State-of-the-Art Pain Procedures

The Illinois Pain Institute Leads the Way

Advanced technology coupled with a more precise understanding of the origins of chronic pain has paved the way for state-of-the-art procedural interventions designed to generate long-term pain relief for patients who otherwise might  have nowhere to turn.

The physicians of the Illinois Pain Institute (IPI) are expertly trained to perform a myriad of advanced procedures once a precise diagnosis of the underlying cause of pain has been identified. Below is a summary of some of the more innovative procedures, how they work and the types of patients who may be candidates.  Make sure you understand the risks associated with each procedure.

• Percutaneous Discectomy
• Vertebroplasty
• Spinal cord stimulation
• Radiofrequency Lesioning
• Intrathecal pump therapy
• Epidural injections
• Selective nerve root blocks
• Facet blocks
• Discography
• Intercostal Nerve blocks
• Sympathetic nerve blocks
• Sacro-illiac and other joint injections
• Intra-discal thermal therapy
• Racz Epidural neurolitic procedure

Percutaneous Discectomy

What is it?
A minimally invasive procedure involving the removal of herniated disk material that presses on a nerve root or the spinal cord.

How it's performed
A needle is placed in the center of the disk to create a series of channels from which tissue is removed from the nucleus and the disc becomes decompressed.

What patients are candidates?
Patients experiencing pain from a contained herniated disc (meaning there is no rupture in the outer wall of a bulging disc) are candidates for this procedure. Patients who have fragments of disc material in their spinal canal or those who suffer from marked narrowing of the spinal canal are NOT candidates for this procedure.

How long does the procedure take?
The total required procedure time might vary between 20 minutes and 1 hour. Total stay at the facility should be limited to 2 or 3 hours.

Recovery
After undergoing percutaneous discectomy, patients can use prescription medication to control pain during the recovery period. Avoid long periods of sitting, as well as bending, twisting, and lifting, for several weeks.

Results
In patients who respond well to this procedure, leg pain should be diminished within days to weeks.

Vertebroplasty

What is it?
Vertebroplasty involves the injection of medical grade cement into a painful fractured vertebral body through a needle; this, in turn, stabilizes the fracture, allowing most patients to discontinue or significantly decrease analgesics and resume normal activity.

How it's performed
It is performed under local anesthesia and light sedation. A small nick is then made in the skin near the spine, and a needle is inserted. Biocompatible bone cement is then injected through the needle and into the vertebral body. The needle is removed and the cement is allowed to harden. The small opening is covered with a bandage.

What patients are candidates?
Candidates for the procedure include men and women who have chronic back pain (at least 6 weeks) and debilitation due to a vertebral body fracture. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from vertebroplasty. Some patients with vertebral destruction from malignant tumors are also candidates for the procedure.

How long does it take?
Within a few hours, patients are up and moving around. Most go home the same day.

Recovery
Patients will receive follow-up care from their IPI physician. To hasten recovery and regain satisfactory levels of activity, patients may benefit from physical therapy or short-term back bracing

Results
Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.

Spinal cord stimulation

What is it?
A procedure involving the implantation of a battery-operated device that sends electrical signals to the spinal cord to intercept pain signals to the brain. Recent advances have made the stimulators last as long as eight years.

How it's performed
After the patient has had a successful trial spinal cord stimulator, an IPI physician implants a permanent device under the skin that sends mild electrical impulses to the spinal cord, while the patient is lightly sedated.

What patients are candidates?
People suffering from neuropathic pain -- burning, stabbing or tingling pain -- particularly after previous back surgery. The procedure doesn't work well for patients with inflammatory disc pain.

How long does it take?
Two to three hours

Recovery
Patients may experience procedure-related pain for a few days. Lifting, bending, stretching, and twisting should be avoided immediately following the procedure. However, light exercise is encouraged to build strength and help relieve pain.

Results
Up to 70 percent effective. Typically, pain is reduced from severe to a tingling sensation.

Radiofrequency Lesioning

What is it?
A procedure in which a section of nerve tissue is heated to cause a long-lasting interruption in pain signals.

How it's performed
An IPI physician identifies the nerve or nerves that are sending pain signals to the brain. Once identified, an instrument is placed under the skin through which electrical stimulation is transmitted to heat the surrounding tissue. A local anesthetic is used sometimes with intravenous (IV) sedation.

What patients are candidates?
Patients with neck or back pain due to facet joint disease, occipital neuralgia or other pains from irritated nerves are ideal candidates. Patients must have been responsive to local anesthetic blocks and cannot be taking a blood thinning medication or have an active infection.

How long does it take?
20 minutes to two hours

Recovery
Muscle soreness at site or lower back for up to a week. Patients are able to return to work as soon as two weeks after the procedure.

Results
Procedure may need to be repeated as the nerve may grow back within 3 to 9 months.

