OUR TREATMENTS
Interventional Procedures
- Trigger Point Injection
- Nerve Root Blocks
- Facet Joint Injection
- Lumbar Epidural Injection
- Cervical Epidural Injection
- Radiofrequency facet joint denervation
- Suprascapular nerve block
- Guanethidine blocks
- Epidural Injections
- Intrathecal Injections
Trigger Point Injection
Sometimes pain can come from the muscles in your body. If a group or area of muscles has suffered an injury or insult, this can cause the muscle to become tense and inflamed. Muscles are supplied by nerves and blood vessels which run to and from different areas of the body. You may feel pain in an area far away from the damaged muscles or the pain may span a wider area. Muscles affected in this way become very tense and will probable feel like a knot or tight band under the painful area. This area is called a trigger point.
A trigger point injection is a way of determining whether you have pain originating from this type of injury. An injection of local anaesthetic and steroid into the trigger point will reduce the muscle spasm and increase the blood flow into the area.
You may be taken into an operating theatre but you may also have this procedure in the Pain Medicine Consultant’s consulting room.
The doctor will feel for the painful area and will inject a combination of a local anaesthetic (to reduce pain) and a steroid (to reduce inflammation) into the trigger point. You may feel a strange sensation as this is injected, but it should not be painful. Please let the doctor know if you are in any discomfort. The consultant may massage the area briefly following the injection.
The procedure should take between 10 – 15 minutes. We will ask you to stay in the hospital for a specified amount of hours following this (varies depending on site of trigger point injection), when we will monitor you to ensure that you are well enough to go home safely.
The trigger point injection should allow you to have more movement in your muscles. It is important to use this opportunity to gradually build up the activity levels. The pain relief can last from days to weeks.
If the procedure is effective it is possible that the Pain Medicine Consultant will repeat it at a later visit, to attempt to obtain longer lasting pain relief and increased movement.
Nerve Root Blocks
Large nerves come out of the spinal cord and pass through a gap in the bones of the spine, before they travel to different parts of the body. This exit point (intervertebral foraman) is a likely point for the nerves to be compressed or ‘pinched’. This pressure on the spinal nerve causes pain and inflammation in your back but may also cause you pain along the path of that nerve, most commonly down your leg.
Nerve Root Blocks are useful for sciatica or nerve pain due to nerve root irritation. They can be performed at the lumbar (lower back) or cervical (neck) levels to reduce inflammation.
The injection of local anaesthetic (lidocaine) and a steroid into around the nerve root aims to give some immediate pain relief and reduce the inflammation of the nerve root.
You will be taken into an operating theatre as the procedure needs to done in a sterile environment. The procedure will be done under X-ray guidance, so you will see some extra equipment in the operating room.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins of your hand. This is used to for pain relief and to make you drowsy during the procedure.
You will be asked to lie face down on the operating room bed and the doctor will examine your back to find the painful area. You will have a number of short x-rays performed on this area. The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
Your Pain Medicine Consultant will insert a needle into the numb area and will take some more x-rays to check the position of the needle. The consultant will insert a little dye that is detectable by x-ray to further check the position. Once the needle is in the correct place, a combination of a local anaesthetic (to reduce pain) and a steroid (to reduce inflammation) will be injected next to the nerve root. You may feel a strange sensation as this is injected but it should not be painful. Please let the doctor know if you are in any discomfort.
The procedure should take about half an hour. We will ask you to stay in the hospital for a specified amount of hours following this, when we will monitor you to ensure that you are well enough to go home safely.
In some patients this procedure can cause an increase in pain for about a week before any beneficial effect is felt; this is normal, simply rest when you need to and be careful. The nerve root injection should allow you to have more movement in your back or neck. It is important to use this opportunity to gradually build up the activity levels. The pain relief can last from days to weeks.
If the procedure is effective it is possible that the Pain Medicine Consultant will repeat it at a later visit to attempt to obtain longer lasting pain relief and increased movement.
Facet Joint Injections
Some back pain conditions are caused by wear and tear of your facet joints in your spine. These are little joints that which help support the weight and control the movement between individual vertebrae of the spine. If these joints get worn (this may be a natural aging process or caused by some specific event) they will not move as freely and may cause pain.
