Tests & Procedures for Pain Management

Chronic pain can prevent you from doing things you love — but you don't have to simply live with the discomfort. At The Institute for Advanced Reconstruction, our revolutionary approach to pain management is paving a better way forward. We use a multimodal approach to manage chronic pain, designing a comprehensive treatment plan to restore your functionality and enhance your comfort.

Dr. Nicole Ferro serves as our pain management specialist, working hand-in-hand with our surgeons to maximize successful patient outcomes through advanced preoperative and postoperative rehabilitation methods.

Diagnosing Your Pain Condition

The first step to effective pain management is understanding its underlying cause. Pain can occur after an accident, or it may present as a symptom of a disease or chronic condition. Identifying the reason for your pain helps us create a targeted treatment plan that will maximize your relief.

We offer several advanced diagnostic tests that can help us determine what’s causing your pain. The right one for you depends on many factors, including where you're experiencing pain, specific symptoms, and prior diagnoses. In general, we may recommend the following diagnostic tests:

  • Blood tests: Certain types of arthritis and infections can sometimes be identified with a blood test.
  • Bone scans: A bone scan uses nuclear imaging to identify infection, fractures, or other disorders.
  • MRIs: Especially useful in diagnosing lower back pain, MRIs can show tumors, herniated discs, scar tissue, and more.
  • CT scans: Computed tomography scans produce 3D X-rays images that provide a clear picture of your body's internal structures.
  • X-rays: The procedure is useful in diagnosing arthritis, disc degeneration, neck and back pain, fractures, and much more.
  • Nerve blocks: Using ultrasound imaging as a guide, we deliver pain medication to sensory nerves to assess the level of pain relief.

Treatments for Pain Management

By combining surgical and non-surgical interventions, our pain management specialists are able to deliver comprehensive relief. Dr. Ferro works in conjunction with our surgeons to create a personalized treatment plan for each patient. Our goal is to improve your day-to-day comfort by targeting the source of your pain.

Non-Surgical Interventions

Our treatment methods focus on non-opiate management supplemented with interventional procedures.

Epidural Steroid Injections

Epidural injections are a safe and effective way to minimize burning pain that originates in the spine and radiates down the arms and legs. Using X-ray guidance, we inject a small amount of corticosteroid into the space above the spinal cord and spinal nerves, which helps reduce nerve irritation due to inflammation and provides pain relief. Most patients are able to resume walking immediately. You can expect pain relief to last for around one to three months, though some patients experience reduced pain for 12 months or longer.

Facet Joint Injections

Arthritis can impact even the smallest joints of the body. When the facet joints are affected, you may experience referred pain of the neck, low back, and buttocks. Facet joint injections use a mixture of anesthetic and corticosteroid to provide pain relief. We inject the medication with a fine needle, using X-ray to guide the insertion. We encourage patients to walk around immediately after the procedure to enhance blood flow, though you should avoid heavy lifting for 24 hours. Your pain relief should last for around four months.

Radiofrequency Ablations

When nerve block testing indicates it can alleviate pain in facet joints, radiofrequency ablation could be a viable option for long-lasting pain relief. The procedure works similarly to diagnostic injections, using needle-like probes to reach the medial branch nerves. Once the probes are in place, we perform a quick simulation test to ensure accuracy. We administer local anesthetic and connect the probes to a machine that delivers a current to the nerve. This current creates a thermal lesion, diminishing the nerve's ability to transmit sensory pain signals back to the brain. You will need someone to drive you home after the procedure, and we recommend resting for the next 1-2 days. While some may experience pain relief immediately, others may need up to three weeks to see results. Pain relief should last for six months to up to 12 months.

Spinal Cord Stimulator Trials

Spinal cord stimulation devices can provide patients with significant relief from pain. To help you assess their effectiveness, we offer device trials before implantation. For the procedure, we use local anesthesia and mild sedation if necessary. The entire process takes about an hour. We use X-rays to help us guide a needle cannula into your epidural space. Then, we place wires on targeted areas of your spine. You will wear the device taped to your back for 5-7 days. During this time, we will assess whether you experience improvements in pain or functionality to decide if the device suits you. Since the device is outside your body and cannot get wet, you should avoid taking a full bath or shower. Refrain from strenuous activities that could pull the leads out of place. When the trial is over, we will remove the device in our office.

Lysis of Adhesions

Multiple surgeries often lead to increased scar tissue, which may entrap spinal nerves and trigger pain and inflammation. We perform lysis of adhesions to break down this tissue and alleviate pain. Using local anesthesia with lidocaine, we access the epidural space from the tailbone area using X-ray guidance. We use a guide wire and contrast dye to identify areas of scar tissue adhesions surrounding the spinal nerves. The procedure breaks up scar tissue adhesions with a high volume of injectate, which minimizes inflammation to provide pain relief. After the procedure, we recommend taking it easy for a few days. Avoid heavy lifting or strenuous activity for several weeks.

