Pain Management Options at Sonoran Pain Management
Want to learn more about a pain management treatment? On this page, you can read short summaries of procedures, watch videos, or download brochures with more detailed information. If you see a chronic pain condition you’re not familiar with, view this resource page to learn more about the condition’s pathology, diagnosis, and treatment. For additional information, contact Sonoran Pain Management at 602-795-PAIN. Pain management services are available in Phoenix and Tempe, AZ.
- Cervical Facet Radiofrequency Ablation
- Cooled Radiofrequency Treatment (COOLIEF*)
- Dorsal Root Ganglion (DRG) Stimulation
- Epidural Steroid Injections (Cervical, Lumbar, Thoracic)
- Facet Joint Injections
- Lumbar Sympathetic Blocks
- Major Joint Injections
- Nerve Blocks
- Percutaneous Disc Decompression
- RACZ Caudal Neurolysis
- Sacroiliac Joint Steroid Injections
- Spinal Cord Stimulator Trial/Implant
- Trigger Point Injections
Cervical Facet Radiofrequency Ablation
This minimally invasive procedure is used by providers at Sonoran Pain Management to reduce or eliminate pain caused by damaged facet joints. In the procedure, a special electrode is positioned in the medial branch nerves (using fluoroscopic guidance). Once placed, a weak electric current is emitted to test the placement. If placement is accurate, the provider cauterizes the nerve, disrupting pain signals that travel between the brain and the neck. This procedure may offer longer lasting pain relief than what is possible with steroid block injections.
Cooled Radiofrequency Treatment (COOLIEF*)
Many patients with chronic hip, knee or SI joint pain are now finding relief through COOLIEF*, a cooled radiofrequency (RF) treatment that is opening up possibilities for adults with joint pain throughout the Phoenix and Tempe areas. Non-surgical and non-narcotic, the brief outpatient COOLIEF* procedure involves a trained pain management specialist or physician directly introducing cooled radiofrequency energy to a larger treatment area than what is possible in conventional RF treatments. This approach targets the sensory nerves that are responsible for sending pain signals to the brain. No excessive heating is used in this procedure, which typically takes less than 20 minutes (hip), 2.5 minutes per nerve (knee), or 25-45 minutes (SI joint). There is no incision, and most patients begin to notice pain relief within just one to two weeks following treatment. For patients who want to avoid long-term opioid use, chronic pain and surgery, COOLIEF* is an excellent minimally invasive outpatient alternative. COOLIEF* offers effective pain relief, greater mobility, and quicker recovery time – all in a cost-effective manner.
A discography (discogram) is a diagnostic procedure used to determine which – if any – spinal discs are causing back pain. At Sonoran Pain Management, you will be given medication intravenously to help you relax. (However, patients must be awake during the procedure in order to communicate with the physician.) The procedure is done while you lay on your stomach. Next, a local anesthetic numbs the skin and tissues on the back. Guide needles are inserted through the back into the target discs. The discs are then pressurized individually with contrast dye. If pressurization causes pain or discomfort, your pain management specialist will ask you to compare it to your normal pain. Radiographic images of each disc are captured, and the needles are removed. This procedure may help your pain management specialist identify the degenerated disc(s) and plan a course of treatment.
Dorsal Root Ganglion (DRG) Stimulation
For many years, spinal cord stimulation was one of the most advanced treatment options for patients with Complex Regional Pain Syndrome Types 1 & 2. At Sonoran Pain Management, some patients are now receiving more advanced care through the new Axium Neurostimulator System for the dorsal root ganglion (DRG). This innovative technology has been proven to provide patients with superior pain relief over traditional tonic spinal cord stimulation (SCS). This new technology offers targeted stimulation to alleviate chronic pain in the lower limbs, including the groin, lower legs and feet. This device is the first and only FDA-approved neurostimulation device of its kind.
Unlike traditional SCS, DRG stimulation targets an area that has an extremely high density of sensitive nerves. Similar to SCS, this new technology causes pain signals transmitted from those nerves to the brain to diminish in intensity or fade away altogether. This new DRG stimulation technology offers significant benefits for patients, caregivers and their families. Long-term clinical data has demonstrated that patients report meaningful pain relief and greater treatment success with DRG stimulation compared to patients who have undergone traditional SCS (74.2% v. 53%).
Epidural Steroid Injections (Cervical, Lumbar, Thoracic)
Epidural steroid injections are commonly used to help manage pain caused by nerve roots that branch off the spinal cord. A cervical ESI injection may provide relief from pain radiating out into the shoulders and arms; a lumbar ESI may help with pain in the lower back, buttocks, and thighs; and a thoracic ESI may address pain in the mid-back and shoulder blade region.
During the procedure, the patient lies face down, and local anesthesia is administered. Next, the pain management specialist inserts a needle into the epidural space and injects a contrast dye. A fluoroscope confirms accurate placement of the needle tip. The steroid-anesthetic mixture is injected next. Patients may need to undergo as many as three injections in order to experience the full benefit the medication can offer.
Facet Joint Injections
Facet joint injections are used to diagnose the source of a patient’s pain, as well as to relieve pain and inflammation. Before the procedure, the skin is numbed with a local anesthetic. Next, the physician inserts a needle into the facet joint (using a fluoroscope for guidance). Contrast dye confirms the needle’s proper placement, and then a mixture of anesthetic and steroid medication is injected to reduce inflammation and provide pain relief. Patients may experience relief for several days or months, and may have up to three injections per year.