Intrathecal pump therapy

What is it?
Intrathecal drug delivery reduces pain by delivering medication directly to the source of pain surrounding the spinal cord, thus requiring much smaller doses of medication for relief.

How it's performed:
A pump and catheter are surgically implanted beneath the skin by an IPI physician. The pump, implanted in the abdominal area, is connected to the catheter, which is tunneled under the skin to the specific site where the medication is needed.

What patients are candidates?
Patients who have intractable cancer pain or have profound side effects from their pain medications.

How long does it take?
One and one half to two hours for the surgical procedure.

Recovery
May require a brief hospital stay.

Results
By delivering medication directly to the source of the pain, less medication is used and, thus, patients experience less side effects associated with pain medication. Additionally, pain relief is more profound.

Epidural Injections

What is it?
An injection that delivers steroids directly into the epidural space in the spine. It is typically used to alleviate low back and/or leg pain.

How it's performed
Prior to the epidural injection, the skin is numbed with lidocaine, which is similar to the Novocain that the dentist uses (a "local" anesthetic). Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space.

What patients are candidates?
Epidural injections can be used for people with symptoms of disk herniation, sciatica, nerve root compression and inflammation in the spine.

How long does the procedure take?
Usually between 15 and 30 minutes.

Recovery
Following the injection, the patient may be monitored for 20 to 60 minutes before being discharged to go home. Patients are usually asked to rest on the day of the epidural steroid injection. Normal activities (those that were done the week prior to the epidural injection) may typically be resumed the following day.

Results
Epidural injections may successfully relieve symptoms caused by a herniated disc.  They also may be used to delay or even eliminate the need for surgery or other procedures for some people who have severe pain caused by a herniated disc.

Selective Nerve Root Blocks

What is it?
Nerve roots are attached to the spinal cord and travel out of each side of the spinal column at every spinal level. They carry signals throughout the body from the skin to the muscles. When one of the nerve roots is irritated, patients may experience pain, numbness, tingling and sometimes weakness down an arm or a leg. 

How it's performed
A specialized blunt needle is placed near the exiting nerve root in question using fluoroscopy. Anti-inflammatory medication is injected around this nerve.

What patients are candidates?
Nerve root blocks are commonly performed procedures for patients with symptoms of a herniated disc, sciatica or swelling and/or irritation in the nerve roots.

How long does the procedure take?
20 to 30 minutes (depending on how many nerve roots are injected).

Recovery
You may have some numbness for a short while after the block. You will be discharged when you can safely walk (expect to be in the center for 1-2 hours). When the procedure is over, the numbing medicine may make your legs feel temporarily weak. Therefore, you should limit your activity on the day of your procedure.

Results
Selective nerve root blocks may successfully relieve symptoms caused by a herniated disc.  They also may be used to delay or even eliminate the need for surgery or other procedures for some people who have severe pain caused by a herniated disc.

Facet Blocks

What is it?
Procedure that is performed to determine whether a facet joint is a source of pain, or as a means of pain relief. Facet joints are located along the entire length of the spine from the neck to the lower back, where one vertebra slightly overlaps another. These joints guide the spine's movement.

How it's performed
After the patient is given a local anesthetic, a facet joint block is done by inserting a needle into the area of the facet joint(s). The doctor watches on a fluoroscope as he or she inserts the needle to make sure it goes into the correct area. Once the doctor is sure the needle is in the correct area, he or she will inject a small amount of anesthetic and anti-inflammatory cortisone.

What patients are candidates?
If you have neck, mid, low back, or leg pain stemming from inflammation, irritation or arthritis of your facet joints you may benefit from a facet injection.

How long does the procedure take?
The entire procedure usually lasts about 15 to 30 minutes.

Recovery
Most patients are able to walk immediately after the procedure. You'll be monitored for a short period of time before you can leave and are expected to take it easy for the rest of the day after the injection.

Results
If the facet joints are the cause of the pain, the patient will experience pain relief.  The pain may be relieved for several hours to several months.  Radiofrequency lesioning may be needed to provide longer relief.

Discography

What is it?
A procedure utilized to identify if the source of pain is from the disc or in the case of multiple level herniations, which levels are the source of the discomfort.

How it's performed
A minimally invasive procedure, discography is performed on an outpatient basis. Using x-ray guidance a needle is placed in the discs of the spine at the level of interest. A pressure gauge is used to measure the pressure of the discs. Then using contrast media, the shape of the disc is identified as the dye is injected.

What patients are candidates?
Patients who experience persistent spinal (cervical, thoracic, lumbar) pain, a disc abnormality is suspected, non-invasive tests have failed to provide an explanation or source of pain, a pain correlation is desired.

How long does the procedure take?
Usually 20 to 60 minutes.

