At CVMC’s Pain Clinic, our team of anesthesiologists provide a variety of outpatient pain block procedures, as well as medical consultations, for alleviating and managing chronic pain.
Our anesthesiologists provide basic pain consultations for patients referred by their primary care physicians. The anesthesiologist will meet with the patient and provide recommendations about pain medication and other options for dealing with chronic pain. While anesthesiologists do not prescribe pain medication, their specialized knowledge about the types of pain medication available and how different pain medications interact or work together can help the patient’s PCP in prescribing a new or modified course of treatment.
Epidural Injections are outpatient procedures conducted in the Ambulatory Care/Day Surgery unit at CVMC. These procedures involve the injection of long-lasting pain medication directly into the epidural space and are commonly used for non-surgical relief of arm, back, neck and lower leg pain (sciatica), as well as other chronic conditions.
What is the Epidural?
The epidural is a sleeve-like space that surrounds the dura, which covers the nerve roots in the spine. Nerves must travel through this epidural space to reach the arms, chest and legs. In order to avoid injecting pain medication directly into the spine or nerves, medication is injected into the epidural space, where it will travel to the nerves, helping to reduce swelling and inflammation and block pain.
Benefits of Epidural Injections
Epidural procedures can benefit patients who have experienced a recent injury by providing pain relief and reducing swelling, therefore allowing the patient to heal and participate in physical therapy. For patients with chronic pain that has not responded to physical therapy, epidurals can be used over time for long-term pain relief. Some epidurals are also used for diagnostic purposes, in order to locate the source of the pain.
Number and Frequency of Injections
The number of initial injections and the long-term frequency of epidural injections vary from patient to patient. Initial relief is usually achieved with one or two injections. If this initial course of treatment provides permanent relief, no additional injections will be required. For those with chronic pain, injections will be repeated as needed, every few months, as the effects wear off. No more than three injections are administered over a 6 month period.
The following types of Epidural Injections are performed at CVMC:
Lumbar Epidural Steroid Injection
This injection of a long-lasting steroid (cortisone) into the epidural space is a common form of pain management for sciatica and lower back pain. Pain relief from this procedure is temporary and on average can last several months.
Lumbar Facet Joint Injections are utilized for both diagnostic and therapeutic purposes. If a patient receives immediate relief from steroid injections to their facet joints, this will confirm that the facet joint is the source of the pain. The injections also include time-released anti-inflammatory medicines, such as cortisone, that can provide long-term relief of several months to a year. For patients who experience long-term relief, this procedure can be repeated over time as necessary.
If the procedure indicates the facet joint but the patient receives only temporary relief (e.g. a few days), they may be referred to Dartmouth Hitchcock or Fletcher Allen Health Care for a Radio Frequency Ablation (RFA). RFA is a procedure that uses radio waves to produce an electrical current that heats up the facet joint, therefore decreasing pain signals from that specific area. Pain relief from RFA can last 6 to 12 months or longer.