Kyphoplasty and vertebroplasty, though similar, are two distinct procedures that restore strength and stability to compressed vertebrae in the spine. Patients with fractured vertebrae – whether caused by osteoporosis, injury/trauma, bone cancer, or other causes – may be candidates for one of these minimally invasive and incision-less procedures through Sonoran Pain Management. In both procedures, special acrylic cement is injected into the collapsed vertebra, restoring height and stability, with the goal of reducing back pain and preventing further spinal collapse.
Lumbar Sympathetic Blocks
Patients with leg pain caused by complex regional pain syndromes may be candidates for lumbar sympathetic blocks at Sonoran Pain Management. The goal of this procedure is identified painful areas and block pain signals from reaching the brain. This procedure is performed with intravenous sedatives, though the patient remains awake. First, a local anesthetic is injected to numb the skin, as well as the deeper tissues. Next, a contrast dye is injected into the painful areas. This is done to confirm precise targeting of the sympathetic nerves. Next, combination anesthetic/saline/anti-inflammatory medication is injected to block pain signals from reaching the brain. Some patients may undergo multiple lumbar sympathetic blocks in order to get pain relief in the legs.
Major Joint Injections
A “major joint injection” is a broad term pain management specialists may use to refer to the practice of injecting the hip, knee, shoulder, or other “major” joint with an anesthetic/steroid mixture. While major joint injection does not treat or “cure” the underlying cause of the painful joint, this therapy can be helpful for managing joint pain caused by osteoarthritis, rheumatoid arthritis, trauma, and other degenerative conditions and injuries. The anesthetic provides short-term pain relief, while the goal of the steroid is to reduce inflammation and provide pain relief for several weeks or months. Most patients will need more than one major joint injection.
A nerve block is a brief diagnostic procedure that’s done to pinpoint the source of pain in the spine. If the diagnostic nerve block is successful in locating the pain, then a longer-lasting anesthetic mixture may be injected to disrupt pain signals from traveling along the affected nerves.
Percutaneous Disc Decompression
This minimally invasive procedure is performed to reduce a herniated disc and resolve pain caused by disc herniation. The outpatient procedure is performed with a local anesthetic to minimize discomfort. Also, no incisions are made, which improves recovery times for many patients. During percutaneous disc decompression, a cannula is inserted into the herniated disc under X-ray guidance. Next, a radiofrequency probe is inserted through the cannula to dissolve small parts of the disc nucleus while maintaining spine stability. This allows the disc to resorb the herniated portion of the disc, providing pain relief.
RACZ Caudal Neurolysis
This procedure is performed to relieve lower back and leg pain that sometimes develops after back surgery (post laminectomy syndrome). During the procedure, a local anesthetic is used to numb the skin and tissues above the sacrum (just above the tailbone). Next, a needle is inserted into the epidural space. Contrast dye is injected through this needle. The dye, when viewed under X-ray, allows the pain management specialist to see the scarred areas in need of treatment. Once the dye has been injected, a small catheter is inserted through the needle. A steroid-anesthetic mixture is administered through this catheter with the aim of alleviating pain caused by pinched nerve roots in this area of the spine.
Sacroiliac Joint Steroid Injections
SI joint injections are used to relieve pain caused by arthritis in the sacroiliac (SI) joints, which are located above the tailbone where the spine meets the hips. First, your pain management specialist at Sonoran Pain Management will administer a local anesthetic to minimize discomfort. Then, a steroid-anesthetic mixture is injected into the sacroiliac joint to minimize inflammation and reduce pain. If this therapy is successful for your pain, you may undergo multiple injections in order to get the best results.
Spinal Cord Stimulator Trial/Implant
A spinal cord stimulator implant (SCS) can be used to manage chronic pain in the back, legs, and arms. The SCS implant is a permanent device that uses electrical impulses to stimulate nerves, blocking pain signals from traveling between the brain and spinal cord. Your pain management specialist may discuss this option with you if other conservative therapies have not been successful.
First, a trial procedure is performed. During this procedure, small wire leads are inserted into the back (often done via epidural needle) and connected to the spinal cord. An external trial simulator administers electrical pulses. If certain leads and electrical impulses are found to be effective in managing pain, then more permanent leads may be placed and a battery-powered pulse generator may be implanted beneath the skin (typically in the buttocks or abdomen). The electrical pulses are then programmed wirelessly with the goal of minimizing back, arm or leg pain.
Watch a special feature on Dr. Zaveri and spinal cord stimulation that aired on NBC Channel 12 News:
Trigger Point Injections
Trigger point injections are used to relieve pain caused by tension headaches, fibromyalgia, myofascial pain syndrome and other conditions. This therapy targets “trigger points,” tender and sensitive areas of muscle that have (usually) been subjected to repetitive motion and contraction. Trigger points can cause referred pain in other seemingly unrelated areas of the body. A trigger point injection may contain an anesthetic, corticosteroid, or a mixture of both. Sometimes, no medication is used at all (a technique known as “dry needling”). Ask your Phoenix pain management specialist for more information.