Advanced/Special Pain Management Techniques

Special Pain Management Techniques

Injection of Local Anesthetic and Steroid
Procedures play an integral part in an invasive pain subspecialty. They are used to help the patients achieve their activities of daily life with a minimal amount of discomfort as possible. Adjunctive therapy might include the use of narcotic analgesics, membrane stabilizers, antidepressants, or centrally-acting or peripherally-acting muscle relaxants. The pain techniques or procedures performed range from the least invasive techniques to more invasive “advanced” techniques. The technique that affords the best and longest lasting relief with the least amount of invasiveness is performed.
The less invasive techniques include:
  • Trigger point injections with local anesthetic and steroid.
  • Peripheral nerve injections with local anesthetic and steroid including lumbar sympathetic blocks.
  • Discograms.
  • Epidural steroid injections in the lumbar, thoracic and cervical region under fluoroscopic guidance.
  • Injections of cranial nerves for control of facial pain.
  • Major joint injections involving shoulders and knees, and spinal axial mechanical joints such as facet and sacroiliac joints.

Advanced Techniques

Advanced pain management techniques are techniques which involve more risk to the patient. This risk may be found in the form of “invasiveness”, i.e. disrupting a nerve/ganglion or joint deep within the body or close to a vital organ. This can include implantation of electrical devices or catheters in the spine to interfere with the pain message to the brain. Examples of these procedures are:
  • Celiac plexus blocks.
  • Splanchnic nerve blocks.
  • Atlanto-occipital joint injections.
  • C1-2 facet injections.
  • Cervical discograms.
  • Sphenopalatine ganglion blocks.
  • Gasserian ganglion blocks.
  • Ganglion impar blocks.

In each of these procedures the substance injected may not be complex, but the site of injection poses some risk to the patient.

Advanced techniques can also pose a risk to the patient because the technique used to “disrupt” the source of pain. This may involve four forms of disruption:

  • Lytic procedures with Phenol or alcohol.
  • Cryolysis.
  • Heating procedures such as radiofrequency lesioning/IDET.
  • Vaporization of disc material.

As an example, the same procedures described under Special Techniques can be performed with the use of lytic agents such as Phenol and alcohol, or they can be performed with heating/cooling probes as in radiofrequency lesioning, intradiscal electrothermal coagulation (IDET), and cryolysis. The risk from the performance of these techniques remains the same, but overall risk increases because of the form of disruption used on the nerve plexus. For patients that do not respond to the above procedures found under Injection of Local Anesthetic and Steroid and who’s pain continues to be uncontrolled, the more invasive modalities can be employed. This can include the lytic procedures previously mentioned, spinal cord stimulation, intrathecal therapy, intradiscal electrothermocoagulation (IDET), and nucleoplasty.

Conditions treated by these techniques include:

  • Upper and lower extremity chronic radicular pain.
  • Headaches.
  • Facial neuralgias.
  • Peripheral nerve neuralgias.
  • Chronic regional pain syndrome (formerly known as RSD).
  • Management of neuropathic/deafferentation pain.
  • Peripheral vascular disease.
  • Post laminectomy syndrome.


Advanced Pain Modalities
3195 W. Ray Road
Suite 1
Chandler, AZ 85226
Phone: [480] 756-6789


Physician Surgery Center of Tempe
1940 E Southern Avenue
Tempe, AZ 85282

Banner Desert Surgical Center
1500 S. Dobson Road
Suite 101
Mesa, AZ 85206