The injection of local anaesthetic (lidocaine) and a steroid into the facet joint aims to give some immediate pain relief and reduce the inflammation of the joint.
You will be taken into an operating theatre as the procedure needs to done in a sterile environment. Because the facet joints are small and it is important to get the injection into the joint space, the procedure will be done under x-ray guidance, so you will see some extra equipment in the operating room.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins in your hand. This is used to for pain relief and to make you drowsy during the procedure.
You will be asked to lie face down on the operating room bed, and the doctor will examine your back to find the painful area. You will have a number of short x-rays performed on this area. The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
Your Pain Medicine Consultant will insert one or two needles into the numb area and some further x-ray to check the position of the needles will be done. Once the needles are in the correct place, a combination of a local anaesthetic (to reduce pain) and a steroid (to reduce inflammation) will be injected into the joint space. You may feel a strange sensation as this is injected, but it should not be painful. Please let the doctor know if you are in any discomfort.
The procedure should take between 10 – 30 minutes. We will ask you to stay in the hospital for a specified amount of hours following this, when we will monitor you to ensure that you are well enough to go home safely.
In some patients this procedure can cause an increase in pain for about a week before any beneficial effect is felt; this is normal, simply rest when you need to and be careful. The facet joint injection should allow you to have more movement in your back. It is important to use this opportunity to gradually build up the activity levels. The pain relief can last from days to weeks.
If the procedure is effective it is possible that the Pain Medicine Consultant will repeat it at a later visit to attempt to obtain longer lasting pain relief and increased movement.
Lumbar Epidural Injection
Epidural injections are used to reduce inflammation from common conditions that cause back pain, such as spinal stenosis, disc herniation or degenerative disc disease.
The epidural space is around the covering of the spinal cord (the dura). Large nerves called spinal nerves come out of the spinal cord, through the epidural space. If these spinal nerves in your lower back become irritated you may have pain both in your back and down your legs.
Lumbar epidural injections aim to give some immediate pain relief and reduce the irritation and inflammation of the spinal nerves.
You will be taken to the operating theatre, as this procedure needs to be done in a sterile environment.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins in your hand. This is used to for pain relief and to administer intravenous fluid during the procedure.
You will be asked to lie on your side (probably your ‘bad’ side), with your legs and head tucked up as far as you can. This may feel uncomfortable. If you are unable to lie in this position, the consultant may ask you to sit on the side of the bed, with your head tucked down as far as you can. This helps to straighten your back and to increase the space between your vertebrae.
The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
You will feel some pushing in your back as the consultant inserts a needle into the epidural space. The consultant will then inject a combination of a local anaesthetic (to reduce pain) and a steroid (to reduce inflammation) into the epidural space. You may feel a strange sensation as this is injected but it should not be painful. Please let the doctor know if you are in any discomfort.
The procedure should take between 10 – 20 minutes. We will ask you to stay in the hospital for approximately 4 hours following this, when we will monitor you to ensure that you are well enough to go home safely.
You may feel some numbness in your legs; this will wear off in the next 1 – 2 hours. It is not uncommon for your blood pressure to drop a little following the procedure, this will be carefully monitored while you are in hospital.
An epidural injection may be successful in relieving lower back pain in about 50% of patients. The effects tend to be temporary, lasting from one week to a year. It is important to use this opportunity to gradually build up your activity levels. A lumbar epidural can provide pain relief for patients during an episode of severe back pain. This allows them a window to push forward with their exercises and progress in their rehabilitation.
If the procedure is effective the Pain Medicine Consultant may repeat it at a later visit to attempt to obtain longer lasting pain relief and increased movement.
Cervical Epidural Injection
Epidural injections are used to reduce inflammation from common conditions that cause back and neck pain, such as spinal stenosis, disc herniation or degenerative disc disease.
The epidural space is around the covering of the spinal cord (the dura). Large nerves called spinal nerves come out of the spinal cord, through the epidural space. If these spinal nerves in the cervical area of your spine (your neck) become irritated this can cause pain both in your neck and into your arms and hands.
Cervical epidural injections aims to give some immediate pain relief and reduce the irritation and inflammation of the spinal nerves.
