Injections

Epidural steroid injections are performed to treat pain caused by disc herniations, spinal stenosis, and/or degenerative disc disease. It can be performed to alleviate sciatica pain. These conditions cause inflammation to the spinal nerves and an epidural steroid injection is performed to reduce the inflammation. The goal is to reduce pain in the neck, back, or pain radiating into the extremities.

At Janerich Pain Specialists, sedation is not required to perform this procedure. An oral medication may be prescribed prior to the procedure to help calm patients. Local anesthesia is used to numb the patient and minimize discomfort. Live x-ray guidance, called fluoroscopy, is used during the procedure to ensure patient safety and proper needle placement. Most patients do not feel pain during the procedure, although they may experience some temporary mild pressure. Patients may return home after the injection. Although every patient is different, pain relief can last months and even years. It can be repeated if necessary to maintain pain relief.

The facet joint refers to a joint in the spine where two adjacent lumbar vertebrae come together. When the facet joints become inflamed from arthritis, they can cause localized pain. Facet joint injections using a steroid and anesthetic can be used to decrease inflammation and alleviate pain.

At Janerich Pain Specialists, we use real time x ray guidance, or fluoroscopy, to ensure that the placement of the needle is in the correct facet joint. Patient sedation is not required for this procedure. Rather, we use local anesthetics, such as lidocaine, before the procedure so that the patient is comfortable during the procedure. General anesthesia is not needed during this procedure. Results vary, but can last multiple months. If needed, repeat injections can be performed.

This procedure involves using local anesthetic to numb the spinal nerve that provides innervation to a facet joint. This nerve can become irritated and cause pain. A medial branch block procedure is a diagnostic injection used to determine the specific spinal level that is causing the pain. It is a required procedure before performing a therapeutic radiofrequency ablation (rhizotomy) procedure that “burns the nerve” which can yield pain relief that is more long term. This procedure does not require patients to be sedated and is performed in the office using live x ray, also known as fluoroscopy, to ensure proper needle placement and safety.

A radiofrequency ablation (Rhizotomy), or RFA, is a therapeutic same day procedure that applies heat to the spinal nerves that innervates the facet joints in the spine. When heat is applied to the nerve, the nerve degenerates and therefore, no longer transmits painful signals to the brain. When this occurs, patients experience pain relief, which can last years or more. If needed, this procedure can be repeated to maintain pain relief.

General anesthesia is not required for this procedure. However, an oral medication may be prescribed prior to the procedure to calm patients if needed. Local anesthesia is used to numb up the skin and soft tissue. Using live x ray known as fluoroscopy, a needle is advanced to the target in the spine. Once the needle is in the appropriate position using fluoroscopy, motor testing is then performed to ensure that the needle is in a safe location. Once proper placement is achieved, heat is applied to the nerves. Some patients may feel a warming sensation at the tip of the needle although many patients feel nothing. After the heating process is complete, the needles are withdrawn and a bandage is placed over the procedure site and patients can return home.

The sacroiliac joint, or SI joint, can become inflamed and cause low back, buttock, or even hip pain. A SI joint injection of a numbing medication mixed with a steroid can be performed to decrease inflammation and alleviate pain. At Janerich Pain Specialists, we use real time live x-ray, or fluoroscopy to ensure precise needle placement within the joint. Patients rarely feel discomfort during the procedure. Results vary with each patient, although most patients experience at least months of relief. The injection can be repeated to maintain relief.

When patients suffer from chronic pain that has not responded to other treatment options, including surgery, a spinal cord stimulator, or SCS, may be considered. A spinal cord stimulator is an implanted device that blocks pain signals from traveling to the brain by stimulating the spinal cord using electrical impulses. At Janerich Pain Specialists, we perform spinal cord stimulator trials during which temporary SCS leads are placed using live x ray to ensure exact placement of the leads and also to ensure that all of the patient’s painful areas are stimulated. After the procedure, the patients may return home and experience firsthand how the device can alleviate their pain. Typically, trials last no more than one week.

Neurotoxins may be used to treat a number of different conditions including spasticity, cervical dystonia, and migraine headaches.

Spasticity is a condition that can develop in patients who have suffered a stroke, brain injury, or spinal cord injury. It may also present in patients who have multiple sclerosis, Parkinson’s disease, cerebral palsy, and other neurological conditions. Often, spasticity presents as the inability to move one or more limbs and can even cause the limb to be in a fixed position. It occurs because the muscles spasm and become tight. When this occurs, it can cause pain and also limit the patient’s functionality.

Botulinum toxins, such as Botox or Dysport, can be used to decrease spasms and relax tight muscles. As a result, the patient will experience pain relief and an easier time with self-care.

Spasticity can be a complex condition and can affect each patient differently. It requires routine follow up to ensure the best care is being provided. Dr. David Janerich has specialized training with neurotoxins to help each of his patient’s individual needs and reach their goals.

Spasticity can be heard with an EMG machine. Therefore, Dr. Janerich uses EMG guidance when performing the botulinum toxin injection to ensure that the correct muscle is being injected. Occasionally, ultrasound may also be used for further guidance and accuracy. On average, it can take up to 14 days for the neurotoxin to start working after it has been administered and it is typically effective for 90 days. Injections are repeated every 90 days to maintain results.

Cervical dystonia refers to the tightening of muscles in the neck such that it limits neck range of motion. The most common presenting symptom is neck pain. When mild to moderate, patients may notice that they cannot turn their head as well. Most patients notice this in particular when driving and needing to look over their shoulder to change lanes. If symptoms progress, the head can become fixed in a tilted position.

When this occurs, botulinum toxin can be used to relax the tight muscles that are restricting the range of motion and also alleviate pain. Dr. Janerich uses EMG guidance to ensure correct needle placement within the tight muscles. The injections are very well tolerated by patients and often little to no pain is experienced during the injections. After the injection occurs, the medication can take up to 14 days to begin working and it can last up to 90 days. Therefore, injections are repeated every 90 days to maintain results.

Botox is FDA approved for Migraine headache prevention. Migraine headaches can be quite debilitating and affect a patient’s ability to function. If a patient is suffering from more than 15 migraine headache days a month and have not responded to other oral medications used to treat migraines, Botox may be considered. The goal with using Botox to prevent migraine headaches is to decrease the number of headaches the patient has per month, decrease the length of time each headache lasts, and also decrease the severity or pain associated with each migraine. It may take up to three injections for Botox to reach maximum benefit, but many patients begin experiencing relief after the first set of Botox injections. Botox can last 90 days and injections are repeated every 3 months to maintain results. If you are wondering if Botox is right for you, schedule an appointment at Janerich Pain Specialists today.

Dr. David Janerich has specialized fellowship training in neurotoxins for the treatment of spasticity, cervical dystonia, and migraine headaches. He completed a fellowship after his residency specifically to learn about these conditions and how botulinum toxin can be used to help treat each patient’s individual needs.