Tri-State combines numerous pain management techniques including osteopathic adjustments, massage therapy, physical therapy in conjunction with Trigger Point Injections, and so much more in order to help you finally get rid of your pain and enjoy life again.
Osteopathic Manipulative Treatment (OMT)
OMT manipulation allows physicians to use their hands to diagnose injury and illness and to encourage your body’s natural tendency towards good health. By combining all other medical procedures with OMT, our Dr. of Osteopathy offers patients the most comprehensive care available in medicine today.
Trigger Point Injection (TPI)
Trigger Point Injection (TPI) is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched (called a jump sign).
The trigger point can trap or irritate surrounding nerves and cause referred pain — pain felt in another parts of the body. Scar tissue, loss of range of motion, and weakness may develop over time.
TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. TPI also can be used to treat Fibromyalgia and tension headaches.
Injections are given in the physician’s office and take approximately 30 minutes. A small needle is inserted into the trigger point and a local anesthetic (e.g., lidocaine, procaine) with or without a corticosteroid is injected. Injection of medication inactivates the trigger point and thus alleviates pain. Sustained relief usually is achieved with a brief course of treatment.
Epidural Steroid Injections
The most commonly performed injection is an epidural steroid injection. In this approach, a steroid is injected directly around the dura, the sac around the nerve roots that contains cerebrospinal fluid (the fluid that the nerve roots are bathed in). Prior to the injection, the skin is anesthetized by using a small needle to numb the area in the low back (a local anesthetic).
Injecting around the dura sac with steroid can markedly decrease inflammation associated with common conditions such as spinal stenosis, disc herniation or degenerative disc disease. It is thought that there is also a flushing effect from the injection that helps remove or "flush out" inflammatory proteins from around structures that may cause pain.
An epidural steroid injection is generally successful in relieving lower back pain for approximately 50% of patients. While the effects of the injection tend to be temporary (one week to one year), an epidural can be very beneficial in providing relief for patients during an episode of severe back pain and allows patients to progress in their rehabilitation.
Selective Nerve Block
A selective nerve block may be performed to help diagnose and/or treat radicular pain (pain related to irritation and inflammation of a nerve serving a particular area of the body). You may need these injections to decrease your pain so that appropriate physical therapy and exercises can be performed for your long-term treatment. Also the nerve blocks allow identification of target sites to direct future care. You may experience numbness and/or relief from your symptoms for up to 6 hours after the injection. Your usual symptoms may then return and may possibly be worse than usual for a day or two.
It may take 3-7 days before you will be able to feel any effects from the medication. If there is no change in your symptoms after 2 weeks, your doctor may want to investigate other possible sources for your pain.
Facet Joint Injections
Facet joint injections - are commonly used to determine what is causing back pain. Facet joint injections are primarily diagnostic injections, meaning that they help your doctor determine the cause of your back pain but may not provide you with any long-term relief from the pain. These injections eliminate pain temporarily by filling the facet joint with an anesthetic medication that numbs the facet joint, the ligaments, and joint capsule around the facet joint. If the facet joint is injected and your pain goes away for several hours, then it is very likely that the joint is causing your pain. Once you and your doctor know what structure is causing your pain, you can begin to explore options for treating the condition.
Sacroiliac (SI) Joint Injections
Sacroiliac (SI) Joint Injections are commonly used to determine what is causing back pain. SI joint injections are primarily diagnostic injections, meaning that they help your doctor determine the cause of your back pain but may not provide you with any long-term relief from the pain. These injections eliminate pain temporarily by filling the SI joint with an anesthetic medication that numbs the joint, the ligaments, and joint capsule around the SI joint. If the SI joint is injected and your pain goes away for several hours, then it is very likely that the joint is causing your pain. Once you and your doctor know what structure is causing your pain, you can begin to explore options for treating the condition.
Peripheral Joint Injection
Peripheral Joint Injection is an injection of a local anesthetic into a joint is also a useful diagnostic technique and may be performed with or without the simultaneous administration of steroid. Such injections are particularly common in the hip and can help distinguish pain originating from the joint itself from referred back pain. Steroid injections have been shown to have therapeutic benefit in the following conditions:
osteoarthritis with associated effusion
Patients who have long-standing arthritic pain are typically referred for intraarticular steroid injections only when other modalities (non-steroidal anti-inflammatory drugs, analgesics, various modes of physical therapy, etc) have failed to adequately control symptoms.
Plasma Disc Decompression (Nucleoplasty)
Plasma Disc Decompression (PDD) is an option for those people who have not responded to conservative care. In many cases PDD provides an alternative to more invasive open surgery. It is a minimally invasive procedure that allows you to go home on the same day of the procedure.
The procedure is performed under x-ray guidance to accurately place a surgical port (passage way) into the disc. Using this minimally invasive approach, a small pathway is made into the disc and a precisely engineered device, known as a SpineWand® surgical device, is then inserted through the surgical port into the center of the disc. The device utilizes Coblation technology to dissolve tissue while preserving nearby healthy tissue.
The removal of nucleus tissue relieves pressure on the protective ring around the disc or annulus, typically allowing the bulge to recede, so that the disc no longer irritates the nearby nerve root. Normally, the entire procedure takes less than an hour, and the patient can leave the medical facility one to two hours later, with no overnight hospital stay required.
A minimally invasive approach using only a small cannula (1mm or 1/20th inch) to access the disc is used, which minimizes scarring or annular disc damage that may be caused by larger or more aggressive devices. Plasma Disc Decompression has successfully become a leading method for performing minimally invasive disc decompression and is a leading choice for physicians around the world.