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Pain Management


 

Indiana Neurology and Pain offers a comprehensive list of pain management services to treat each of our patient’s inpidual pain needs. We are now accepting patients in the Greater Indianapolis area!

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Medication Management

It is our belief that most patients do the best with medical management (both opioid and non-opioid therapy), lifestyle modifications (including avoidance of painful triggering events as well as physical therapy and home exercise programs to improve muscle strength and mobility) and selected periodic interventional pain management techniques.

We also incorporate a multi-modal treatment approach, which may include psychological therapy, physical therapy, and occupational therapy. Medication management in considered integral part of therapy. Medication options includes both Non-Opioid and Opioid treatment. Non-opioid medication categories compromise of Non-steroid anti-inflammatory medications, corticosteroids, muscle relaxants, anti-depressants, anti-convulsants and topical applications.

Opioids are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Conservative approach is favored for opioid medications and patients are constantly educated about increased risk for TIAs, strokes, respiratory failure, overdose and various other cardio-respiratory risks with emphasis on lower effective therapeutic dose. Patient are advised against combined use of sedating medications such as anxiolytics, sleep aids, cough syrups, alcohol and membrane stabilizers with their opioid medications and close monitoring is done with periodic Urine Drug Testing (UDT).

 
Injections and Blocks

Therapeutic Injections, sometimes also called nerve blocks, are often used to treat acute and chronic pain symptoms by providing temporary pain relief. The type of Injection (steroid or opioid), and where it is administered varies depending on the source of the pain. Below are the procedures Indiana Neurology and Pain offers to our patients:

Interlaminar Epidural Steroid Injection:

The Interlaminar epidural steroid Injection delivers steroid medication to the epidural space of the spine, which is the area that surrounds the sac containing the spinal cord and nerves. This temporarily reduces the inflammation of the spinal nerves, effectively relieving symptoms of pain, numbness, and tingling. The injection site is placed directly between 2 vertebrae, targeting nerves on both sides of the spine. This procedure is generally recommended for patients with failed back surgery syndrome, spinal stenosis, and other neuropathic disorders that cause chronic pain.

Transforaminal Epidural Steroid Injection:

The Transforaminal epidural injection also delivers anti-inflammatory medication to the epidural space of the spine, but targets the nerves on only one side of the spine. This epidural treatment is often recommended for patients who have undergone spinal surgery, providing precision relief from chronic pain.

Caudal Epidural Steroid Injection:

The Caudal epidural steroid Injection targets the epidural space near the end of the spine, enabling the delivery of higher doses of steroid medication (if necessary). This type of epidural injection is highly effective for treating a variety of chronic pain conditions, including intervertebral disc damage.

Facet Joint Injection:

The Facet joint injection is a precision treatment that administers steroid or anesthetic medication to the facet joint (the small joints in each segment of the spine), providing fast pain relief and reduced inflammation. This procedure is very effective in treating pain from back injury, mechanical stress from bad posture or heavy physical labor, and arthritis of the spine.

Sacroiliac Joint Injection:

Inflammation of the Sacroiliac joints (the joints that connect the sacrum, or bottom area of the spine, to the hip) often manifests as lower back pain or sciatica nerve pain. Sacroiliac joint injections serve both diagnostic and therapeutic goals – to identify the source of pain by injecting anesthetic to the suspected joint, and to achieve long lasting pain relief by administering anti-inflammatory medication to the affected joint.

Trochanter Injection:

Hip pain that is the result of Trochanteric Bursitis (inflammation of the bursa located on the upper outside area of the hip, which are sacs that cushion and lubricate the areas between the bones and tendons) can be effectively treated with the Trochanter injection. The procedure relieves hip pain delivering a combination of anesthetic and corticosteroid medication to the affected join, quickly reducing symptoms of pain and inflammation.

Genicular Nerve Block and Neurotomy:

Especially recommended for patients who prefer steroid-free and non-surgical treatment options for knee pain, Genicular nerve block and neurotomy (nerve ablation) works by blocking the pain signals from being transmitted by the nerves to the brain. The nerves are blocked with a direct injection of anesthetic, providing immediate pain relief. Long-term pain relief is achieved by treating the genicular nerves with specific radio-thermal waves, effectively reducing knee pain without the risk of surgery or steroids.

Medial Branch Block:

The Medial Branch nerves are connected to the Facet joints, which transmit pain signals to the brain. The Medial Branch block provides immediate pain relief by injecting anesthetic directly to the affected nerves, halting pain signals at the source.

Ganglion Impar Block:

The Ganglion Impar Block is a safe, non-surgical treatment that is designed to reduce chronic pelvic or rectal pain by blocking pain signals from the network of nerves called the Ganglion Impar (located in the pelvic region near the coccyx). A combination of anesthetic and anti-inflammatory medication work to provide immediate and long-term pain relief: first by blocking or minimizing the signal transmission of overactive nerves, and then by relieving the inflammation and irritation behind the pain symptoms.

Sympathetic Nerve Blocks (Lumbar, Coeliac, Superior Hypogastic):

Chronic pain emanating the sympathetic nerves (the group of nerves located in the front side of the spine) can be effectively managed and even eliminated in some cases, with Sympathetic Nerve Block therapy. Anesthetic is administered by injection near the spine, usually achieving immediate pain relief for most patients. Additional blocks and injections may be recommended for longer-term pain relief.

 
RF Ablation

Radiofrequency Ablation (RFA) is a highly effective, non-surgical therapy for treating chronic pain resulting from arthritis of the spine. RFA is a minimally invasive procedure, usually performed with local anesthetic and mild sedation. An electrical current via a radio wave is used to heat up a small area of nerve tissue. Pain relief is achieved by blocking the transmission of pain signals to the brain.

