Eradicating Pain

patient under goes ct scan

Pain Management

With an estimated 100 million Americans suffering from chronic pain annually, it’s no surprise that pain is a popular topic at physician and radiology offices across the country. Pain management and the replacement of traditional open surgeries with minimally invasive procedures is one of the driving forces behind the growth of interventional radiology.

Interventional radiologists use their expertise in reading X-rays, ultrasound and other images to guide small tubes such as catheters through the blood vessels or other pathways to treat everything from varicose veins and tumors, including procedures that target pain with special injections. These non-surgical, minimally invasive procedures can be used to treat back and joint pain on an outpatient basis with faster recovery times and much less cost than traditional surgery.

At Northern Arizona Radiology, physicians trained and experienced in interventional radiology deal with dozens of pain management cases each month. One of those physicians is Kenneth Salce, M.D., a board-certified radiologist, who said the tools and technology available to physicians have made image-guided pain injections an increasingly common choice for managing pain.

“Pain can be a complex issue, and every patient has a unique situation,” said Salce. “However, image-guided injections are non-surgical and proven to be quite effective for a range a circumstances. The precision with which we are able to target specific joints and regions adds to the effectiveness of such injections and may help avoid invasive surgery.”

According to Salce, the most common procedures using imaging guidance at NAR include:

  • epidural steroid injections for back pain (epidural injections are placed in a space that surrounds the spinal cord)
  • epidural steroid injections for sciatica, a type of nerve pain in the lower back and legs
  • spine facet joint injections for lower back pain (facet joints allow your back to twist and bend)
  • joint injections for the shoulder, hip, elbow and ankle

Pain injections are done with special guidance techniques called X-ray fluoroscopy and CT fluoroscopic guidance, Salce said. “A small amount of contrast material is injected, and X-rays are used to make sure the anti-inflammatory steroid medication is delivered through a specialized, flexible needle to a precise location,” he said. “The steroids penetrate into the surrounding nerves and structures to help reduce inflammation and swelling. A small amount of anesthetic is given to the patient just before the injection.”

Pain injections can also be done with ultrasound guidance. An MRI exam is sometimes ordered in conjunction with these procedures to provide further information about the area being targeted.

“These injections can provide us with valuable information that also helps us better identify the source of pain for even more precise targeting during follow-up procedures,” Salce said.

Any interventional procedures that require hospitalization are performed by Northern Arizona Radiology physicians at Flagstaff Medical Center.

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