Other Injections

Other Injections

Several other types of interventions or injections can be performed for chronic pain. Some of them are listed here.

1 - Trigger Point Injections

1. What are trigger points?

Trigger points are tender knots or cords of muscle that will not relax. These can cause pain and decreased range of motion.

The goal of trigger point injections is to break this cycle of muscle spasm and allow the muscles to relax.

2. The Procedure

You will be positioned either in a chair or on a bed. The injection sites will be washed with a sterile cleaning solution. The most tender areas, or trigger points, will be identified. Local anesthetic (“numbing” medication) will be injected into the trigger points, sometimes using ultrasound guidance.

3. After the Procedure

You will remain in the recovery room or clinic for observation. The staff will give you discharge instructions.

2 - Stellate Ganglion Block

1. What is the stellate ganglion?

The stellate ganglion is a group of nerves that regulate many bodily functions, including blood flow and sweating in the arms, head, and neck. Sometimes, these nerves can be involved in the transmission of pain, even after an injury has healed. This can result in a condition known as Complex Regional Pain Syndrome (or CRPS).

The goal of a stellate ganglion block is to “numb” the nerves that carry the pain message, hopefully breaking the cycle of pain signaling. This allows for more active participation in physical therapy, which can improve pain and symptom control long term in CRPS. Sometimes, a series of these blocks may be recommended 1-2 weeks apart to help give more long term pain relief.

2. The Procedure

You will be positioned on your back. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection.

Local anesthetic (“numbing” medication) will be injected into the skin. Contrast dye will be used to confirm the appropriate position of the needle. Then, local anesthetic will be injected at that site; sometimes, other medications are injected as well.

3. Before the Procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

4. After the Procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

3 - Lumbar Sympathetic Block

1. What are lumbar sympathetic nerves?

Lumbar sympathetic nerves are a group of nerves that regulate many bodily functions, including blood flow and sweating in the legs. Sometimes, these nerves can be involved in the transmission of pain, even after an injury has healed. This can result in a condition known as Complex Regional Pain Syndrome (or CRPS).

The goal of a lumbar sympathetic block is to “numb” the nerves that carry the pain message, hopefully breaking the cycle of pain signaling. This allows for more active participation in physical therapy, which can improve pain and symptom control long term in CRPS. Sometimes, a series of these blocks may be recommended 1-2 weeks apart to help give more long term pain relief.

2. The Procedure

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection.

Local anesthetic (“numbing” medication) will be injected into the skin. Contrast dye will be used to confirm the appropriate position of the needle. Then, local anesthetic will be injected at that site; sometimes, other medications are injected as well.

3. Before the Procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

4. After the Procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

4 - Celiac Plexus Block

1. What is the celiac plexus?

The celiac plexus is a collection of nerves in the abdomen that sends pain messages from the pancreas, liver, gallbladder, stomach, and intestines to the brain.

The goal of a celiac plexus block is “numb” the nerves that carry the pain message, hopefully breaking the cycle of pain signaling. In patients with pain from pancreatic cancer, longer lasting relief may be obtained by injecting alcohol or phenol; this procedure is called neurolysis.

2. The Procedure

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection.

Local anesthetic (“numbing” medication) will be injected into the skin. Contrast dye will be used to confirm the appropriate position of the two needles on either side of the celiac plexus. Then, local anesthetic will be injected at that site; sometimes, other medications are injected as well.

3. Before the Procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

4. After the Procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

If a neurolysis is being performed, you will be observed in the hospital, typically for 2-4 days.