Padda Institute Center for Interventional Pain Management

What are facet joints and why are facet joint injections helpful?

The spine is designed to bend and turn. Along with the intervertebral discs, facet joints (also referred to as Z joints or zygapophyseal joints) enable the spine to bend and twist. Each vertebra has two sets of facet joints. One set of facet joints is located at the top and a corresponding set is at the bottom.

Facets joint are small joints a little larger than the size of your thumbnails located in pairs on the back of your spine. They provide stability and guide motion in your back. If the joints become painful they may cause pain in your neck, shoulder, low back, abdomen, buttocks, groin or legs.   The pattern and location of pain helps to determine the likely facet joints involved.

Working like a hinge, the articulating surfaces of each facet joint are coated with smooth cartilage allowing friction free movement. Although the facet joint bones fit snugly together, there is a lubrication system. The lubricating ‘oil’ is called synovial fluid and resembles uncooked egg whites. This fluid also nourishes the cartilage tissues. A block that is performed to confirm that a facet joint is the source of pain and decrease pain and inflammation in a facet joint or joints.

A patient with primary facet pain, proven with either one or more blocks, may be a candidate for a facet rhizotomy using radiofrequency (RF). The patients selected for rhizotomy are those who are not surgical candidates and who have failed other conservative measure.

By using the radiofrequency rhizotomy, the surgeon denervates the medial branch nerve which runs along the posterior spine near the facet joints.

Radiofrequency ablation or lesioning is a term used when radio waves are used to produce heat to destroy tissue, usually a nerve. It has been used for several years with great success in patients who have abnormally fast heartbeats. More recently, it is being used to destroy tumors. It is also a non-surgical option to treat your spine pain.

Spine pain is the second most frequent pain complaint. It occurs in 65 to 80 percent of the population at one time or another, and can be disabling and frightening. Its costs to society are great.

In the case of spinal pain, radiofrequency waves are transmitted through a needle placed into the facet joint under x-ray guidance. This procedure is also known as rhizotomy.

Sciatica particularly refers to the pain that radiates along the sciatica nerve. The sciatic nerve branches from the lower back, along with the hips, and down to the leg. Mainly, Sciatica affects only one side of the body and mostly it occurs when there is a herniated disc or compression in some part of the nerve. The major cause said to the sciatic nerve is a herniated disc which leads to compression on the sciatic nerve and readily damages it. The most common causes of sciatic nerve damage are obesity, sedentary lifestyle, sleeping patterns, high heels that lead to the damage of sciatic nerve.

Padda Institute center for interventional pain management offers tailored treatments after diagnosing the root cause of the pain. If you feel any symptoms or discomfort, schedule your appointment with one of the best pain management doctors in the St. Louis area.

Caution: If you’re having your worst migraine ever or symptoms that are unusual for you or frightening, see a doctor as soon as possible. You need to be sure this IS a Migraine and not something more serious such as a stroke. 

Caution: Pregnant women should immediately alert their physician as many of the medications used to treat migraines can cause birth defects. The goal of the Padda Institute Headache Section is to provide diagnosis and treatment that will help people who experience severe pain regain a better quality of life.  (The treatment needs of patients who have occasional mild headaches are significantly different from those patients whose attacks are frequent and completely disabling.)  If your quality of life is impacted from migraine, chronic head pain, or nerve pain in the face you need a plan of action from a team of highly experienced specialists. We provide a collaborative approach combined with the latest technology resulting in individualized care. Our goal is to provide effective, compassionate care to improve your quality of life. Headaches are serious Headache remains one of the most common health issues which challenge physicians and other health professionals, migraine is the 12th most disabling disorder in the United States..  The symptoms of head pain are a frequent cause of human suffering and disability.  According to a World Health Organization analysis, severe Migraine attacks are as disabling as quadriplegia (paralysis of both arms and legs).  Suicide attempts are three times more likely among people who have Migraine with aura than among people who do not have Migraine. More than 1,400 American women with Migraine with aura die each year from cardiovascular diseases compared to women who do not have Migraine.

Stellate Ganglion Block

Your body has special nerves known as sympathetic nerves in your neck which ,control blood supply and sweating to your arms and hands . These nerves can be anesthetized to change the blood flow to a limb and to decrease the pain which is mediated by these sympathetic nerves:

• Reflex sympathetic dystrophy  (RSD), also called Complex Regional Pain Syndrome (CRPS) typically involves a nerve injury involving the sympathetic nervous system.  Patients who suffer crushing or partial nerve injury develop excruciating burning pain accompanied by changes in blood supply to the area of the injury.   People with CRPS may exhibit abnormal sensation throughout all or part of the affected area. This often includes increased sensitivity to stimuli such as touch, pressure, or temperature.

