Interventional Pain Medicine

Hoag’s team consists of physicians, physician assistants, and nurse practitioners who have specialized training in pain management. They treat various types of chronic pain in both an outpatient and inpatient setting including:

• Back and Neck pain due to injuries or degenerative arthritis

• Lumbar and Cervical Radiculopathy (aka “Sciatica”)

• Post-laminectomy syndrome (aka “Failed Back Surgery Syndrome”)

• Cancer pain

• Complex regional pain syndrome (aka “Reflex Sympathetic Dystrophy”)

• Arthritis

• Headaches

• Orofacial Pain

• Myofascial (Muscular) pain syndromes

• Neuropathic pain including diabetic neuropathy and post shingle neuropathy

• Lumbar Spinal Stenosis due to Ligamentum Flavum Hypertrophy

• Coccydynia (tailbone pain)

• Pelvic pain

• Post traumatic or post surgical acute pain

If a full work-up of pain has not been performed, the team will refer for appropriate diagnostic procedures. The clinic has the capability to perform Nerve Conduction Studies/Electromyography to diagnose neuropathy or radiculopathy. Additionally there are diagnostic blocks which can help identify the source of pain in some cases. These include medial branch blocks and lateral branch blocks to diagnose facet and sacroiliac joint pain, respectively. Discography of the cervical or lumbar discs can be utilized to identify the most symptomatic disc and may help guide surgical intervention.

Hoag’s team employ a multi-disciplinary approach to complex chronic pain conditions since clinical studies have demonstrated that this approach is superior than any single modality.

• Spine Injections

• Peripheral Nerve Blocks

• Joint/Muscle Injections

• Botulinum toxin (Botox) Injections for Chronic Migraine or Limb Spasticity

• Medication Management

• Pain Neuropsychology

• Consultation with Spine Surgeons, Neurologists, and Rheumatologists as Needed

• Physical/Aqua/Occupational Therapy

• Referral to Chiropractic, Acupuncture, or Complementary Medicine

• Advanced Pain Intervention

• Epidural Steroid Injection (Cervical/Thoracic/Lumbar)

• Transforaminal Epidural/Selective Nerve Root Blocks

• Occipital Nerve Blocks

• Facet Joint Steroid Injections (Cervical/Thoracic/Lumbar)

• Medial Branch Blocks (Cervical/Thoracic/Lumbar)

• Sympathetic Blocks (Stellate Ganglion Blocks, Lumbar Sympathetic Blocks, Ganglion Impar Injections)

• Interscalene Blocks

• Intercostal Nerve Blocks

• Ilioinguinal/Iliohypogastric Blocks

• Piriformis Injections

• Pudendal Nerve Blocks

• Epidural Blood Patch

• Shoulder Injections

• Knee Injections (Steroid or Viscosupplementation/Gel Injections)

• Hip Injections

• Ankle Joint Injections

• Trigger Finger Injections

• Elbow Injections

• Thumb Joint Injections

• Trigger Point Injections: These injections in muscles are designed to help relieve pain associated with Myofascial Pain Syndrome, a condition in which regional muscle pain is experienced.

• Spinal Cord Stimulation Trial/Implant: a technology in which a battery and one or more electric wires are implanted in the body. The wires are placed in the epidural space, near to the spinal cord. When activated, these wires carry electric impulses that can block or disrupt ordinary pain impulses via the Gate Control Theory. Patients may feel a tingling sensation when this device is on. Note: this is not the same as a TENS unit.

• Peripheral Nerve Stimulation Trial/Implant: a technology in which an electric wire is implanted in the body. The wires are placed adjacent to peripheral nerves. When activated, these wires carry electric impulses that can block or disrupt ordinary pain impulses. Patients may feel a reduction in pain along the distribution of the peripheral nerve which can reduce pain along the knee, ankle/foot, shoulder, head/neck or lower back regions.

• Radiofrequency Ablation/Neurotomy of Medial Branch (cervical/thoracic/lumbar): involves stunning and/or burning of small nerves that supply the facet joints of the spine. This procedure can provide 6-24 months of pain reduction if successful. The nerves that are burned in this procedure are expected to regrow with time and this procedure can be repeated.