• Woburn Office: 781-927-PAIN (7246)
  • Beverly Office: 978-927-PAIN (7246)

NSPM Education

Our team is dedicated to the care and treatment of patients in pain. We want to understand your needs and offer the best options to reduce pain and improve activity. Below are services we offer and can assist you with.

Epidural Lysis of Adhesions with Catheter Placement

What is an Epidural Lysis of Adhesions with Catheter Placement?
Also called Racz procedure, this procedure is performed to remove excessive scarring in the epidural space. The epidural space is a thin area between the inside of the spine and the protective layer around the spinal cord. Fibrous epidural lesions can develop after spinal surgery, or can occur secondary to an annular tear, hematoma or infection. Scar tissue may restrict the natural movement of nerves causing inflammation and pain. Patients who have had prior neck or back surgery but still have persistent pain may benefit from this procedure. Patients who have herniated disks that are not surgically correctable may also receive pain relief from this procedure.

This technique is accomplished by the use of a catheter (tube) which physically breaks up scar tissues as well as medications that help to soften scar tissue. It is done with the use of a fluoroscope (x-ray machine) to assist the physician in placement of the catheter.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the procedure hurt?
Mild sedation will be administered to ease any anxiety; however, general anesthesia is not an option since your participation in the procedure is critical to reduce the risk of any complication. The physician will inject local anesthetic to numb up the area prior to placing the catheter through the skin. Once the local anesthetic has set in, the epidural needle will then be introduced through the skin and into the sacral hiatus.

What should I expect after the procedure and what are the side effects?
Pain may increase in the first 48-72 hours because of the mechanical forces used to break up the scarring. The beneficial effects are usually appreciated 2-4 weeks following the procedure. In general, this procedure improves symptoms temporarily, but pain relief can sometimes last for months to years. If necessary, the procedure can be repeated. Because epidural scarring is a difficult problem to treat, some patients may not experience any relief.

Facet Block

What is a Facet Block?
A Facet Block is an injection of local anesthetic (numbing medicine) and steroid medication into a joint in the spine. A medial branch block is similar, but the medication is placed outside the spinal joint space near the nerve that supplies the joint. This nerve is called the medial branch to the facet joint. You may require multiple injections depending upon how many joints are involved. Facet blocks are usually used to treat back pain from arthritic changes in the facet joints or for mechanical low back pain.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over-the-counter medications, including herbal and vitamin supplements.

How long does the Facet block injection procedure take?
The procedure takes about 10 minutes.

Will the procedure hurt?
Most people report that the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure though every person’s response to any procedure is individual.

What should I expect after the procedure and what are the side effects?
Your back or neck pain may be improved immediately after the injection from the local anesthetic medication. It is important to keep track of how you feel for the rest of the day. The steroid medication, when used, takes 2 or 3 days to have effect in most people and has the strongest effect in about 1 week.

What should I do after the procedure?
Some localized tenderness may be experienced for a couple of days after the injection. Using an ice pack with a barrier such as a towel between the skin and ice, three or four times a day will help this. You may take your prescribed pain medications after the injection. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

Intercostal Nerve Block (INB)

What is an Intercostal Nerve Block (INB)?
An intercostal nerve block is an injection of local anesthetic (numbing medication) sometimes with a steroid medication, injected just under the rib, where the intercostal nerve lies. An INB is typically performed for pain in the area of your ribs that comes after having surgery in that area, a rib fracture, herpes zoster (shingles), or when the intercostal nerve becomes trapped.

How long does an INB injection take?
The injection takes about 10 minutes.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the injection hurt?
Most people report that the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure though everyone’s response to the pain is individual. As the injection is near a nerve, it is possible to get a temporary “electric shock” sensation that disappears immediately

What should I expect after the procedure and what are the side effects?
After the injection, you will feel numb in a band-like fashion that follows the rib(s). Your pain may be improved. It is important to keep track of how you feel for the remainder of the day. The steroid medication, when used, usually takes 2-3 days to have an effect, and usually peaks in about 2 weeks. You may feel lightheaded from the local anesthetic medication. This usually lasts a short time. Some tenderness around the injected area may occur for a couple of days after the injection. Using an ice pack with a barrier such as a towel between the skin and ice three or four times a day will help this. You may take your pain medication as prescribed following the injection as needed. Please note how much pain medication you have taken, the amount of pain relief you received, as well as how long the pain relief lasted.

