroid medication into the cervical (neck), thoracic (upper back) or lumbar (lower back) region anesthetizes the facet joints and blocks the pain. Pain relief from this procedure is intended to help a patient better tolerate physical therapy during rehabilitation for a back condition or injury.
During a radiofrequency neurotomy, radio waves are sent, via injection, to interrupt pain signals between the brain and the affected nerve. A physician delivers heat-generated waves, using image-guided technology to directly target and block the nerve. Up to 50 percent of patients with facet or sacroiliac joint pain experience relief, lasting between 3 and 18 months, after the injection,
When scar tissue restricts the normal movement of nerves, an individual can experience persistent pain. Epidural scar tissue lysis is a procedure designed to remove excess scar tissue in the epidural space (the area between the inside of the spine and the protective layer around the spinal cord). Using a fluoroscope to visualize the affected area, the physician injects a medication that disperses the scar tissue and applies steroids to decrease inflammation and boost pain relief.
The sympathetic nerve block procedure is used to establish if there is damage to the sympathetic nerve chain, a set of nerves that extends the length of the spinal cord. Using image guidance, the physician inserts a needle into the lumbar (lower) or thoracic (upper) area of the back and injects an anesthetic medication into the targeted area. While it is primarily done for diagnostic purposes, the procedure may bring long-term pain relief to the damaged area.
During a joint injection, the physician injects a steroid medication into the affected area to reduce swelling and inflammation of joint tissues. The goal is to reduce irritation and alleviate joint pain.
If a patient has chronic leg or arm pain, and has not found relief through conventional therapies, then spinal cord stimulation may be an option. The procedure involves sending low voltage electrical signals from an implanted battery-powered generator to nerves in the spinal cord in order to interrupt pain signals. After spinal cord stimulation, patients usually experience a tingling sensation instead of pain.
The spinal infusion pump (also known as a morphine pump or an intrathecal infusion pump), delivers concentrated amounts of medication into the spinal fluid space via a small catheter. The purpose of this procedure is to continuously saturate pain receptors with concentrated medication.
Spinal discography is performed to diagnose conditions of the spinal discs. During the procedure, the physician injects contrast dye into healthy and diseased discs to pinpoint pain and determine if any discs have tears or other disruptions. Spinal discography can aid physicians in diagnosing herniated, bulging or torn discs, and degenerative disc disease and help them determine an appropriate course of treatment.
A peripheral nerve block is used for the diagnosis and treatment of nerve pain, which is sometimes the result of damage to a nerve. The procedure involves the injection of a local anesthetic and sometimes an anti-inflammatory steroid, targeted around a specific nerve. Disrupting painful nerve impulses can result in various degrees of symptom relief. If a patient attains limited relief after the first block, the physician may recommend a series of several blocks, which may bring sustained relief.
Known for its ability to smooth wrinkles, injections of Botox® (a brand name drug that contains botulinum toxin) may also reduce muscle pain. The medication works by blocking nerve impulses to the muscles in the injected area. As a result, the muscles relax and muscle spasms decrease, reducing pain and increasing range of motion.
Minimally Invasive Lumbar Decompression (MILD) is performed to treat lumbar spinal stenosis (LSS). LSS is a condition in which the spinal canal narrows and compresses the spinal cord nerves in the lower back. This narrowing may be caused by thickened ligament tissue, formation of excess bone or bulging of the discs. Symptoms can include pain or numbness in the buttocks, leg and lower back. During the MILD procedure, the small pieces of bone and excess tissue that cause the narrowing of the spinal cord are removed. The procedure is done in an outpatient ambulatory setting using minimal sedation