Interventional Procedures We Offer

Greater Auricular Nerve Block

The greater auricular nerve is a cutaneous branch of the cervical plexus that innervates the skin of the auricle as well as the skin over the parotid gland and mastoid process. The greater auricular nerve also supplies branches that innervate the deep layer of the parotid fascia. Pain in the distribution of the greater auricular nerve can be treated with ultrasound-guided injection and sustained pain relief may be obtained with Pulsed radiofrequency ablation.

Botox for Vaginismus

Pudendal Nerve block

Pudendal neuralgia commonly presents as chronic debilitating pain in the penis, scrotum, labia, perineum, or anorectal region. A pudendal nerve block is crucial for the diagnosis and treatment of pudendal neuralgia. The pudendal nerve is located between the sacrospinous and sacrotuberous ligaments at the level of the ischial spine. Ultrasonography, but not conventional fluoroscopy, allows visualization of the nerve and the surrounding landmark structures.

Botox injections into pelvic floor muscles

A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings. Injecting botulinum toxin type A (Botox) into hypertonic pelvic floor muscles may aid the relaxation of pelvic floor musculature. Nesbitt-Hawes et al reported that clinical outcomes for single and subsequent Botox injections for recurrent pelvic pain are similar. In the subsequent injection, there is a cumulative effect with lower vaginal and maximal contraction pressures. Long-term treatment with Botox is generally tolerable and efficient; nevertheless, following an initial positive therapeutic effect, symptoms may sometimes fail to respond to upcoming treatments.

Stellate Ganglion Block (SGB) For Long Covid

Stellate ganglion block (SGB) is a safe, routine medical procedure that has been in common use since the 1940s, mainly to relieve pain. Its use in long covid, however, is relatively new. Emerging research suggests that SGB may help a subset of patients with long covid who have not found relief from evidence-based treatments such as therapy and medication. The evidence for use of SGB in the management of Long Covid is limited. A case series was published by Luke Liu and Deborah Duricka in the Journal of neuroimmunology in 2022. This case series describes the improvement of long covid symptoms after local anaesthetic blockade of the cervical sympathetic chain bilaterally in two patients suggesting that a regional sympathetically mediated process is involved in the maintenance of their long covid symptoms.

Prolotherapy

Prolotherapy is a method of injection treatment designed to stimulate healing. Many musculoskeletal injuries and pain syndromes lend themselves to prolotherapy treatment includ- ing low back and neck pain, chronic sprains and/or strains, whiplash injuries, tennis and golfer’s elbow, knee, ankle, shoulder or other joint pain, chronic tendonitis/ tendonosis, and musculoskeletal pain related to osteoarthritis. Prolotherapy works by raising growth factor levels or effectiveness to promote tissue repair or growth. It can be used years after the initial pain or problem began, as long as the patient is healthy.

Low Dose Naltrexone (LDN)

Naltrexone is used as an off-label treatment in low doses for several chronic immune-modulated. Although only small-scale clinical trials have been performed, these suggest efficacy in several diseases including fibromyalgia, Crohn’s disease, multiple sclerosis, complex regional pain syndrome (CRPS) and chronic fatigue (ME). Within a specific dosage window, opioid antagonists such as naltrexone can exert a “paradoxical” analgesic effect. Low dose Naltrexone (LDN) is a considered to be a relatively new class of therapeutic agent called glial cell modulators. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone’s better-known activity on opioid receptors.

Botox Injections for Chronic Pelvic Pain

Pelvic pain is a common disorder in women, causing significant morbidity. Often the etiology is not clear as it results from a complex interaction between neurologic, musculoskeletal and endocrine systems that is further influenced by behavioral and psychological factors. A comprehensive approach to the problem requires recognition of the multiple organ systems that may be involved. Botulinum toxin has been shown to be effective in treating chronic pelvic pain caused by hypertonicity in the pelvic floor muscles.

Thoracic Medial Branch Blocks and Cooled RF (Coolief)

The role of thoracic facet joints in chronic back pain has received very little attention, as compared to lumbar and cervical facet joints. Thoracic spinal pain can be as chronic and disabling as neck and low back pain, even though it is less common. Linton et al estimated the prevalence of all spinal pain in the general population as 66%, with 15% reporting thoracic pain, 44% reporting neck pain and 56% reporting low back pain.

Pulsed Radiofrequency of Dorsal Root Ganglion (DRG)

Dorsal root ganglia (DRG), which contain the cell bodies of primary afferent neurons transmitting sensory information from the periphery to the central nervous system, play a key role in the pathogenesis of chronic pain syndromes caused by spinal pathology and peripheral nerve injury. Pulsed radiofrequency of the dorsal root ganglion (PRF-DRG) is a potentially attractive alternative to epidural steroid injection in the treatment of chronic lumbar radicular pain. It is target-specific and avoids the use of steroids, thereby eliminating their potential side effects.