What should I do after the procedure?
No heat is to be used on or around the injected area for the remainder of the day. No tub, bath, or soaking in water (i.e. pool, Jacuzzi, etc.) for at least 48 hours. You may eat, drink, and take your medications as prescribed on the day of the procedure (both before and after) unless instructed otherwise by your physician. If you experience shortness of breath, contact your physician or go to the Emergency Room.

Lumbar Sympathetic Block (LSB)

What is a Lumbar Sympathetic Block (LSB)?
A lumbar sympathetic block (LSB) is an injection of local anesthetic (numbing medicine) into or around the sympathetic nerves. These sympathetic nerves are a part of the sympathetic nervous system. The nerves are located on either side of the spine, in the lower back. Normally, these nerves control basic functions like regulating blood flow. In certain conditions, these sympathetic nerves can carry pain information from the peripheral tissues back to the spinal cord. A LSB is performed to block the sympathetic nerves that go to the leg on the same side as the injection. This may, in turn, reduce pain, swelling, color, sweating and other unusual changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving the legs. Certain patients with neuropathy or peripheral vascular disease may also benefit from lumbar sympathetic blocks.

How long does the SGB injection take?
The injection procedure takes about 10 minutes.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues. We will numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation that makes the procedure easier to tolerate.

What should I expect after the procedure and what are the side effects?
Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some temporary weakness or numbness in the leg, although this is actually not a desired effect of a lumbar sympathetic block.

What should I do after the procedure?
We advise the patients to take it easy for a day or so after the procedure. Perform the activities that you can tolerate. Some of the patients may go for immediate physical therapy. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back at the injection site.

Occipital Nerve Block (ONB)

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What is an Occipital Nerve Block (ONB)?
An Occiptal Nerve Block (ONB) is an injection of local anesthetic medication next to the greater and lesser occipital nerves, which are located just beneath the scalp in the back of the head. Since these nerves are superficial, just below the skin. This block does not involve brain surgery. This type of injection blocks both the greater and lesser occipital nerves, and is useful in diagnosing and treating a condition known as occipital neuralgia. When treating occipital neuralgia or various other painful conditions, a steroid medication is added to the local anesthetic medication. The block may be done on either the left or right side of the back of the head, or both as indicated. The goal of this procedure is to relieve or reduce pain in the back of the head in the scalp. If you respond to the first injection, you may require repeat injections. Usually, a series of such injections is needed to treat the problem. Some patients may need two or 3 injections, and others may require more. Response to this type of injection will be individual. However, patients who are treated earlier in the course of their illness, tend to respond better than those who have this treatment after 6 months of experiencing symptoms.

If you do not get relief from the injection, you may not have occipital neuralgia. This means that the pain in the occipital region (in the back or back and side of your head) may not be due to damage or dysfunction of the occipital nerves. If this is the case, your physician may choose to order different testing to identify or diagnose the cause of your pain.

How long does the ONB procedure take?
This procedure takes about 10 minutes.

Will the injection hurt?
The procedure involves inserting a needle through the skin, beneath the scalp and moving the needle in a fan-shaped pattern to block both occipital nerves. Some discomfort may be felt, although each person’s response to any procedure is individual.

What should I expect after the procedure and what are the side effects?
Immediately after the injection, the back of your head may feel warm. You may have a small lump on the back of your head for a few hours to days. In addition, you may notice that your pain may be gone or lessened considerably. An ice pack with a barrier such as a towel between the skin and ice may be used after the procedure is completed to reduce minor swelling. The local anesthetic effect will wear off in a few hours. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

What should I do after the procedure?
We recommend patients avoid strenuous activities for a day following the procedure; however, you may perform other normal activities as tolerated. You should be able to return to work the next day. You may experience some soreness at the injection site, and you may use an ice pack with a barrier such as a towel to help relieve this as needed.

