63 Shaker Road, G04
Albany, NY 12204

Phone: (518) 487-4093
Alt Phone: (518) 487-4095
Fax: (518) 487-4102


Services

Capital District Interventional Pain and Rehabilitation will employ a comprehensive approach to pain management utilizing medication, rehabilitative therapies, behavioral approaches, interventional techniques, and neurosurgical referrals as required. Interventional pain management approaches employ diagnostic and therapeutic techniques to assist in identifying and relieving pain. These approaches may also restore a patient’s ability to perform regular activities much faster, while relying on very few medications. Compared to traditional pain management methods, which have shown mixed outcomes, interventional therapies that rely on injection procedures have demonstrated promising results. Some patients even believe that a treatment that may have failed before can prove positive results when combined with one or more interventional therapies.

Common pain conditions that may be treated without surgery include:

  • Radicular pain syndrome or radiculopathies resulting from a herniated disk or stenosis
  • Discogenic pain from internal disc disruption syndrome, degenerative disk disease or herniated disc
  • Facet arthropathy
  • Sacroiliac joint dysfunction
  • Various post surgical pain
  • Complex regional pain syndrome, reflex sympathetic dystrophy or causalgia

Cervical and Lumbar Epidural Steroid Injections
These kinds of injections are used to treat nerve inflammation, which can cause neck, shoulder, arm, back or leg pain.

The membrane that covers the spine is called the dura. The space that surrounds it is called the epidural space. When the nerves that travel along the dural membrane become inflamed, it can be quite painful. Inflammation can occur when the discs that normally cushion the spine are damaged or rub up against the bony structure of the spine.

An epidural steroid injection involves an injection of steroidal medication to the epidural space to reduce the swelling of the nerve roots. Usually a total of (3) epidural injections are given about 1-2 weeks apart. Although the epidural injection may not provide permanent pain relief, it may bring relief for several weeks of months while the injury/cause of pain is healing.

Facet and Selective Nerve Root Blocks
The facet and selective nerve root blocks are of two types; diagnostic and therapeutic. The diagnostic blocks are used to determine selected face joints and the nerve roots as possible pain generators. The therapeutic blocks are employed as a precision treatment once the facet joints or the nerve roots are deemed possible sources of pain based on diagnostic blocks or clinical and radiological judgment.

Facet Block – Facet joints, which connect bones in the spine, facilitate motion. Each vertebra has two sets of facet joints: one pair faces upward and one downward. The joints, which are located at the back of the spine, are like hinges that link the vertebrae together.

Selective Nerve Root Block – Nerve roots are attached to the spine and grow 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.

Block procedures are helpful in discovering whether nerve root or one or more facet joints are injured or stressed.

Medial Branch Nerve Block Procedure
As with many spinal injections, medial branch procedures are best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve injury or other injury).

On the day of the injection, patients are advised to avoid driving and doing any strenuous activities, and to get plenty of rest the night before.

The injection procedure includes the following steps:

  • An IV line will be started in selected patients so that adequate relaxation medicine can be given, as needed.
  • The patient lies on an x-ray table, and the skin over the area to be tested is well cleansed.
  • The physician treats a small area of skin with a numbing medicine (anesthetic), which may sting for a few seconds.
  • The physician uses x-ray guidance (fluoroscopy) to direct a very small needle over the medial branch nerves.
  • Several drops of contrast dye are then injected to confirm that the medicine only goes over these medial branch nerves.
  • Following this confirmation, a small mixture of numbing medicine (anesthetic) will then be slowly injected onto each targeted nerve.
  • The injection itself only takes between fifteen an thirty minutes

After the procedure, the patient typically remains resting on the table for twenty to thirty minutes, and then is asked to move the affected area to try to provoke the usual pain. Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the medial branch nerves that were injected are carrying pain signals from the spinal joints to the brain. On occasion, patients may feel numb or have a slightly weak or odd feeling in their neck or back for a few hours after the injection.

The patient will discuss with the doctor any immediate pain relief.  Ideally, patients will also record the levels of pain relief during the next week in a pain diary. A pain diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed.

Radiofrequency Rhizotomy
Radiofrequency (RF) rhizotomy or neurotomy is a therapeutic procedure designed to decrease an/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves destroying the nerves that innervate the facet joints with highly localized heat generated with radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken.

Provocative Discogram
This procedure helps find the cause and the level of the painful disc in chronic back and leg pain as a part of pre-operative assessment for surgery or stimulation.

Sacroiliac Joint Injection
The sacroiliac joint is a large joint in your lower back and buttocks region. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, abdomen, hip, buttock or leg.

A sacroiliac joint injection has both diagnostic, as well as a therapeutic value. Studies have shown, that the diagnostic sacroiliac joint block is the only way to confirm pain originating from this joint. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the joint is numb it means this joint is more likely than not your pain source. Furthermore, time-release cortisone will be injected into the joint to reduce any presumed inflammation, which on many occasions can provide long-term pain relief.
Although there are numerous ways to treat sacroiliac joint dysfunction, sacroiliac joint injections work powerfully to reduce your inflammation and they can provide months of relief.

Piriformis/Sciatic Nerve Block
The sciatic nerve can be compressed at many sites. The nerve leaves the pelvis through the sciatic notch where it lies under the Piriformis muscle. This is the most frequent site of sciatic nerve entrapment and is called piriformis syndrome. Sciatic nerve entrapment can lead to buttock pain and pain that radiates down the back of the leg to the foot. The purpose of this block is for diagnosis and treatment of sciatic nerve entrapment and irritation.

Spinal cord stimulator
A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, and electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control. SCS has notable analgesic properties and, at the present is used mostly in the treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.

Trigger Point Injections
During this procedure the trigger point is injected with a local anesthetic, and sometimes a steroid, to inactivate the trigger point and relieve the pain.

Sympathetic Blockade
During this procedure, a local anesthetic is injected into nerve tissue in order to block the sympathetic nerves and reduce pain.