Services
Botox? and Myobloc? Injections
Botox? and Myobloc? are types of botulinum toxin A and B respectively. This medication injected into a muscle spasm, can be extremely effective for a variety of chronic pain problems. These are extremely safe and effective and last from 2-6 months. They can be repeated if the result is favorable. Although most people have heard of Botox? for its cosmetic indications, these indications are universally not covered by insurance plans. Both Botox? and Myobloc? have approved indications covered under most every insurance plan. For more information on Botox? visit www.botox.com and for more information on Myobloc visit www.myobloc.com.
Counseling
The Birmingham Pain Center offers mental health counseling and treatment. Dr. Jay Heisler provides psychological counseling, while Dr. Wayne Gossman provides psychiatric care.
Diagnostic Nerve Block
Diagnostic nerve blocks are used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief.
Discography
This is a diagnostic test. The physician inserts a needle into the intervertebral disk. Contrast or dye is injected into the disk. The physician may measure the pressure inside the disk if necessary. During the contrast injection, the patient is asked to report if the additional pressure on the disk reproduces his or her pain. This lets the physician know which particular disks are painful. Once the procedure is completed, the patient is taken to a diagnostic center for a CAT Scan of this area. This test will reveal any disk that is “disrupted.” This means that there may be tears in the outer ring of the disk that were not seen on an MRI scan or other test. This test is the best way to make an accurate diagnosis of a disk problem in some cases.
Epidural Catheter Procedures
This is similar to an Epidural Steroid Injection except that instead of using a needle at one particular nerve level, a catheter (a small flexible tube) can be inserted through a needle and manipulated within the spinal canal. This allows the physician to break up scar tissue (Lysis of Adhesions) and inject many different nerve areas from a single needle stick. This is an excellent treatment for patients who have had lumbar (low back) spine surgery.
Epidural Steroid Injections
An Epidural Steroid Injection is a procedure performed under fluoroscopic guidance (a type of X-ray) where the physician places a needle into the spinal canal and injects a cortisone type medication and local anesthetic. The epidural space is a space inside the spinal canal between the bony canal of the vertebrae and the sac that contains the nerves, spinal cord and spinal fluid. There are several different approaches to this space that they physician may use. This depends on the medical problem being treated. The purpose of this is to try to provide a nerve block and to suppress the inflammation that is affecting the nerves that are carrying the painful nerve signal to the brain. For most spinal conditions, this is a very effective way to decrease pain. The results vary, but usually, the injections last from 3 months to 1 year. Depending on the medical problem, they may totally stop the pain and it may never have to be repeated. They can be repeated if the pain returns and sometimes are performed in a series of two or three injections 2-3 weeks apart.
Hyaluronate Injections
This is a medication that is injected into the knee joint only for osteoarthritis of the knee. It is a protein substance that provided lubrication to the knee and thus pain relief. It is extremely effective. The two products that we currently use are Synvisc® and Hyalgan®. Information on Synvisc® can be found on the web at www.synvisc.com and information on Hyalgan® can be found at www.hyalgan.com. Results are variable – usually from about 6 months to upwards of 2 or more years.
Joint Injections
Since every joint in the body is susceptible to arthritis and chronic pain, sometimes a cortisone and/or anesthetic injection directly into the joint is necessary for relief. Some of these injections are performed under a type of x-ray guidance called fluoroscopy. This lets the doctor see exactly where the medicine is going.
Medications
The physicians may use a variety of different medications based on your particular medical and/or psychological condition, allergies, financial resources and insurance plan formularies. Medications can vary from anti-inflammatory medicines to opioid pain medicines, nerve medications to anti-depressants, anti-seizure medications to muscle relaxants and many others. Each person is different and if medicines are to be used, the treatment will be uniquely tailored to your specific needs. If any controlled substances are used in your treatment plan, you will be required to complete a Prescription Drug Agreement with your doctor and The Birmingham Pain Center.
Myelography
This is a diagnostic test. The physician inserts a needle into the spine of the low back. The needle is advanced into the sack that holds the spinal fluid (thecal sack). This part of the procedure is commonly called a spinal tap or lumbar puncture. Once the needle is placed, contrast o dye is injected into the spinal fluid. Immediately afterwards, x-rays are taken and a CAT Scan is taken. This test allows the physician to evaluate your nerves and spinal structures. This test reveals the presence of conditions that cause a pinched nerve (nerve compression). This test is used when an MRI Is not feasible or the MRI is not conclusive. Often times neurosurgeons and orthopedists and pain doctors use this test to see if spine surgery is necessary.
Physical Therapy
The Birmingham Pain Center is currently in the process of considering adding in house physical therapy to compliment our chronic pain services.
Spinal Infusion Pumps
Spinal infusion pain pumps are spinal drug delivery systems. The surgeon makes a pocket under the skin that's large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. The surgeon also inserts a catheter, which carries pain medicine from the pump to the space around the spinal cord. The implants deliver medicines directly to the spinal cord, where pain signals travel. For this reason, spinal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills.
Sympathetic Blocks
A sympathetic nerve block is one that is performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body, such as opening and narrowing blood vessels.
Tendon Injections
This involves injecting an anesthetic medication and usually some steroid (cortisone-like) medication into a tendon insertion area. This decreases pain and inflammation. This is a very easy and effective way to treat tendonitis pain.
Trigger Point Injections
This involves injecting an anesthetic medication into a painful muscle area. This decreases pain and relaxes the muscle. This is a very easy and effective way to treat myofascial (muscle) pain.
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