Pain relief from RFA typically lasts from six to 12 months, but in some cases can last for years.

For more information on Radiofrequency Ablation click here.

 
Spinal Cord Stimulator

Spinal Cord Stimulation (SCS)

Spinal cord stimulation, is a minimally invasive procedure that directs mild electrical pulses to interfere with pain messages reaching the brain. A small device implanted near the spine generates these pulses. The implanted generator used in spinal cord stimulation has similarities to a cardiac pacemaker, leading some to call the device a pacemaker for pain.

The trial period is similar to long-term therapy, except that the device transmitting current is not implanted in the body. Instead, just the wires are inserted and an external transmitter sends electrical pulses to the electrical contacts near the spinal cord.

 
Intrathecal Pain Pump

Intrathecal Pain Pump Trial & Management

Intrathecal drug delivery (IDD), is a method of giving medication directly into the spinal cord. The system comprises of a small pump that is surgically implanted under the skin of the abdomen and delivers medication through a catheter to the intrathecal space. Because medication is delivered directly to the spinal cord, symptoms can be controlled with a much smaller dose than is needed with oral medication.

The trial period is similar to long-term therapy. A catheter is inserted into the intrathecal space and medicine is delivered that mimics the amount and dosage that will be given with the implant. A successful trial will move on to a full implant. Regular refills and management of pain medicine will be given on a 30-90 day basis, depending on the patient’s needs.

Advantages of Intrathecal Therapy

  • Adjustable Pain Relief – Ability to increase or decrease the dosage to provide more or less pain. Minimally Invasive Procedure – After a successful trial, the implant surgery will be scheduled. This surgery usually only requires one incision for the pump and the catheter is placed with a needle. There are few side effects and it is reversible.
  • Reduced Opioid Use – With the pain relief experienced, patients are often able to take fewer or no oral pain medications.
  • Targeted Pain Relief – IDD delivers pain relief to the exact areas needed, instead of oral opioid’s which affect the entire body’s system.
  • No or Limited Side Effects
  • Cost-Effective

 
Stem Cell Recruitment Therapy

Stem Cell Recruitment Therapy

Stem Cell Therapy is a medical procedure that uses stem cells to treat a condition. Stem cells are the specific cells a body uses to repair itself and heal. They can be thought of as master cells. The human body generates stem cells within areas where repair or disease is present, but they are also present throughout various body tissues.

Research has shown that stem cell therapy can target damaged tissue and introduce healing by organizing cells to form new tissue5. Stem Cell therapy uses a patient’s own cells to treat his or her condition. Adult stem cells have anti-inflammatory properties, and help other cells regenerate and stabilize.

Stem cell therapy is administered through a single injection of Human Amniotic Fluid, AF. Patients have reported relief and repair of spinal injuries, joint injuries and soft tissue injuries.

What is an Amniotic Fluid Injection (AF)?

Amniotic Fluid contains a rich mixture of collagens, cytokines, elastins and growth factors that creates an extra-cellular matrix which supports healing and has the potential to reduce scarring and inflammation. AF is filled with growth factors which assist the body in tissue repair, reducing pain and inflammation and contributing to the regeneration and reconstruction of injured tissue.

What benefits does Amniotic Fluid Injections offer?

  • Powerful Treatment: Relieves pain associated with joints, soft tissue and spinal injuries.
  • Convenient & Painless: 15 minute in office, single injection.
  • All Natural & Drug-free: Over 200 different Growth Factors with anti-inflammatory effects.
  • Quick & Reduced Recovery Time: Return to everyday, low impact activities.
  • Safe, Non-steroidal Alternative to Surgery: Recruits your body’s stem cells to reconstruct and regenerate the injured tissue that is causing pain.

The treatment is ideal for patients suffering the following:

  • Spinal injuries: neck pain, mid or lower back pain, sacroiliac joints
  • Joint Injuries: knees, hips, shoulders, elbows, wrists, ankles, fingers and toes
  • Soft tissue injuries: plantar fasciitis, tennis elbow, rotator cuff syndrome

How does amniotic fluid injections work?

Amniotic Fluid takes advantage of the body’s ability to repair itself. With an amniotic fluid injection, your physician injects the amniotic fluid from amniotic tissues into your body. The amniotic fluid has anti-inflammatory properties, similar to cortisone and steroid shots. However, amniotic fluid goes far beyond the benefits of standard “injection therapy.”

While cortisone and other drugs only provide temporary pain relief, amniotic fluid actually restores degenerated tissue while providing pain relief. The growth factors in the amniotic fluid may recruit your body’s own stem cells, directly mitigating the repair and the regeneration of healthy tissue. Additionally, amniotic fluid injections contain hyaluronic acid, which lubricates joints and tendons, easing the pain and helping restore mobility.

Are Amniotic Fluid Injections covered by insurance?

Yes, amniotic fluid injections are covered by Workers’ Comp., Medicare and commercial Insurances. Consult your physician to see if you are covered.

For more information about Amniotic Fluid Injections for joint, tendon, and spinal injuries, contact us.

 
Integrative Medicine

Integrative and Complimentary Alternative Medicine

Integrative medicine pairs traditional medicine with other treatments to care for a patients mind, body, and spirit. Integrative medicine is the practice of medicine that focuses on the whole person and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.

It combines state-of-the-art, conventional medical treatments with other therapies that are carefully selected and shown to be effective and safe. The goal is to unite the best that conventional medicine has to offer with other healing systems and therapies derived from cultures and ideas both old and new.

Integrative medicine is based upon a model of health and wellness, as opposed to a model of disease. Whenever possible, integrative medicine favors the use of low-tech, low-cost interventions.

 
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