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Epidural Injections

The membrane covering the spinal cord and nerve roots is called the dura. A narrow space surrounding the dura is called the epidural space. Nerves leave the spine through the epidural space and travel to the rest of the body. If these nerve roots become irritated and inflamed from a damaged disc or severe arthritis of the spine, pain may occur in areas the nerves travel to. We use fluoroscopy (X-ray) to carefully and accurately place steroid added to injection into the epidural space to decrease nerve root inflammation, accelerate healing and give pain relief. Indications:Disc herniation (sciatica), Radicular Pain, Spinal Stenosis, Cancer Pain

Facet Injections

When low back pain, thoracic pain, or neck pain originates from facet joints (located at the back of each vertebra on each side), facet joint injections that include local anesthetic and a steroid may reduce inflammation and provide pain relief. Zen Pain and Wellness doctors use fluoroscopy (X-ray) to accurately place the injection. Alternatively, the nerve to the facet joint may be blocked using a local anesthetic. If adequate pain relief is observed, radiofrequency lesioning may be used on the nerve branches to help provide long-term pain relief.Indications:Back pain, Neck pain Whiplash, Painful facet arthritis, Cervicogenic headaches

Medial Branch Blocks

Medial branch blocks (MBBs) are a minimally-invasive, non-surgical treatment that are used for arthritis-related neck and back pain. This pain management technique works by reducing the inflammation and irritation in the facet joints of the spine that is causing your pain. An exciting aspect of this pain relief modality is that, if it successful, a more long-term treatment option called radiofrequency ablation of the medial branch can be employed.

Spinal Cord Stimulation

This relatively new treatment consists of a highly sophisticated, small computer that’s implanted under the skin. It delivers a low-voltage signal through fine wires to the spinal cord, or selected nerves and masks the pain sensation with a pleasant tingling or massaging sensation.Indications:Intractable nerve injury pain, failed back syndrome, complex regional pain syndrome (formerly known as Reflex Sympathetic, some headaches).

Medication Management

When chronic pain doesn’t respond to interventional or conservative therapies, medications may be beneficial. Many associate pain medicines with narcotics. But every pain is different, so not all pain is treated the same. We use many different kinds of medicines to help manage chronic pain. For example, pain that is caused by nerve damage is best treated with certain anti-seizure or anti-depressant medications and sometimes narcotic medications. The pain caused by fibromyalgia is commonly treated with anti-seizure and/or anti-depressants. Other types of chronic pain respond best to narcotic medications and other types of medicines.Interventional Spine Medicine providers take prescribing narcotics very seriously. They work with patients closely to develop a treatment plan that helps them manage their pain safely as they are carefully monitored for potentially serious side effects.Patients receiving these medications sign a narcotic agreement that describes the side effects of chronic narcotic use, the risks involved and ISM policies regarding the misuse of narcotics. We have a very strong policy that includes no tolerance to misuse or abuse of any kind.

Peripheral nerve blocks

Peripheral Nerve Blocks employ injection of a local anesthetic such as lidocaine to numb the nerves believed to be triggering pain. To help locate the triggering nerves causing the pain, we use ultrasound or electrical stimulation.Indications:Painful nerve conditions (Occipital Neuralgia, Ilioinguinal Neuralgia, Meralgia Paresthetica)

Trigger Point Injections

Trigger point injections are used where bundles of muscle fibers become tight, knotted and unable to relax. They can occur as a result of injury, spinal or skeletal abnormality or poor biomechanics. Treatment to relieve trigger points include targeted trigger point injections of local anesthetic with or without steroids, chiropractic care, massage, stretching and physical therapy. In intractable cases, botulinum toxin injections often provide substantial and lasting relief.Indications:Myofascial pain, neck pain, shoulder pain, back pain

Quantitative Sensory Testing

Identifies early nerve damage (neuropathy) and helps determine treatment progress. More sensitive than an electromyelogram (EMG), it can detect abnormal function in small sensory nerves in patients with numbness or tingling, especially in the extremities, even when an EMG is normal.Indications:Diabetic pain and Neuropathy, Radiculopathy, Neuropathy

Ultrasound guided injections

Ultrasound guided injections are emerging as a new alternative to low dose x-ray guidance (fluoroscopy) for the delivery of therapeutic medications for some procedures. It allows the physician to see inside the patient and image not only bony structures, but also soft tissues to include nerves, muscles, joints, bursa, and blood vessels. It can be used to guide a needle into specific areas and identify nerves while avoiding vessels – thereby increasing accuracy in addition to safety.