Botox for TMJ Dysfunction

Temporomandibular disorder (TMD) is a nonspecific term used to describe orthopedic and myofascial disorders that affect the TMJ. The prevalence of TMD is between 30% and 44%, with up to 25% of the population seeking professional care for TMD. Symptoms are commonly related to pain surrounding the joint and may include headache, periauricular pain, neck pain, decreased jaw excursion, jaw locking, and noise at the joint with movement.

Knee n-STRIDE APS Injection for Osteoarthritis

Knee osteoarthritis (OA) is a common degenerative disease characterized by chronic pain, joint stiffness, reduced function, cartilage degradation, loss of subchondral bone, and synovial inflammation. Although symptoms may be alleviated with conservative therapies such as analgesic drugs, lifestyle modifications, and physical therapy, no disease-modifying treatment is currently available. In the end phase of OA, joint replacement surgery is currently considered the only solution to relieve symptoms.

Genitofemoral Nerve ablation

Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin and scrotal pain that is localized along the distribution of the genitofemoral nerve.  Existing specific treatments are inefficient and often fail. Radiofrequency neurolysis (pulsed radiofrequency )appears to be significantly more effective than local nerve infiltrations.

Genitofemoral Nerve Block

Genitofemoral neuralgia is one of the most common causes of lower abdominal and pelvic pain encountered in clinical practice. Genitofemoral neuralgia presents as paresthesias, burning pain, and occasionally numbness over the lower abdomen, which radiates into inner thigh in men and women and into the labia majora in women and the bottom of the scrotum and cremasteric muscles in men. A genitofemoral nerve block can be diagnostic as well as therapeutic in patients with genitofemoral neuralgia. 

Lumbar Cooled Radiofrequency

Lumbar zygapophyseal or “facet” joint pain accounts for 15-30% of low back pain cases in the adult population. When facet-mediated pain fails to improve with conservative treatment, interventional treatment may be indicated. The COOLIEF Lumbar Cooled Radiofrequency System uses revolutionary cooling technology for lumbar medial branch neurotomy. Many patients may fail standard RF treatments, or have a challenging anatomy. The COOLIEF* Cooled RF System enables placement of a large volume, spherical lesion encompassing the medial branch nerve in one pass, eliminating the need for multiple passes.

Supraorbital Nerve Block

Supraorbital nerve block can be useful in the management of supraorbital neuralgia.Supraorbital neuralgia is a rare type of neuralgia characterized by persistent pain over the supraorbital region and forehead along with shock-like paresthesias in the distribution of the supraorbital nerve. It is also known as a goggle headache or swimmer’s headache.

Phrenic Nerve Block and Ablation

A phrenic nerve block is useful in the diagnosis and treatment of intractable hiccups. It is also occasionally useful as both a diagnostic and therapeutic manoeuvre to determine whether pain from subdiaphragmatic processes, including abscess and malignancy, is being mediated via the phrenic nerve. A phrenic nerve block with local anesthetic is also used in a prognostic manner before ablation of the phrenic nerve for treatment of intractable hiccups.

Occipital Nerve Ablation

Pulsed radiofrequency ablation of the occipital nerve is a safe and effective option for management of occipital neuralgia and refractory headaches, especially in patients who have not responded to simpler treatments.

Knee PRP Therapy for Osteoarthritis

Osteoarthritis of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint. Platelet-rich plasma injections aim to promote cartilage repair and relieve osteoarthritic symptoms, potentially delaying the need for joint replacement surgery. Platelets produce growth factors that are thought to stimulate chondrocyte proliferation, leading to cartilage repair.

Knee Viscosupplementation Injection

Viscosupplementation therapy has been used increasingly during the last decade, and helps the patients with both pain reduction and halting the disease progression by different mechanisms such as inducing endogenous hyaluronic acid production, inflammation suppression and reduction of the degradation of the cartilage.

Abdominal Cutaneous Nerve Block

Abdominal cutaneous nerve entrapment syndrome (ACNES) is not an uncommon condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses. Abdominal cutaneous nerve block can be of diagnostic and therapeutic value in patients with chronic abdominal pain secondary to abdominal cutaneous nerve entrapment.

Botox For Back Pain

Chronic low back pain is a common condition with diverse etiologies. It is a major cause of functional impairment and disability. In recent years, our understanding of the pathophysiology of low back pain has improved significantly especially in regard to the contribution of dorsal root ganglia and pain mediators.