Recovery
After the procedure, the patient may be required to have a CT scan of the back to further visualize the discs. If there are no complications, the patient is discharged 40 to 60 minutes after the procedure.

Results
For the first month following the procedure, your disc continues to heal. You may begin to feel a reduction in pain. However, pain reduction may occur in 3 to 4 months.

Intercostal Nerve Blocks

What is it?
Temporarily blocking or disrupting painful nerve impulses associated with non-cardiac pain in the chest wall area.

How it's performed
A small needle is placed just under the lowest portion of each rib that causes discomfort.

What patients are candidates?
Patients who have pain in the rib area due to trauma either via rib fractures, repetitive overhead maneuvers, shingles-pain, coughing or unknown reasons are candidates.

How long does the procedure take?
10 to 20 minutes depending on how many levels need to be blocked.

Recovery
Vital signs may be observed for about 20 to 60 minutes.  The patient is able to leave when vital signs are stable. You may experience some numbness or soreness at needle insertion sites.

Results
Relief is often very rapid. Patients may require a series of injections for long term relief. Also, patients receiving relief of their symptoms may be candidates for cryoanalgesia or pulsed radiofrequency.

 

Sympathetic nerve blocks

What is it?
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.  However, they may sometimes carry painful impulses as well.

How it's performed
Involves injecting anesthetic into different nerves. These may include stellate ganglion, celiac plexis, hypogastric plexis, ganglion of impar and lumbar sympathetic nerve blocks.

What patients are candidates?
Patients with nerve (neurogenic) pain, most commonly the constant burning pain of Reflex Sympathetic Dystrophy (RSD)(Complex Regional Pain Syndrome)(CRPS) in the arm or leg are candidates for the procedure.

How long does the procedure take?
20 to 30 minutes.

Recovery
Patient usually is monitored for 30 to 60 minutes and then can resume activity as tolerated.  Patient is instructed to rest for the day of the procedure.

Results
Usually, there is a progressive increase in the interval between when blocks are needed due to the pain relief provided by the procedure.

 

Sacroiliac and Other Joint Injections

What is it?
A procedure involving a diagnostic and therapeutic injection into the sacroiliac or other joint. Anti-inflammatory steroid medication and local anesthetic provide short or long-term pain relief.

How it's performed
Usually using a flouroscope for guidance, a needle is introduced into the correct portion of the sacroiliac or other joint. The position may be confirmed by injecting a small amount of contrast dye.The local anesthetic and anti-inflammatory steroid is injected.  Local injections into the ligaments may be helpful.

What patients are candidates?
Patients with pain caused by arthritis, injury, or strain of the sacroiliac joint or other joint are good candidates for the procedure.

How long does the procedure take?
Anywhere from 10 to 20 minutes.

Recovery
You may be monitored for a short period of time before you can leave and are expected to take it easy for the rest of the day of the injection. Most patients are able to walk immediately after the procedure.

Results
The effects of sacroiliac or other joint injections may be temporary, providing relief from one week up to years, or in some cases permanently.

 

IntraDiscal Thermal Therapy

What is it?
A minimally invasive treatment in which controlled levels of thermal energy (heat) are applied to a broad section of the affected disc wall with an annular tear.

How it's performed
Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. With the guidance of x-ray images, your physician will advance a needle into the disc. The SpineCATH catheter will be passed through the needle and into the disc. Once it is in the appropriate position, the temperature of the heating section of the catheter will be gradually increased, raising the disc wall temperature. Once the therapy is completed, the catheter and needle are removed, and you will likely be sent home with a Band-Aid over the needle insertion site.

What patients are candidates?
Patients with one or two discs being the primary source of lower back pain may be candidates for SpineCATH IDET therapy.

How long does the procedure take?
Typically lasts less than one hour.

Recovery
The discomfort generated when the disc is heated may take several days to subside, and your physician may prescribe medication.

Results
Typically, within 12 to 16 weeks following the procedure, most patients report they usually begin to experience relief.

 

Racz Epidural Neurolytic Procedure

What is it?
Procedure involving passing Racz epidural catheter into the epidural space and injecting medicine directly at the site of nerve injury or adhesion to decrease the pain and break up adhesions. The epidural space is the area around your spinal cord.

How it's performed
A catheter is placed in the in the epidural space through which a solution of medication and local anesthetic can provide profound analgesia. It is optimal to place the epidural catheter close to the patient's painful dermatome as possible.

What patients are candidates?
Patients in members with epidural adhesions, adhesive arachnoiditis, or failed back syndrome from multiple previous surgeries for herniated lumbar disk are candidates.

How long does the procedure take?
Typically takes 30 to 50 minutes.

Recovery
General soreness at the injection site as well as in your lower back for up to two weeks

Results
Most patients report pain relief and increased mobility for two months or longer.

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