There are countless underlying causes of back pain, most of which can be treated at Granite State Pain Associates. These include cervical spine disorders, degenerative disc diseases and spinal conditions, herniated discs, lumbar spine disorders, sciatica, and osteoarthritis, to name just a few. Spine symptoms will typically resolve with the appropriate non-operative approach, including physical therapy, pain management, lifestyle changes,  and other modalities. Our aim is to return patients to regular activities quickly, without heavy reliance on medications.
If painful symptoms persist despite conservative measures, interventional spine care (injections) may be recommended. The goals of interventional spine care are to relieve, reduce, or manage disabling symptoms while improving a patient’s overall quality of life, using minimally invasive techniques that can be performed under IV sedation.

Conscious sedation is the primary method of sedation used at Granite State Pain Associates for spinal injections and implants. It is a technique whereby medications such as propofol and/or versed are safely injected through an IV (intravenous) site which produces a very relaxed state that will allow you to better tolerate any discomfort during the procedure. You are often very sleepy, able to speak and respond appropriately to questions though you may slur your words a bit. There is usually a short period of amnesia which reduces or eliminates memory of the procedure itself, and of conversation carried on during the process.

The epidural space lies outside the spinal cord between the vertebrae and the dura mater (a tough membrane which encloses the spinal cord and the cerebrospinal fluid). Via the epidural, the spinal nerves to the entire body can be accessed and treated with medications. The space is filled with loose fatty tissue and small blood vessels.

While oral pain medications and steroids are widely dispersed by the body’s circulation, epidural injections by contrast deliver medications directly to the pain generator. This targeted approach can often lessen or eliminate the side effects that many oral medications have. Another benefit is that an epidural steroid injection can help control localized inflammation while at the same time “flushing out” the area of inflammatory proteins and chemicals that may many times contribute to pain.

There are two primary purposes of nerve blocks:

• To temporarily ‘block’ or control pain caused by a particular nerve or spinal nerve root by interrupting the pain signal before it reaches the brain.
• As a diagnostic technique in which blocking the pain signal that causes pain helps to identify the nerves that are the pain generators or carriers of the pain.

Although nerve blocks can be beneficial to many pain sufferers, it is important to understand that they are only one of many tools used in a comprehensive and individualized pain treatment plan.  Nerve blocks are usually used in conjunction with other treatment approaches such as physical and exercise therapy. Blocks can offer a window of opportunity that allows for effective rehabilitation to take place, ultimately helping the patient return to normal function.

Trigger points are soft tissues (usually muscle) which when palpated cause a reproduction of the patient’s pain.
Sometimes the trigger point is palpable as when a band of muscle is contracted. Usually local anesthetic (e.g. Novocaine) is injected; sometimes Botox (botulinum toxin) is used.

The use of Platelet-Rich Plasma to treat acute and chronic injuries was developed in the 1970’s, but has been used much more widely in recent years for athletes and for pain management, dental, cardiac and plastic surgery patients. In this treatment process, a patient’s own blood is drawn and manipulated in a way that multiplies its normal healing capacity. It is then injected back into the injured area, where the PRP can speed the healing process of injuries and conditions such as sprains, chronic tendinitis, osteoarthritis, nerve damage and more. It can also be used post surgery to kick start recovery.

Most painful disorders can be treated safely and effectively with a blend of medications, injections, physical therapy, and behavioral and lifestyle counseling.

Pain management is always an individualized process.  A plan that works for one person can be very different from what works for another.  Medication management, therefore, often involves time, patience, and a course of repeated trials and re-assessments.  It is your responsibility to understand the prescribed medication regimen, take medications only as directed, and communicate their effectiveness to your provider.  In order to manage medications effectively, it is necessary to be seen by your provider at regular intervals. Medication changes over the telephone are discouraged.

A discography is a diagnostic procedure in which a fluoroscopically-guided x-ray dye is injected into a suspect spinal disc and an x-ray (discogram) is taken.  The injection pressure may reproduce the pain and visually demonstrate the pathology, such as a tear in the lining of the disc.
The results of discography can be used to predict success with IDET (IntraDiscal ElectroThermal Therapy) or Nucleoplasty.

Myelography is a diagnostic tool that uses x-ray to examine the structures within the spinal column following injection of contrast dye into the cerebrospinal fluid. The examination can show conditions such as spinal tumors, spinal cord swelling and herniated discs.

Spinal cord stimulation is identical to the procedure for PNS described above, except that it delivers electronic impulses directly to spinal cord not peripheral nerves. The permanent implant is a bit more complicated than with peripheral neuromodulation, and attendant risk of complication is somewhat greater.

Learn more about Granite State Pain Associate’s qualifying information for Medical Marijuana / Therapeutic Cannabis

Somersworth Physical Therapy is located onsite at our Somersworth location to provide comprehensive evaluation and treatment of musculoskeletal disorders.

The convenience of having qualified physical therapists on site has proven invaluable to the providers and patients of Pinewood Medical Center alike.

Somersworth Physical Therapy is committed to providing the most current and up to date treatments ensuring that every patient lives a stronger, healthier life.

Chemical neurolysis is nerve ending destruction using chemicals (e.g., dextrose, alcohol) to promote pain relief. The nerves readily absorb the chemical and over several treatments the nerve endings are destroyed.

Epiduroscopy is a method of directly visualizing and potentially treating pain generators inside of the spinal column.  A small flexible fiberoptic catheter is inserted through a tiny incision and the areas of concern can be visualized on a video monitor.  Medication can then be injected through the same catheter.

Radiofrequency lesioning is a minimally invasive procedure to treat pain, using a specialized machine called a “radiofrequency lesion generator.”  Lesioning destroys the sensory nerve endings of painful joints in the spine.

Vertebroplasty is a minimally invasive procedure used to treat compression fractures of the vertebrae.  By injecting an acrylic cement mixture into the center of the collapsed bone, vertebroplasty can strengthen and stabilize the fracture rendering it far less painful.  The procedure is usually done on an outpatient basis and requires only local anesthetic.

Viscosupplementation (joint lubrication therapy) is an injection in which a lubricating gel-like substance (hyaluronate) is injected into the knee joint. The knee bends an average of 1 million times per year. To aid in all that movement, the joint is naturally filled with synovial fluid which acts as a lubricant and shock absorber.  The injection of hyalurinate is used to supplement the synovial fluid which is often deficient in arthritic knees.

The concentration of natural occurring hyaluronate in the synovial fluid is reduced resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the knee, resulting in joint pain, stiffness and worsening of osteoarthritis.

Epidurography is both a diagnostic and treatment tool.  It is used to assess the structure of the epidural space in the spine by injecting contrast dye under fluoroscopic guidance. This procedure is usually also done before epidural steroids are administered to ensure accurate delivery of therapeutic material to the source of your pain.  The procedure is used in the detection of herniated discs that are not seen with myelography.

Fluoroscopy is a continuous mode of x-ray that captures moving images and allows the physician to deliver a safer more accurate, and effective injection.  It also is classically used for procedures that involve placing a tube, catheter or other device internally.
As with any X-ray, you do not feel any sensations from fluoroscopy itself.