• • Patients with severe ischemic limb pain have sharp, aching pain as a result of circulatory insufficiency.  Patients in end-stage PVD (peripheral vascular disease) will complain of rest pain with or without ulcers.
    1. Severe pain (claudication and rest pain)
    2. Decreased pulse in the limb
    3. Abnormal skin temperature
    4. Abnormal skin color
    5. Nonhealing ulcers
    6. Other trophic changes

Bed rest and strong pain medicine are no longer the only treatments for back pain caused by compression fractures of the spine. Now there is a breakthrough minimally invasive medical procedure called percutaneous vertebroplasty that uses bone cement to fill in the spaces of a broken or crushed vertebra.

Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable. Vertebroplasty stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies. Percutaneous vertebroplasty strengthens the treated vertebra and gives pain relief in most patients. The term “percutaneous” means injecting a fluid through a needle. “Plasty” means to mold or form. Thus, vertebroplasty helps mold the vertebrae by injecting a fluid into the bone. In this case, the doctor injects a bone cement mixture of polymethylmethacrylate (the same cement used in joint replacement surgery), barium or tantalum powder (makes the cement visible on X-ray), an antibiotic, and a solvent into the vertebral body. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast. Vertebrae are bones that form a flexible column to protect the spinal cord. A compression fracture occurs when a vertebra breaks or is crushed. When this happens, a person can feel extreme pain that may last a lifetime. Often the pain keeps the person from performing normal activities. Certain cancers, benign tumors, or osteoporosis of the spine can cause compression fractures.

Back pain affects nearly everyone at some point in their adult life. Often times the exact cause of pain is not readily apparent, as there are many factors which may contribute to a patient’s back pain, including disc disease, referred pain, as well as psychological factors. This can make the exact site and level responsible for the back pain more challenging to localize and diagnose. Unfortunately, while imaging studies (X-RAYs, MRI and CT scans) are helpful in screening the spine for potential causes of back pain, sometimes they don’t demonstrate an exact cause for a patient’s pain.

Back pain may arise from any anatomic structure within or around the spine which has nerve endings and is capable of transmitting pain. These structures include discs, facet joints, muscle, nerves, ligaments and dura (the membrane lining of spinal canal). All of these structures are either directly touching or in close proximity to the epidural space. Pain may be either within the spine itself (‘axial’), or radiating from the spine (‘radicular’). Both of these types of pain are ideally alleviated with the ESI.

The Epidural Injection (ESI)is a procedure that anesthetizes the space around the spinal sac (dural sac). This procedure may be performed at any level of the spine, although is most commonly performed in the lumbar spine or cervical spine. As opposed to a selective nerve root block, or a facet injection, which target a specific nerve or joint on one side of the spine, the ESI treats several consecutive levels on both sides of the spine.

The ESI procedure delivers a low volume of concentrated medication directly into a portion of the epidural space. The ESI typically covers the epidural space of about 3 vertebral body levels.

Nerve roots exit your spinal cord and form nerves that travel into your arms or legs. These nerves allow you to move your arms, chest wall, and legs. These nerve roots may become inflamed and painful due to irritation, for example, from a damaged disc or a bony spur.

A selective nerve root block provides important information to your physician and is not a primary treatment. It serves to prove which nerve is causing your pain by placing temporary numbing medicine over the nerve root of concern. If your main pain improves after the injection then that nerve is most likely causing your pain. If your pain remains unchanged, that nerve probably is not the cause of pain.

Pancreatitis is the inflammation of the pancreas. The pancreas is a large gland behind the stomach and near to the first part of the small intestine. The pancreas secretes digestive juices into the small intestine through a tube called the pancreatic duct.

The pancreatitis inflammation mostly happens when digestive enzymes start digesting the pancreas on its own. The illness can be acute or chronic relying on the severity of the case. Either form is said to be serious and can lead to complications. Thus, a proper pancreatitis treatment is important. Acute pancreatitis occurs almost suddenly but it can be treated in a few days.

An imaging test used to diagnose pain is called a discogram. It is also known as a discography. Discogram helps specialists determine if a specific abnormal disc in the spine is causing pain.

Padda Institute has a full range of advanced imaging tests X-Rays, MRI, and CT scans available right at the center. We determine the root cause of pain through the patient’s history and physical examination, reviewing X-Rays, CT’s/MRI’s, or other diagnostic injection procedures such as sacroiliac & facet joint injections or nerve root blocks before performing discography.