Vertebropasty and kyphoplasty are two innovative, minimally-invasive, non-surgical procedures that have proven to strengthen the vertebrae of your spine and significantly improve pain caused by vertebral body compression fractures. Fractures are often secondary to osteoporosis, cancer metastasis, or trauma. Arizona Pain Specialists is happy to provide these treatments to the Phoenix area. These exciting new therapies have helped people even when conservative therapies have not provided adequate relief

Sympathetic Nerve Block

Sympathetic nerve block is the injection of a local anesthetic into a sympathetic ganglion to diagnose or treat pain disorders that involve the sympathetic nervous system. 
The sympathetic nervous system is a linkage of nerves throughout the entire body. The nerves originate in the spinal cord and branch out to influence many bodily functions, such as blood pressure, urination, defecation, and sexual arousal. 
A ganglion is a bundle of nerves that come together. The stellate ganglion (upper body) as well as the sympathetic chain (lower body) supply the entire body’s sympathetic nervous system. When these nerves are irritated or injured, the blood supply to your hands, feet, or other areas may be affected and can produce pain or sensory changes. Headaches, neck pain, and facial pain can also be seen in patients who have sympathetic nerve dysfunction.

Platelet Rich Plasma

Platelet rich Plasma or PRP, is enriched blood product composed primarily of platelets — a type of cell found in the blood — is an emerging clinical tool for use in a wide variety of medical applications. With PRP, blood plasma is concentrated with higher than normal amounts of platelets, which most famously play a role in blood clotting, but have also been discovered to release a multitude of protein growth factors involved in many other biological responses involved in healing and tissue repair (Mishra & Pavelko, 2006). The theory behind PRP is that by introducing platelets in large quantities to a site of injury, the excess of growth factors might stimulate healing of long-term injuries that may contribute to chronic pain (Sampson, Gerhardt, & Mandelbaum, 2008).

Celiac Plexus Block

A celiac plexus block is commonly performed for abdominal pain and especially effective for pancreatic cancer pain. The celiac plexus is a bundle of nerves located in front of the diaphragm and behind the stomach near the celiac artery and the abdominal aorta. The celiac plexus innervates the liver, pancreas, gallbladder, stomach, spleen, kidneys, intestines, adrenal glands, and blood vessels. Blocking this region can relieve pain caused by one of these organs. A celiac plexus block can be used to treat intractable pain from upper abdominal cancers. The most commonly and effectively treated cancer with celiac plexus blocks is pancreatic cancer and associated metastasis

Intercostal Nerve Block

The intercostal nerve is found between ribs throughout the thoracic region. Injecting anesthetics, steroids, or other medications inhibits the transmission of pain signals and reduces inflammation of these nerves. This procedure may also be used to diagnose pain and identify the route of the pain signal.

Ganglion Impar Block

Ganglion impar block is an excellent way to treat chronic, neuropathic perineal pain from visceral or sympathetic pain syndromes, especially if they are secondary to malignancy. If you have vague, poorly localized perineal pain that is frequently accompanied by sensations of burning or urgency, you may benefit from this block. However, since the symptoms of burning and urgency, especially if they’re associated with urination or defecation, may be secondary to a medical condition (i.e. urinary tract infection, sexually transmitted infection, prostate inflammation, etc.) it is important to first consult your primary care doctor to make sure you are not experiencing perineal area pain from one of these causes.

Occipital Nerve Blocks

Occipital nerve block is numbing of the greater and lesser occipital nerve. The block is an injection composed of an anesthetic and a corticosteroid next to the greater and lesser occipital nerves, which are located just beneath the scalp, superficial to the skull, in the back of the head. It is most often used in the diagnosis and treatment of occipital neuralgia and cervicogenic headache (Afridi 2006). Occipital neuralgia will typically follow a trauma to the nerves over the occiput (back of the head) and is characterized by an acute onset of pain in the distribution of the occipital nerves. Cervicogenic headache is more chronic, with an insidious onset characterized by pain in the same distribution. Most patients with cervicogenic headaches have associated spondylosis or problems of the cervical facet joints in the neck and therefore may need an additional block in the cervical facet joint to completely alleviate their symptoms. A group of people suffering from cervicogenic headaches was split into two categories, one of which received the occipital nerve block. The study found that analgesic consumption, duration of headache and its frequency, nausea and vomiting, photophobia (fear of light), phonophobia (fear of noise), decreased appetite, and limitations in functional activities were significantly less in the blocked group compared to control group. The study therefore concluded “the nerve stimulator-guided occipital nerve blockade significantly relieved cervicogenic headache and associated symptoms at two weeks following injection.” (Naja 2006)

Botulinum Toxin Injections

Botulinum toxin injections are safe and effective for the treatment of various painful neuromuscular conditions. We use botulinum toxin injections to help relieve pain associated with cervical dystonia (spasm) and myofascial pain. Often, botulinum toxin injections are very useful in treating certain types of chronic headaches, including migraines.

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