Frequently Asked Questions

At Prime Pain Specialists, we offer interdisciplinary chronic pain management services utilizing pharmacological approaches and interventional pain procedures.

Call Our Office

(484) 869-2817

Visit Our Office

301 S. Seventh Ave. Suite 315
West Reading, PA 19611

Email Us

contact@primepainspecialists.com

How can I relieve lower back pain?

There are many potential causes of low back pain. We understand that the most effective treatment depends on the correct diagnosis of the cause of pain.

Unlike many Interventional Pain Medicine Physicians, Dr. O possesses additional specialities as a board certified Internist and Neurologist. This unique combination and set of skills allows Dr. O to provide the most comprehensive diagnosis in determining the origins of pain and the best solutions for pain relief.

Our process at Prime Pain Specialists is to the first undergo a comprehensive evaluation which includes your medical history and physical examination, followed by imaging studies that may include a magnetic resonance imaging (MRI) or computerized tomography (CT) scan. A correct diagnosis is made, and treatment options tailored to each patient’s pain is offered.

How can I relieve neck pain?

The approach is similar to that mentioned for lower back pain.

What is an epidural injection?

The “dura” is the thick covering of the spinal cord and spinal nerves. Epidural injection is injection of steroid on top (“epi”) of the dura (“epidural”). This can be done in the neck, mid-, and lower back depending on the source of pain. An x-ray machine or “fluoroscopy” is used to safely guide the needle injection.

How is an epidural injection performed?

The patient is positioned face-down. The area to be injected, for example, the lower back, is thoroughly cleaned and the skin and tissues of the area is numbed. After confirmation with a contrast dye, an epidural needle used to deliver the steroid medication into the epidural space with the guidance of x-ray (“fluoroscope”). The point of injection is dressed with Band-Aid.

What are the types of epidural injections?

Epidural injections could be interlaminar or transforaminal in the neck or back. In addition, in the lower back, there could be caudal epidural injection. Your Physician at Prime Pain Specialists will work with you to determine the best approach suitable for your type of pain.

Do epidural injections work?

Yes, most of the time. However, just like many forms of treatment in medicine, it is known that a small fraction patients that do not respond for different reasons. At Prime Pain Specialists, we work through these reasons with our patients and/or provide them with other options to relieve their pains.

Are epidural steroid injections painful?

At Prime Pain Specialists, epidural injections are generally well-tolerated when done under local anesthesia (which means that the skin and tissues of the area is numbed). Occasionally, monitored anesthesia care (MAC) may be used (can we briefly explain this?). We typically do not use general anesthesia or intubation.

I take a blood thinner. Do I need to stop this medication for epidural injections?

To reduce the risk of bleeding, your blood thinner needs to be stopped a few days before the procedure. Your pain physicians will work with you, your family doctor, and other specialists (for example, your cardiologists), to determine for how long the blood thinner should be stopped. Generally, the blood thinner can be resumed within hours of completing the procedure.

Do I need to fast before my procedure?

Epidural injections are usually performed under local anesthesia (which means that the skin and tissues of the area is numbed) and fasting is not necessary. However, if monitored anesthesia care (MAC) (can we briefly explain this?) is used, you may need to avoid food or drink two hours before the procedure. When will i be able to eat/drink after if MAC is used?

Are epidural injections safe?

Epidural injections are generally considered to be safe with very low incidence of serious complications like bleeding, nerve damage, positional headache, or infection. At Prime Pain Specialists, our interventional pain physicians take very careful measures to prevent complications before, during, and after the procedure.

Are there any side effects from epidural injections?

Epidural injections are generally considered to be safe but reported side effects include pain at the site of injection, localized increase in pain, restlessness, anxiety, facial flushing, sleeplessness, elevated blood sugar, transient non-positional headaches, or allergic reactions. Prime Pain Specialists’ interventional pain physicians take very careful measures to prevent or reduce the occurrence of side effects before, during, and after the procedure.

What to expect after an epidural injection?

Generally, epidural injections are safe and well-tolerated. Pain relief from the injection usually starts a few days after the procedure. Immediately after an epidural injection in the lower back for example, there may be transient (short-lived) numbness of the legs, soreness in the back, or facial flushing. Patients with diabetes may experience increase in their blood sugar levels. At Prime Pain Specialists, we work with your primary care physician to carefully monitor your well-being after the procedure.

Do I need to repeat epidural injections?

Epidural injections typically lead to pain relief for 3-12 months and the procedure may need to be repeated periodically as necessary.

How can I get relief from headaches?

There are many causes of headaches and treatment is usually dependent on the cause. The Physicians at Prime Pain Specialists are trained experts who are able to correctly diagnose the cause of headache and tailor treatment accordingly.

What are the small joints of the back called?

The small joints of the back are called the “facet joints.” Each bone of the neck or back (“vertebra”) is connected to its neighbor above by two facet joints and to its neighbor below by 2 facet joints. Each facet joint is supplied by 2 medial branch nerves. Pain arising from these joints is a major cause of back or neck pain.

Are spinal facet injections painful?

Spinal facet injections are generally well-tolerated when done under local anesthesia (which means that the skin and tissues of the area is numbed). Occasionally, monitored anesthesia care (MAC) may be used (can we briefly explain this?).