Lateral Femoral Cutaneous Nerve Block

Painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN) was first described by Bernhardt in 1878, the symptom complex

IlioInguinal Nerve Ablation

Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a frequent complication of surgical procedures involving a lower abdominal incision such as hernia repair, appendicitis surgery, or cesarean sections. Radiofrequency neurolysis (pulsed radiofrequency )appears to be significantly more effective than local nerve infiltrations. It is a safe and effective treatment for chronic inguinal pain.

Hip Joint Cooled Radiofrequency Ablation

Chronic osteoarthritis pain of the hip joint is often not effectively managed with non-pharmacological or pharmacological

Stellate Ganglion Block (SGB) For PTSD

Stellate ganglion block (SGB) is a safe, routine medical procedure that has been in common use since the 1940s, mainly to relieve pain. Its use in post-traumatic stress disorder (PTSD), however, is relatively new. Emerging research suggests that SGB may also help a subset of patients with PTSD who have not found relief from traditional evidence-based treatments such as therapy and medication. A recently completed trial, funded by the US army, found statistically significant evidence that SGB injection can alleviate the sometimes-debilitating symptoms associated with past trauma. Treatments led to a double-digit drop in the score of what is known as the CAPS-5 test, a multifactor evaluation considered the standard for assessing PTSD symptoms. For many cases, the relief came soon after the first injection. For others, two treatments were needed.

Lumbar Medial Branch Blocks

Lumbar medial branch blocks are local anesthetic injections targeting the articular nerves (the medial branches) that transmit sensory information including nociceptive signals from the facet joints. A lumbar medial branch block test is very specific and is intended to determine whether a particular lumbar facet joint is a source of pain.

Cervical Medial Branch Blocks

Cervical medial branch blocks are local anesthetic injections targeting the articular nerves (the medial branches) that transmit sensory information including nociceptive signals from the cervical facet joints.

Botox For Migraine

Botulinum toxin type A (Botox, Allergan) is a purified neurotoxin complex, which is derived from the bacterium Clostridium botulinum. It has neuromuscular transmitter blocking effects. Botox® (onabotulinum toxin A) is licensed specifically for the treatment of chronic migraine. Botox® has not been shown to be effective for any other headache type (e.g. episodic migraine, tension-type headache, cluster headache) as yet.

Suprascapular Nerve Ablation

Suprascapular nerve block remains a useful tool for pain control for different shoulder chronic pain syndromes as well as for acute pain relief following trauma and surgery.

Golfer’s Elbow Injection

Epicondylitis is one of the most common elbow problems in adults, occurring both laterally and medially. Medial epicondylitis of the elbow, commonly referred to as 'golfer's elbow,' is characterized by pathologic changes to the musculotendonous origin at the medial epicondyle.

Tennis Elbow Injection

Lateral epicondylitis, or 'tennis elbow', is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment.

Platelet Rich Plasma Therapy

Platelet-rich plasma (PRP) injection has emerged as a treatment alternative for many musculoskeletal conditions.

Botulinum Toxin Injection (Botox)

C botulinum is a gram-positive anaerobic bacterium that produces the botulinum neurotoxin (BoNT).

Suprascapular Nerve Block

Shoulder pain is common in the community, affecting 15–30% of adults at any one time. Causes include degenerative disease

Coolief: Genicular Nerve Block & RF Neurotomy of Knee Joint

Chronic osteoarthritis pain of the knee is often not effectively managed with non-pharmacological

Plantar Fascia Injection

Plantar fasciitis, reportedly the most common cause of pain in the inferior heel, is estimated to account for 11 to 15 percent of all foot symptoms requiring professional care among adults. Plantar fasciitis has been reported to account for about 10 percent of injuries that occur in connection with running and is common among military personnel.

Achilles Tendon Injection

Achilles tendinitis exists along the spectrum of peritendinitis to tendinosis or tendinopathy. This is a painful, swollen, and tender area of the Achilles tendon and peritenon usually secondary to repetitive activity or overuse.

Quadratus Lumborum Injection

Quadratus lumborum is one of the common sources of low back pain and one that is easily missed or ignored.

Iliolumbar Ligament Injection

Iliolumbar ligament is often over looked as a source of low back pain. The iliolumbar ligament plays an important biomechanical role in anchoring the spine to the pelvic ring and stabilizing the sacroiliac joint.

Ischial Bursa Injection

Bursitis is an inflammation or degeneration of the sac-like structures that protect the soft tissues from underlying bony prominences. Bursitis may result from a local insult or be a manifestation of a systemic disease.

