New Jersey Society of Interventional Pain Physicians

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The mission of our Society is to educate physicians in the development of safe, cost effective, high quality interventional pain management techniques and safe office practices, to advocate for and facilitate legislation which will promote access to high quality care for New Jersey citizens, and to educate the public, state and other health officials, insurance companies and allied health personal on what treatments are available to alleviate pain and eliminate the problems associated with it.

Procedures
Acupuncture
This is a technique where we place a fine needle into acupuncture points used to block pain or change energy flow throughout the body where there are blocked meridians. It has been demonstrated that electric currents travel through the facial planes of the body and makes contact with the skin through acupuncture points where there is a connection of veins, nerves and arterioles on the surface and on a deeper level these meridians connect with organs and other structures. Every cell and organ has a positive and a negative polarity which is necessary to maintain integrity and function. When these meridians are blocked by trauma, or illness a chain reaction can occur and these energy channels become blocked where the energy flow to the organ system can be affected further. To restore health acupuncture tries to normalize this energy flow. Acupuncture does not cure the dysfunction, but it gives a "tune up" to the body which allows the immune system and organ system to work more efficiently to allow the body to heal itself more efficiently.
Botox Injections
Botulinium toxin is used in medicine to relieve pain, get rid of wrinkles as a cosmetic use and to relax chronic muscle spasm. It has proven to be a safe procedure. It works by permanently binding to the receptors that carry nerve conduction to the muscle. Thus they block the nerve causing a relaxation of the muscle. Since nerves tend to grow back the beneficial effect can last up to 6 months. We use it for chronic neck or back spasms, writer's cramp, piriformis syndrome where the sciatic nerve is trapped in the buttock muscles, RSD pain, chronic nerve pain affecting the skin area, and muscle tension or migraine headaches. We also use it to reduce spasticity in patients that have abnormal muscle tone after a stroke or spinal cord injury or multiple sclerosis. Yes we also use it for reducing facial wrinkles. When we inject Botox we often use nerve conduction, EMG, Ultrasound or fluoroscopic guidance for added accuracy of placement in the muscle or adjacent to the nerve. Since Botox pound for pound is one of the most expensive substances on earth we do not want to waste any in the wrong locations.
Costovertebral Joint Injections
The small joints connecting the ribs to the sternum in the front or spinal column in the back can be a source of pain which is sometimes confused for a heart attack in the chest area or feel like a knife is stuck in the back. With fluoroscopically guided injections with a variety of medications we can alleviate this pain.
Discograms
This is a test to answer the questions where MRI falls short. It is an anatomic and functional test. The Disc in the spine can cause low back or leg pain. With this test we put a very fine needle into the center of the disc and we measure the pressure and test it to not only look for a cause of pain but also to look for tears, cracks and herniations in the disc not visible with MRI scanning.
Epidural Injections
These are specialized injections of anesthetic and cortisone used to reduce nerve pain or pain from a painful disc. Pain relieving medication can be delivered directly to the site of injury to provide rapid relief in either the neck, mid, or lower back. When necessary we can pass a very fine catheter into the spine and steer it to the site of injury for pin point precision.
Facet Injections
The spine is connected by small joints which are a common source of back or neck pain and arthritis. Under fluoroscopic guidance, steroids or prolotherapy solutions can be injected to alleviate the pain.
Intradiscal Electro Thermocoagulation (IDET)
Sometimes a painful disc is not herniated but merely torn on the inside. There are tiny nerves inside which can cause chronic back or leg pain. Only the discogram can make this diagnosis. To treat this we can place a coiled wire into the disc and heat it to a critical temperature which can cauterize the painful nerve endings and provide pain relief.
Joint Injections