Cluster headaches are among the most intense types of headaches, as they occur in cyclical cycles or cluster intervals. A cluster headache is caused by significant pain in or around one eye on one side of the head that wakes you up in the middle of the night. Cluster episodes last from weeks to months and are frequently followed by remission periods, during which the headaches stop. During the remission period, there are no headaches for months, if not years. Cluster headaches are uncommon and do not pose a life-threatening threat. Cluster headache attacks can be made shorter and less painful with the right treatment. In addition, medications can help you to have fewer cluster headaches. Cluster headaches have two dominant forms: episodic cluster headaches, and chronic cluster headaches.

CRPS, abbreviated as Complex Regional Pain Syndrome, is a disorder causing certain clinical conditions, chronic pain being the primary one. This form of chronic pain typically affects the arms and legs and is of two types – Type I CRPS and Type II CRPS. Type I CRPS occurs due to trauma, while Type II CRPS is caused by nerve injury in the limbs, stroke, surgery, and sometimes even heart attack.

Several terms such as – Reflex Sympathetic Dystrophy, Algodystrophy, and Causalgia have been used for this chronic pain condition. However, since 1995, Complex Regional Pain Syndrome has been used as the standard term. It is important to see your doctor if you feel any symptoms, as CRPS can be treated if detected early. Feel free to call us to fix an appointment with our specialists.

Diabetic neuropathy is a form of nerve injury that can emerge as a result of diabetes. High blood sugar (glucose) levels can harm nerves all over your body but mostly affect the nerves in the legs and feet. Diabetic neuropathy symptoms can range from discomfort and numbness in your legs and feet to complications with your digestive system, urinary tract, blood vessels, and heart, depending on which nerves are impacted. Some people only experience minor signs and symptoms; while for others, it can be quite stressful. Diabetic neuropathy is a severe diabetes syndrome that affects up to 50% of people with the disease. However, proper blood sugar management and a healthy lifestyle can typically avoid or slow the progression of diabetic neuropathy.

The hip joint is a large joint where the leg joins the pelvis, functioning as a ball and socket joint. The top of the thigh bone (the femur) is a round ball, which fits into the socket formed by a cavity in the pelvic bone. The ball is held in the socket by a grouping of ligaments that form a capsule around the joint. This capsule of ligaments contains a lubricating synovial fluid and cartilage, which allows the two bones to move against each other with minimal friction.

Lumbar Sympathetic Nerve Block (including Celiac Plexus Block and Ganglion Impar Block)

Your body has special nerves known as sympathetic nerves in your back which ,control blood supply and sweating to your legs and feet . These nerves can be anesthetized to change the blood flow to a limb and to decrease the pain which is mediated by these sympathetic nerves:

• Reflex sympathetic dystrophy  (RSD), also called Complex Regional Pain Syndrome (CRPS) typically involves a nerve injury involving the sympathetic nervous system.  Patients who suffer crushing or partial nerve injury develop excruciating burning pain accompanied by changes in blood supply to the area of the injury.   People with CRPS may exhibit abnormal sensation throughout all or part of the affected area. This often includes increased sensitivity to stimuli such as touch, pressure, or temperature.
• Patients with severe ischemic limb pain have sharp, aching pain as a result of circulatory insufficiency.  Patients in end-stage PVD (peripheral vascular disease) will complain of rest pain with or without ulcers.
  • Severe pain (claudication and rest pain)
  • Decreased pulse in the limb
  • Abnormal skin temperature
  • Abnormal skin color
  • Non healing ulcers
  • Other trophic changes

• Common types of PVD
  • Arteriosclerosis
  • Diabetic arteriosclerosis
  • Raynaud’s disease
  • Buerger’s disease

Typically, migraines affect one side of the head and cause throbbing pain or a pulsating sensation. It is commonly accompanied by nausea, vomiting, excessive light, and sound sensitivity. Migraine episodes can last anywhere from hours to days, and the pain might be severe enough to affect your usual activities. 

A warning sensation known as an aura arises before or with a headache for some people. Medications can reduce migraine pain and prevent some migraines. The correct medications, in combination with self-help treatments and lifestyle adjustments, may be beneficial.

At Padda Institute, our goal is to identify the root cause of migraines. We might order a diagnostic test after reviewing the clinical history of the patient and if the examination document does not reveal any neurologic findings, such as papilledema.  Consult with our specialists today.