PainCare - the leading Pain Management specialists in NH

What do I need to do to prepare for my procedure?

If you are new to PainCare, we ask that you follow the detailed instructions given to you at the time of your consult appointment. They usually include the following:

If having IV sedation, do not eat or drink anything for 8 hours prior to your procedure time and have someone with you to drive you home following the treatment.

• Take your regular medications at the normal time with a sip of water only.
• Avoid smoking for 24 hours prior to your procedure.
• Call PainCare if you have a fever, cold or flu, or notice any other changes in your physical condition.  Your provider may want to reschedule your appointment.
• Call PainCare to let us know if you suspect you are pregnant.

When should I arrive at PainCare? 

• Please plan to arrive 15 minutes prior to your scheduled appointment time.  This will allow time to check in with our receptionist and to take care of any necessary paperwork, and to start an IV if sedation is to be administered.
• Be sure to have a driver if you are receiving IV sedation for your procedure.

What can I expect before and during the procedure? 

• You are greeted in the waiting room by a medical staff member and escorted into the procedure area.
• The nurse or medical assistant (MA) will take your basic vital signs such as blood pressure and pulse and briefly assess your pain problem.
• If you elect to be sedated for the procedure, an IV will be started at this time.  The availability of a driver will be confirmed at this time.  You will not be allowed to have IV sedation without a driver.
• You may be asked to change into a hospital gown at this time that allows for easier access to the anticipated injection area as well as to protect your own clothing from the soap used to cleanse the site.
• You are then escorted into the procedure room.

How long does the procedure take?

The procedure usually takes about 5-20 minutes (depending on the extent of the injections) followed by a recovery time of 30-40 minutes during which time you are monitored by our nursing staff.  You will not be allowed to have sedation unless you have someone with you to drive you home.

What happens during a typical procedure?

• You are asked to lie on the procedure table on your belly (often with a pillow under the hips to slightly flatten the curve of the spine).
• The nurse/MA will cleanse the area to be injected with a sterile soap solution.
• You will be greeted by your provider who will confirm your pain location and type of procedure you will be receiving.
• You will be sedated by a qualified anesthetist (if you have elected to receive sedation).
• The provider will then numb the appropriate area to be injected with a local anesthetic similar to Novocaine.
• A needle is inserted into the intended site, guided by fluoroscopy (real-time x-ray) allowing the medical provider to precisely place the needle near the source of pain.
• Once the needle is in place, a small amount of contrast "dye" is injected to confirm proper location followed by a combination of local anesthetic and steroid which bathes the pain generator.  If not sedated, the patient may feel some pressure during the injection, depending on the amount of fluid injected, but it is usually not painful.

What can I expect afterwards? 

• Once the injection is done, you are transferred by stretched to the recovery area for approximately 30 minutes where your vital signs, pain, and numbness are monitored.  If the patient has had sedation, recovery time may be slightly extended.
• The patient's arms or legs may feel dull and heavy after the treatment.  This is temporary and will wear off, usually within minutes.
• The injection site may be mildly tender for a few days after the local anesthetic (Novocaine) wears off and you might experience slight bruising. Applying ice for short periods may be helpful.
• The medical staff will give you specific instructions to follow at home and will call you within 2-3 days to see how you are doing.
• Once the local anesthetic wears off, you will often experience no difference in your usual pain.  Steroid usually begins to takes effect, decreasing inflammation in approximately 24-72 hours.  Occasionally, the beneficial effects will be delayed for as long as 7-10 days.
• A temporary increase in your usual pain is possible and considered normal for a few days following the injection.  This can be due to increased pressure on the pain source caused by the injected fluid as well as the mild chemical irritation caused by some medications.
• After a half-day of rest, normal activities typically can be resumed.

What are the possible risks associated with my procedure?

Most people will not have experience any problems as a result of a procedure. As with any procedures, however, there is always the possibility of unexpected side effects.  For example, infrequently injection can cause some temporary numbness and malfunction of the bladder or bowel immediately following the procedure. Other risks to consider:

• Infection, though rare, is always a risk during any invasive procedure.  However, by following sterile technique throughout, the infection is almost non-existent.
• Dural puncture when doing an epidural injection can cause a 'spinal headache' that usually clears within a few days of rest and fluids. Though it is very infrequent, it may be necessary to perform a simple procedure to stop the headache called a blood patch (a small amount of blood is taken from a vein in the arm and injected into the epidural site which then clots to stop any leaking fluid from the dura).
• Bleeding is extremely rare but again a slight risk as with any invasive procedure, especially if the patient has an underlying disease, or takes medication, which promotes bleeding.
• Nerve damage is very rare and can occur from direct trauma from the needle, or from infection or bleeding.  With the aid of fluoroscopy to visualize and guide the injection, the risk of nerve damage is absolutely minimized.
• Allergic reaction to the medications used in the procedure is a possible, though rare, event.