You will be taken to the operating theatre, as this procedure needs to be done in a sterile environment. This procedure may be done with the assistance of x-rays, so you may see some extra equipment in the operating room.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins in your hand. This is used to for pain relief and to administer intravenous fluids during the procedure.
You may be asked to lie on your front or your side, with your head supported on a special pillow. The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
You may feel some pushing in your neck as the consultant inserts a needle into the epidural space. The consultant will then inject a combination of a local anaesthetic (to reduce pain) and a steroid (to reduce inflammation) into the epidural space. You may feel a strange sensation as this is injected, but it should not be painful. Please let the doctor know if you are in any discomfort.
The procedure should take between 10 – 20 minutes. We will ask you to stay in the hospital for approximately 4 hours following this, when we will monitor you to ensure that you are well enough to go home safely.
It is not uncommon for your blood pressure to drop a little following the procedure; this will be carefully monitored while you are in hospital.
A cervical epidural injection may be successful in relieving neck pain in about 50% of patients. The effects tend to be temporary, lasting from one week to a year. It is important to use this opportunity to gradually build up your activity levels. A cervical epidural can provide pain relief for patients during an episode of severe neck pain. This allows them a window to push forward with their exercises and progress in their rehabilitation.
If the procedure is effective the Pain Medicine Consultant may repeat it at a later date to attempt to obtain longer lasting pain relief and increased movement.
Radiofrequency facet joint denervation
Some back and neck pain conditions are caused by wear and tear of your facet joints in your spine. These are little joints that which help support the weight and control the movement between individual vertebrae of the spine. If these joints get worn (this may be a natural aging process or caused by some specific event) they will not move as freely and may cause pain.
This procedure is used when patients have already had at least one facet joint injection which was effective. This procedure attempts a longer lasting effect by creating a heat lesion on the medial branch of the nerve, with the goal of interrupting the pain signals, thus eliminating the pain.
A medial branch nerve lesion affects the nerves carrying pain from the facet joints. These medial branch nerves do not control any muscles or sensation in the arms or legs so there is no danger of negatively affecting those areas. They do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.
You will be taken into an operating theatre as the procedure needs to done in a sterile environment. Because the medial nerve branch is small and it is important to get the lesion in the correct place, the procedure will be done under X-ray guidance, so you will see some extra equipment in the operating room.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins in your hand. This is used to for pain relief and to relax you during the procedure.
You will be asked to lie face down on the operating room bed, and the doctor will examine your back to find the painful area. You will have a number of short x-rays performed on this area. The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
Your Pain Medicine Consultant will insert one or two needles into the numb area and some further x-rays to check the position of the needles will be done. When the Pain Medicine Consultant is sure the needle is in the correct place a small electrical current will be passed through the needle to assure it is next to the correct nerve. This should briefly recreate the usual pain and produce a mild tingling sensation. Once the needle is in the correct place, the machine will heat up only the tip of the needle to create a lesion on the nerve. You may feel a strange sensation as this is done, but it should not be painful. Please let the doctor know if you are in any discomfort. This may be repeated for up to 4 or 5 nerves.
The procedure should take between 30 – 90 minutes. We will ask you to stay in the hospital for approximately 1hour following this, when we will monitor you to ensure that you are well enough to go home safely.
On the day after the procedure, you may carefully return to regular activities. Your neck or back will usually be very sore during the next one to four days. This pain is usually caused by muscle spasms and irritability while the targeted nerves are responding to the treatment over the next seven to fourteen days. This is normal, simply rest when you need to and be careful. Your Pain Medicine Consultant may give you some extra pain killers to take in this time.
Full pain relief is not expected for about 6-12 weeks after the procedure when the nerves have completely died. Sometimes, the back or neck may feel odd or slightly weak for several weeks after the procedure. Again this is normal, simply rest when you need to and be careful.
The nerves will eventually grow back but your pain may or may not recur. If the pain does recur, a second radiofrequency can be performed, and similar results will usually be achieved.
Success rates vary depending on patient selection, but typically about 30% to 50% of patients undergoing this procedure will experience significant pain relief for as much as two years. Of the remaining patients, about 50% will get some pain relief for a shorter period. Some patients do not experience any relief from pain as a result of this procedure.