How long do facet blocks last?

ANSWER

What is a medial branch block?

Medial branch nerves are small sensory nerves that supply a facet joint and send pain signals to the brain. There are 2 medial branch nerves to each facet joint. At appropriate levels in the neck or back and under x-ray guidance, the pain from medial branch nerves can be blocked through injections to diagnose the facet joint as the source of pain.

What is Radiofrequency Ablation/Lesioning (RFA)?

RFA is a procedure to treat neck and back pain by disrupting the small sensory nerves or medial branch nerves that supply the small joints of the neck or back. Each small joint of the back or neck is supplied by two medial branch nerve and these 2 nerves must be disrupted to treat pain at each joint.

Why do I need "diagnostic" injections before RFA?

To confirm the diagnosis of pain coming from a facet joint, it is usually necessary to perform one or two “diagnostic medial branch blocks.” This diagnostic block is done by injecting the 2 medial nerves that supply each facet joint. Several joints are typically injected during the procedure. Depending on the level of relief during the facet joint injection, an RFA can be scheduled.

Do I need to be admitted for the diagnostic injection or RFA?

No. These are outpatient procedures.

Do I require anesthesia for RFA?

Local anesthesia to numb the skin and underlying tissues are given. Occasionally, light intravenous sedation is given. You will still be able to communicate with your health care providers during the procedure (“conscious sedation”). General anesthesia including intubation is typically not needed.

How is RFA performed?

With the aid of x-ray (“fluoroscope”), a radiofrequency needle and an electrode probe are used to disrupt and treat pain at affected each joint. At Prime Pain Specialists, our doctors will be asking you questions about specific sensations and their locations during this phase.

I take a blood thinner. Do I need to stop this medication for RFA?

No.

Do I need to fast before my procedure?

RFA is usually performed under local anesthesia (which means that the skin and tissues of the area is numbed). Fasting is not necessary. However, if monitored anesthesia care (MAC) (can we briefly explain this?) is used, you may need to avoid food or drink two hours before the procedure.

Do I need to repeat RFA?

Disrupted nerves slowly re-grow. It may be necessary to have follow-up treatment with RFA.

What are the benefits of RFA?

RFA is a minimally invasive and relatively safe procedure that can provide pain relief for an average of 3-12 months. Patients can decrease the amount of pain medications consumed and be more functional with adequate pain relief.

Is RFA risk-free?

The risks of RFA are generally low but reported complications include bleeding, infection, increase in back or neck pain, nerve damage and paralysis are rare. As with all procedures, you will be required to sign a consent before the procedure. Your physicians will work with you to reduce potential risks and complications.

Will I be able to drive the day of the procedure?

We usually do not recommend driving on the day of the procedure. You will need to have a driver to drive you home after the procedure.

How soon will I be seen in the clinic after RFA?

You will be seen in follow-up within 2-4 weeks following an RFA or sooner if needed. You can call Prime Pain Specialists office 24/7 with questions.

I have back pain and wish to undergo RFA. How soon can I be scheduled?

You will need to be evaluated first to determine the source of your pain. If your pain is coming from the facet joints in the back, you mat be scheduled for diagnostic injections (“diagnostic medial branch blocks”). Depending on the findings and confirmation you may be scheduled for RFA. The process from your initial clinic evaluation to RFA performance can take an average of 3-4 weeks.

What is spinal cord stimulator (SCS) therapy?

This is a safe, outpatient procedure which involves the use of an advanced medical device, special electrodes, and connections to batteries to alter the activity of the nervous system and reduce pain by stimulation of the dorsal column (“the back”) of the spinal cord. In the proper setting as it is at Prime Pain Specialists, the therapy is safe, cost-effective, helps with pain, improves function, and enhances health-related quality of life.

What types of pain are treated by spinal cord stimulator (SCS) therapy?

At Prime Pain Specialists spinal cord stimulator therapy is used to treat chronic pain following spine surgery, pain from diabetes nerve damage, complex regional pain syndrome (CRPS) also called reflex sympathetic dystrophy syndrome, post-herpetic neuralgia, and post-amputation pain.

Is spinal cord stimulator (SCS)therapy safe?

Yes. The occurrence of serious complications like bleeding, infection, or paralysis is very low.

Are there phases to spinal cord stimulator (SCS) therapy?

Yes. The SCS therapy involves 2 phases:

1) Trial phase-percutaneous placement of leads. This may last 3-7 days. Depending of the pain relief experienced by the patient, the next phase is scheduled.

2) Permanent implant phase-surgical placement of leads

Why do I need a psychological assessment prior to undergoing spinal cord stimulator (SCS) therapy?

This is an insurance requirement in ALL patients undergoing spinal cord stimulator therapy.

Have a Question? Get in Touch.

Have a question about conditions treated, treatments, or other pain management services? Please complete the form below and a pain management professional will contact you within the next business day.

Call Our Office

(484) 869-2817

Email Us

contact@primepainspecialists.com

Visit Our Office

301 S. Seventh Ave.
Suite 315
West Reading, PA 19611


Prime Pain Specialists