Trochanteric Bursa Injection

Trochanteric bursitis is a term used to describe chronic, intermittent pain accompanied by tenderness to palpation overlying the lateral aspect of the hip.

Rectus Sheath Block

The rectus sheath block was first introduced into clinical practice in 1899 by Schleich when it was used to achieve perioperative muscle relaxation and as an analgesic adjunct. More recently it has been used increasingly for chronic abdominal wall pain.

Intercostal Nerve Block

The intercostal nerve supplies sensation to the thorax and abdomen. Consequently, intercostal nerve blocks and the neuromodulatory techniques may be used to provide analgesia, not only in acute pain but also in chronic pain management.

Pulsed Radiofrequency Treatment

The first pulsed radiofrequency procedure on a lumbar dorsal root ganglion, took place on February 1, 1996. Since then, it has been applied to treatment of myriad pain conditions, including cervical radicular pain, facial pain including trigeminal neuralgia, sacroiliac joint pain, facet arthropathy, shoulder pain, postsurgical pain, radicular pain, groin pain and myofascial pain conditions.

Occipital Nerve Block

Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation or dysesthesia in the affected area.

Inguinal Nerve Block

Ilioinguinal, iliohypogastric, and genitofemoral nerves are collectively known as 'border nerves' because these nerves supply the skin between the abdomen and the thigh.

Piriformis Injection

Piriformis syndrome is an elusive clinical entity. It is likely that this condition is overlooked and overdiagnosed with equal propensity. It is characterized by buttock pain with a variable component of sciatic nerve irritation and probably represents the most common cause of extraspinal sciatica. Systematic clinical assessment will generally lead to the correct diagnosis.

Ganglion Impar Block

Ganglion impar block can be performed in patients with coccyx pain not responding to conservative treatment and simpler injections. It is also indicated in pelvic visceral pain and perineal pain.

Coccyx Injection

Pain in the region of the coccyx is referred to as coccygodynia. Despite being recognised for many centuries, coccydynia remains an unsolved mystery because of the perceived uncertainty in identifying the origin of the pain.

SacroIliac Joint injection

The relationship between the sacroiliac joint (SIJ) and low back pain has been a subject of much debate with some researchers regarding SIJ pain as a major contributor to the low back pain problem, with others regarding it as unimportant or irrelevant. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks.

Trigger Point Injection

Myofascial trigger point injections are frequently indicated for myofascial pain syndrome and are performed as blind procedures. Although these injections are usually safe and effective, complications have been reported. Avoiding the risk of radiation, ultrasonography provides real-time visualization of soft tissue, bone and cartilage, and may be used to guide injections.

Cervical Facet Radiofrequency Denervation

Radiofrequency lesioning refers to delivery of high frequency electrical current in the RF range (500kHz) to patient tissue via an RF electrode to induce a biological effect, such as thermal destruction of nerves that carry painful impulses. As the current is applied at destructive levels, a well-circumscribed heat lesion appears.

Lumbar Facet Radiofrequency Denervation

Radiofrequency lesioning refers to delivery of high frequency electrical current in the RF range (500kHz) to patient tissue via an RF electrode to induce a biological effect, such as thermal destruction of nerves that carry painful impulses. As the current is applied at destructive levels, a well-circumscribed heat lesion appears.

Nerve Root Block

Selective nerve root blocks are based on the assumption that delivering a small amount of medication to a specific target can accurately identify the source of pain and provide information that could affect or predict their surgical outcome.

Dorsal Root Ganglion Block

Dorsal root ganglia (DRG), which contain the cell bodies of primary afferent neurons transmitting sensory information from the periphery to the central nervous system, play a key role in the pathogenesis of chronic pain syndromes caused by spinal pathology and peripheral nerve injury.

Thoracic Facet Joint Injection

The role of thoracic facet joints in chronic back pain has received very little attention, as compared to lumbar and cervical facet joints.

Cervical Facet Joint Injection

Neck pain is common in the general population and even more common in a chronic pain management practice. Studies have estimated the prevalence of neck pain in the general population to be approximately 34%.

Lumbar Facet Joint Injection

Facet joints can be a common source of chronic low back pain. Facet joints are thought to play a part in 15% to 45% of patients with low back pain, 54 to 67% of patients with neck pain and 48% of patients with thoracic pain.

Caudal Epidural Injection

The caudal approach to the epidural space is the earliest known technique for epidural steroid injection or blocks. Caudal epidural steroid injection is a safe, effective technique when performed with appropriate care under imaging.

Lumbar Epidural Injection

Epidural steroid injections are one of the most commonly performed procedures in pain medicine. Although they have historically been utilized for spinal pain of all types, they are widely acknowledged to work better for neuropathic pain.