Radio Frequency Lesioning (RFL)

What is Radiofrequency Lesioning (RFL)?
This is an outpatient procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. Pain relief may last for at least 6 to 18 months. This procedure is performed using Fluoroscopy. Fluoroscopy is a type of X-ray that identifies bony structures. A local anesthetic is used to numb an area on the skin. After confirmation of needle tip placement, a small electrical current is passed through the needle to perform sensory and motor testing. Finally, an electrode is used to send a radio wave frequency, which turns the nerve off.

What are the pre-requisites in order to perform this procedure?
In order to perform the RFL, we would need to perform two separate diagnostic test injections, called Medial Branch Blocks (MBB). These injections consist of different types of numbing medications. Depending on the amount of pain relief after these injections, we may continue to proceed with the final RFL procedure.

How long does the RFL procedure take?
The procedure takes about 30 minutes.

Will the procedure hurt?
This should easily be tolerated by the patient with only mild sedation. Intravenous sedation and analgesia will be available. This makes the procedure easier to tolerate. It is necessary for you to be awake enough to communicate easily during the procedure. We also numb the skin and deeper tissues with a local anesthetic prior to inserting the needle. There is moderate discomfort involved for a few weeks after. You may have numb areas with increased sensitivity (like a deep sun burn).

What should I expect after the procedure and what are the side effects?
Initially, there will be muscle soreness for up to 7-10 days afterward. Ice packs will usually control this discomfort. After the first 4-6 weeks, your pain may be gone or quite less. Some patients may have some “deep sun burn” type of feeling. Some may develop hypersensitivity or burning pain, or numb areas for a few weeks.

What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform activities as tolerated.

Sacroiliac Joint Injection (SI)

What is a Sacroiliac (SI) Joint Injection?
A Sacroiliac (SI) Joint Injection is performed with a long acting steroid medication and local anesthetic (numbing medication). The sacroiliac joints are located in the back where the sacrum joins the pelvis. The goal of a sacroiliac injection is to provide pain relief by reducing the inflammation at the SI joint.

How long does the SI joint injection take?
The procedure takes about 10 minutes.

What are the pre-requisites in order to perform the procedure? You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over-the-counter medications, including herbal and vitamin supplements.

Will the injection hurt?
Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure, though everyone’s response to pain is individual.

What should I expect after the procedure and what are the side effects?
Immediately after the injection, you may feel that your pain may be lessoned or gone. This is a result of the local anesthetic that was injected. This should only last for a few hours. Your pain may return and you may have a sore back for one to two days. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief by the third to fifth day, which may last days to months. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

What should I do after the procedure?
Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is soreness at the injection site. You may apply ice with a barrier such as a towel between the skin and ice to the affected area to help relieve the soreness. After the first day, you may perform activity as tolerated.

Stellate Ganglion Block (SGB)

What is a Stellate Ganglion Block (SGB)?
A stellate ganglion block (SGB) is a sympathetic block in which a local anesthetic (numbing medication) is injected into the bone of the neck for pain located in the head, neck, chest, or arm. This may be caused by Chronic Regional Pain Syndrome, which is often a result of nerve injury causing adrenaline in the body to stimulate pain signals. It may also be caused by herpes zoster (shingles), or intractable angina or heart related chest pain. Stellate ganglion blocks are also used to see if blood flow can be improved in circulation problems from Raynaud’s or CREST syndrome.

How long does the SGB injection take?
The injection procedure takes about 10 minutes.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the injection hurt?
The physician has to press on your neck to locate the area to be injected. Many patients find this awkward and somewhat uncomfortable. The injection itself is done using a very small needle. Most people say the burning/stinging of the numbing medicine is the most uncomfortable part of the procedure, though everyone’s response to pain is individual.