Arthritis and sprains can cause chronic joint pain in the hip, knee, ankle, shoulder, elbow, wrist or fingers, toes, and TMJ. When Physical Therapy, or NSAIDS are not helpful we have a variety of methods to alleviate this pain. Cortisone is one option. When that is not successful we can use Hyaluronic Acid which is a gel like medication which acts as an inflammatory and nourishes the joint. They come in different brand names such as Hyalgan, Supartz or Efluexa. This can alleviate pain 3-6 months at times. Sometimes we also add vitamins and glucosamine sulfate. Our newest methods for restoring joint health and reducing pain are the Regeneration and Growth Factor Therapies. These injections are often done with ultrasound or fluoroscopic guidance for accuracy.
Minimally Invasive Spinal Surgical Techniques
Unlike open spine surgery which requires an incision, removal of bone and frequently a hospitalization, new technological advances have miniaturized the tools needed for spine surgery. Now, trained pain management physicians are performing these procedures. There are 4 methods of removing a disc herniation. "Nucleoplasty", uses a special wand which carries electrical energy into the disc creating a plasma field which melts the disc which contacts the wand turning it into a gas thus removing or decompressing the disc. The "Dekompressor" is a device which drills into the disc grabbing disc material along the way and removing it thru repeated entries. "Hydrocision", also known as Hydrodiscectomy, uses a high pressure water jet which cuts through the disc and then sucks out the disc fragments through a suction port. In effect, vacuuming out the disc. All of these procedures are done under real time fluoroscopic guidance using a 360 degree view into the spine. The newest technique is called Laser Assisted Endoscopic Discectomy. This technique is similar to Arthroscopy of the knee only the tools have been miniaturized to be used in the spine. The spinal scope, which has a working channel, is placed into the disc and is attached to a large video monitor allowing us to look inside the disc on the big screen. Through this can we place either a laser, or radiofrequency heating device to vaporize it or we use a grabbing device to pull out the disc. You have the added advantage of being able to remove scar tissue and disc pressing on the nerve and remove bone spurs in the way if they are narrowing the canal where the nerve passes. This is the future of spine surgery.
Nerve Blocks
Not all pain is of spinal origin. When a peripheral nerve is injured often we need to do a nerve block with an anesthetic and anti-inflammatory to block the pain and reduce the pain cycle.This is usually done with ultrasound, fluoroscopic or electromyographic guidance for safety and accuracy. Often we can pin point where the problem is and direct treatments to the region to ameliorate the problem.
Radiofrequency Neurolysis
This technique uses a special needle which can be heated to a precise temperature placed adjacent to the nerve going to the facet joint in the spine used to cauterize it and alleviate pain for up to 24 months.
Sacroiliac Joint Injections
These joints are located below the waist and between the hips. They transfer all the body weight from the spine to the legs and can be a source of pain when there is slippage or weak ligaments surrounding the joint. Under fluoroscopic guidance we can inject the joint with a variety of medications to alleviate the pain.
Selective Spinal Nerve Blocks
Both peripheral and spinal, selective joint, muscle, ligament or tendon injections. These are often performed using either real time ultrasound or fluoroscopy for accuracy.
Spinal Cord Stimulation
In failed back syndromes where there is chronic scar tissue and leg pain we can implant a pair of electrodes on the outside of the spinal column and attach it to an implantable stimulator. This exchanges a light pleasant electrical sensation which can block the pain signals from reaching the brain. The stimulation is fully adjustable by remote control and the batteries can last 10 years or more.
Trigger Point Injections
Muscles are a common source of pain especially when they develop little knots we call trigger points. These can be a great source of chronic pain and nerve irritation. Often this can be relieved with physical therapy, heat treatments, massage and changing postural factors. When it persists we can perform painless trigger point injections with an anesthetic into the muscle to break up the spasm. We describe the injection as an internal massage of the knot to tear it apart and release the spasm. Since there are over 600 muscles in the body this technique requires a keen knowledge of the anatomy and a skilled pair of hands to find the painful trigger points. The pioneer in this field is Dr. Janet Travell who was President Kennedy's personal physician. She also treated his chronic back pain when he was in office.
 

 

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