Diagnostic Nerve Blocks

A peripheral nerve block is a diagnostic test that helps identify which sensory nerves are causing pain and if your pain originates from the nerve or joint. The test allows us to assess nerves in various regions, including your knee, shoulder, occiput, arms, legs, and pelvis. Using ultrasound guidance, we isolate the nerve and guide a thin needle to the area to inject a mixture of steroid and anesthetic medication, thus providing pain relief. Most patients can resume normal activities the day after the procedure. Pain relief may last as little as a few hours or days to several weeks, depending on the medication mix used.

Peripheral Joint Injections

Conditions such as bursitis and arthritis can lead to pain in the peripheral joints. Peripheral joint injections use steroids and anesthetic medication to reduce inflammation and provide targeted pain relief. The procedure uses ultrasound or X-ray to guide a thin needle into the joint area. Once in place, we administer medication to alleviate joint pain in the elbow, shoulder, knee, hip, and ankle. The procedure takes only minutes to complete. You can expect pain relief to last for months.

Tendon Sheath / Bursa Injections

Repetitive-use injuries can prove to be very painful and take several months to heal. To help reduce pain and inflammation, we offer injections using a combination of corticosteroid and local anesthetic. We administer the medication to the painful areas surrounding the tendons and joint spaces using a thin needle guided by ultrasound. When used in combination with consistent physical therapies, this process often results in pain relief and allows for improved functional use. Most patients report feeling a reduction in pain and inflammation within a few days.

Botox® for Migraines

When traditional migraine therapies such as medication prove inefficient, Botox® (OnabotulinumtoxinA) injections could be a practical next step in your migraine management. Botox® works by reducing the ability of specific facial muscles to contract, increasing relaxation and alleviating migraine frequency. Using a fine needle, we inject Botox® into various muscles surrounding the face, neck, shoulders, and temple. We recommend taking the rest of the day off following the procedure and avoiding strenuous activity for 24 hours. It may take up to four weeks for you to notice a reduction in migraines. The most common treatment timeline involves an injection every 12 weeks, or four times per year.

Medication Management

Dr. Ferro provides comprehensive treatment to diagnose and manage complex peripheral neuralgias by working with our plastic and reconstructive surgeons who specialize in peripheral nerve conditions. This unique collaboration at The Institute for Advanced Reconstruction allows us to coordinate world-class care for patients, from diagnosis and surgical planning to surgery and post-operative rehabilitation.

Surgical Interventions

We take a comprehensive approach to pain management, merging advanced surgical techniques with the latest interventional procedures. The right surgery will depend on the cause and location of your pain. Some of the surgical procedures we offer include:

  • Nerve decompression surgery for diabetic neuropathy: This innovative, minimally invasive procedure relieves pressure on swollen, damaged peripheral nerves, allowing room for the nerves to “breathe” — alleviating symptoms of neuropathy and reducing the risk of amputation.
  • Pudendal nerve decompression surgery for chronic pelvic pain: In this procedure, we alleviate pelvic pain and pressure by decompressing the pudendal nerve and its associated nerve structures. We have seen great success with this minimally invasive technique, with many patients experiencing significant relief from symptoms.
  • Brachial plexus reconstruction for shoulder or arm pain: We perform advanced nerve surgeries for brachial plexus damage, including nerve grafting, nerve transfer, nerve repair, and decompression and neurolysis.
  • Free periosteal core decompression for avascular necrosis: This procedure combines core decompression with free tissue transfer, replacing the dead portion of the bone with new bone and restoring blood supply to the affected area.
  • Nerve decompression surgery for migraines and headaches: Also known as trigger point surgery, this procedure targets the nerves in the head and neck region that cause or contribute to headache or migraine symptoms, removing muscle, tissue, and blood vessels from the areas in which the nerves travel.
  • Joint denervation surgery (neurectomy) for joint pain: This microsurgical technique targets the nerves causing the pain, cutting and then placing the affected nerve into a nearby muscle to cease pain. As we only remove pain-transmitting nerves, you won’t need to worry about loss of sensation or functionality.
  • Targeted muscle reinnervation (TMR) surgery for phantom limb pain: Misdirected nerve growth after amputation can lead to pain in the residual limb. This surgery involves the transfer of nerves that once controlled the amputated limb, allowing nerves to grow back into the new muscles, decreasing pain.
  • Microsurgical denervation of the spermatic cord for chronic testicular pain: We use a minimally invasive procedure to surgically cut nerves that send pain signals from the testicles to the brain, alleviating chronic testicular pain.

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