What should I expect after the procedure and what are the side effects?
There are expected changes that result from blocking the sympathetic nerves. These changes last about 4-6 hours. You may note, on the injected side: drooping of the eyelid, “bloodshot eye”, stuffy nose, temperature increase, you may also experience hoarseness and/or difficulty swallowing, and a warm arm.

What should I do after the procedure?
Your neck may be tender or feel bruised after the injection. One eye may be droopy for 1-2 hours only. If you experience hoarseness in your voice, use caution when swallowing. If your arm gets numb or heavy you will have to protect it with a sling until sensation returns, usually for 4-6 hours. You may take your prescribed pain medications after the injection.

Transforaminal/Epidural Steroid Injection (TFE)/(ESI)

What is a Transforaminal/Epidural Steroid Injection (TFE/ESI)?
This is an outpatient procedure in which we inject steroid medication into the epidural space. Sometimes, a local anesthetic is added to the steroid mixture. The epidural space is a space located in the spine between the vertebrae. The goal of a TFE/ESI is to provide relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. A TFE/ESI will not correct the pre-existing medical problem (i.e. spinal stenosis, herniated or bulging disc, arthritis, etc.) but may decrease the level of pain. The injections are done in a series of three, approximately 1 month apart. An injection may be repeated every 3 months if the pain returns.

How long does the TFE/ESI procedure take?
The procedure takes about 10 minutes.

What are the pre-requisites in order to perform this procedure?
You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the injection hurt?
Most people report that the stinging or burning of the numbing medicine is the most uncomfortable part of the procedure though every person’s response to any procedure is individual.

What should I expect after the procedure and what are the side effects?
Most people don’t feel any different immediately after the injection though the pain may be temporarily removed or worsened. The steroid medication takes two or three days to start to have an effect in most people and peaks in about one week. Therefore, it may be awhile before you feel a change in your pain. Some tenderness around the injection site may be experienced for a couple of days after the injection. Using an ice pack with a barrier such as a towel between the ice and skin three or four times a day will help this. You may take your prescribed pain medications after the injection. It is important that you keep track of the amount of pain medication you are using.

What should I do after the procedure?
No heat is to be used on or around the injected area for the remainder of the day. No tub, bath, or soaking in water (i.e. pool, Jacuzzi, etc.) for at least 48 hours. You may eat, drink, and take your medications as prescribed on the day of the procedure (both before and after) unless instructed otherwise by your physician.

Trigger Point Injection (TPI)

What is a Trigger Point Injection (TPI)?
A trigger point is a tight band of tissue within a muscle, that when pressed upon, causes your typical pain. Trigger Point Injections (TPI) are ordered by your physician to try to help “break up” the tight muscle. A TPI is an injection of local anesthetic (numbing medication), with or without steroid medication, into the trigger point in the muscle. You should be involved in an active stretching and strengthening program to help prevent the trigger points from coming back. TPI may need to be repeated, especially if you are unable to perform exercises because of pain or spasm. Stretching and exercise are key to both eliminating and preventing trigger points.

How long does the TPI take?
The procedure takes under 10 minutes.

Will the injection hurt?
The most effective trigger point injections are the injections that feel like your typical pain at the time of the injection. Therefore, there may be temporary discomfort/pain upon the injection, but as it is local anesthetic (numbing medicine) with or without steroid medication, the discomfort/pain is short-lived.

What should I expect after the procedure and what are the side effects?
Your pain will be improved immediately after the injection from the local anesthetic medication. The steroid medication, when used, usually takes two or three days to have an effect in most people and has its stronger effect in about two weeks. Some tenderness around the area injected may be experienced for a couple days. Using an ice pack with a barrier such as a towel between the skin and ice three or four times a day will help this. Do not use heat for the remainder of the day of the injection. Have someone massage the area injected to help break up the spasm is helpful. Gentle stretching exercises of the involved area are also recommended. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

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