Suprascapular nerve block
Shoulder pain is extremely common and the most usual cause is problems with a tendon or muscle. You may remember it starting with sudden pain on lifting something or during some sort of exertion or fall, which lead to a strain or tear of muscles or ligaments. But, like many neck or back soft tissue injuries, the cause is not always noticed or remembered.
Alternatively there may be inflammation of the tendons around the shoulder (tendinitis) which can also lead to a 'frozen shoulder'. This usually settles after a few months, during which time regular pain relief may be helpful. But scarring of the inflamed tissues can be extensive and occasionally it's advisable to have a suprascapular nerve block.
The suprascapular nerve supplies feeling to most of the shoulder. The injection of local anaesthetic (lidocaine) around the nerve aims to give some immediate pain relief.
You will be taken into an operating theatre as the procedure needs to done in a sterile environment.
The Pain Medicine Consultant will put a cannula (a little plastic tube) into one of the veins in your hand. This is used to for pain relief and to make you drowsy during the procedure.
You will be asked sit up in an appropriate chair, and the doctor will examine your shoulder. The consultant will inject some local anaesthetic to numb the area; this may feel uncomfortable.
Your Pain Medicine Consultant will insert a needle deeper into the numb area. Once the doctor is sure the needle is in the correct place, some local anaesthetic (to reduce pain) will be injected around the nerve. You may feel a strange sensation as this is injected, but it should not be painful. Please let the doctor know if you are in any discomfort.
The procedure should take between 10 – 30 minutes. We will ask you to stay in the hospital for X hours following this, when we will monitor you to ensure that you are well enough to go home safely.
In some patients this procedure can cause an increase in pain for about a week before any beneficial effect is felt; this is normal, simply rest when you need to and be careful. The suprascapular nerve block should allow you to have more movement in your shoulder. It is important to use this opportunity to gradually build up the activity levels. The pain relief can last from days to weeks.
If the procedure is effective it is possible that the Pain Medicine Consultant will repeat it at a later visit to attempt to obtain longer lasting pain relief and increased movement.
Guanethidine blocks
Guanethidine blocks are used for a condition called Complex Regional Pain Syndrome (CRPS).
In the condition CRPS, part of your sympathetic nervous system may be damaged or not working properly. The sympathetic nervous system usually keeps control of your body’s readiness to fight, or flee from, a danger.
A guanethidine block tries to block signals to the sympathetic nervous system for a time, in an attempt to re-regulate it.
You will be taken to the operating theatre, as this procedure needs to be done in a sterile environment.
The Pain Medicine Consultant will put in two cannulas (little plastic tubes). One will go into a vein on the affected limb to give guanethidine to you, the other will be in a vein on an unaffected hand and is used to for pain relief and to relax you during the procedure.
Your affected limb will have a tourniquet put on above the level of pain. This will be inflated, to keep the guanethidine in the affected limb. Your limb will turn pale and mottled blue as the blood flow in it stops. This can be an uncomfortable procedure, please let the doctor know if you are in any discomfort.
Two drugs, lidocaine (a local anaesthetic for pain relief) and guanethidine, are then injected through the cannula into the limb and the tourniquet will remain on for the next 20 – 30 minutes.
At the end of this time, the tourniquet will be deflated and your limb will become red and warm. You may feel a little light-headed, this is normal. We will ask you to stay in the hospital for approximately hours, when we will monitor you to ensure that you are well enough to go home safely.
In the following few days you may continue to feel a little light-headed and weak; this is normal, simply rest when you need to and be careful. The guanethidine block should allow you to have more movement in your affected limb. It is important to use this opportunity to gradually build up the activity levels in this limb. The pain relief can last from days to weeks.
If the procedure is effective it is possible that the Pain Medicine Consultant will repeat it at a later visit to attempt to obtain longer lasting pain relief and increased movement.
Epidural Injections
This page is still under construction and is due to be completed shortly. Please contact the Wellington Hospital Enquiry Helpline on +44 (0) 20 7483 5148 if you have any questions on this procedure.
Intrathecal Injections
This page is still under construction and is due to be completed shortly. Please contact the Wellington Hospital Enquiry Helpline on +44 (0) 20 7483 5148 if you have any questions on this procedure.