THE RICHEIMER PAIN
from The Richeimer Pain Institute
NERVE BLOCKS: Part I
After last month’s Pain Update about epidurals, I received several questions about what blocks we do and why we do them. I will provide you with a two part synopsis. If your group would like me to present a slide show talk, A Guided Tour of Nerve Blocks, please email me at the address below, or telephone 310-829-8080.
What are blocks?
Why do we do blocks?
Remember, blocks are not the best treatment for all pain problems. Patients often ask me, “Doc, can’t you just do a nerve block?” Often blocks are not possible, are too dangerous, or simply are not the best treatment for the problem.
The facet joints of the spine can also cause pain. Injections into the facet joints or blocks of the nerves that go to the facets can often be very helpful with these pains. This problem is more common in the lumbar spine, but also occurs in the neck.
Discograms (intradiscal injections of contrast under fluoroscopy or CT imaging) can determine if and which disc is the source of the pain. This can help a surgeon determine which levels of the spine require surgery. If the patient is found to have a painful disc, they may be a candidate for a new and promising technique, intradiscal electrothermoplasty (IDET). In a procedure similar to a discogram, a wire is temporarily inserted into the disc and used to heat the disc. This destroys the invading sensory nerves and causes the proteins of the disc wall to reshape and slowly strengthen (over 3-6 months). The procedure cannot be done if the disc has already severely degenerated.
Next time, I will continue with Part II, when we will look at:
Peripheral nerve blocks
Until then… Steven Richeimer, M.D.
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