Treatments

Advanced Pain Management Treatments

At the heart of Dr. Arash Esmailzadegan’s practice is a commitment to providing personalized, evidence-based pain management solutions tailored to each patient’s unique needs. With advanced training in interventional pain management and a focus on minimally invasive techniques, Dr. Esmailzadegan offers a comprehensive range of treatments designed to alleviate pain and improve quality of life. From innovative therapies like Botox® injections for chronic migraines to targeted procedures such as epidural steroid injections and spinal cord stimulation, this section highlights the cutting-edge treatments available to help patients find lasting relief. Explore the options below to learn more about how Dr. Esmailzadegan can help you manage and overcome pain.

Botox Injections

BOTOX® (onabotulinumtoxinA) is a prescription medication injected into muscles to prevent chronic headaches. It is approved for treating headaches that occur more than 15 days per month. Botox® is used to prevent headaches in adults with chronic migraines, who experience 15 or more headache days each month, with headaches lasting 4 or more hours daily, in individuals aged 18 or older.

Cervical Epidural Steroid Injections

Cervical epidural steroid injections are used to relieve pain in the neck, shoulders, and arms caused by pinched or inflamed nerves in the cervical spine. Conditions such as herniated discs, spinal stenosis, or arthritis can compress nerves, leading to inflammation and pain. The procedure involves injecting medication into the epidural space to reduce swelling and inflammation, providing pain relief. Risks, though rare, may include infection, allergic reactions, spinal headaches, nerve damage, or prolonged pain.

Cervical Facet Rhizotomy (Neurotomy)

Cervical facet radiofrequency neurotomy (facet rhizotomy) treats nerve pain in the neck and/or shoulders. This procedure is beneficial for patients who experience temporary relief after local anesthetic blocks of the nerves supplying the cervical facet joints. The treatment “turns off” the specific nerve carrying pain signals, providing relief for about a year or longer in some cases.

Discography

Discography uses imaging guidance to inject contrast material into the center of one or more spinal discs. This helps identify the source of back pain and guides treatment for abnormal intervertebral discs, which are the cushion-like structures between the vertebrae of the spine.

Facet Joint Injections

Facet joint injections are used to diagnose and treat pain originating from the facet joints, which are small joints located between the vertebrae in the back of the spine. These joints are surrounded by a capsule filled with synovial fluid, which reduces friction between bones. Injections can help determine if the facet joints are the source of pain and provide therapeutic relief.

Intercostal Nerve Blocks

Intercostal nerve blocks involve injecting medication to relieve chest pain caused by conditions like shingles or surgical incisions. Intercostal nerves, located under each rib, can become irritated or inflamed, leading to pain. A steroid and local anesthetic injected under the rib reduce inflammation and alleviate pain. These blocks can also help diagnose the source of pain.

Intrathecal Pump Implantation and Management

Intrathecal pain pump implantation delivers medication directly to the intrathecal space (around the spinal cord) to block pain signals from reaching the brain. This targeted drug delivery provides significant pain relief with smaller doses than oral medications, reducing side effects like drowsiness, nausea, and constipation. A trial is conducted first to determine if the treatment is effective, and if successful, a permanent pump may be implanted.

Kyphoplasty

Kyphoplasty is a minimally invasive procedure used to treat spinal compression fractures, often caused by osteoporosis. These fractures typically occur in the thoracic or lumbar spine. The procedure aims to reduce pain, stabilize the vertebra, and restore its normal height.

Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections (ESIs) are minimally invasive procedures that help relieve neck, arm, back, or leg pain caused by inflamed spinal nerves. Conditions like spinal stenosis, spondylolysis, or disc herniation can compress nerves, leading to pain. Medication is delivered to the epidural space, providing pain relief that can last from several days to years, allowing patients to resume normal activities and physical therapy.

Lumbar Facet Rhizotomy (Neurotomy)

Lumbar radiofrequency neurotomy (facet rhizotomy) treats nerve pain originating from the spine joints in the lower back. This procedure is effective for patients who experience relief after nerve blocks. It “turns off” the specific nerve carrying pain signals, providing relief for about a year or longer in some cases.

Lumbar Sympathetic Nerve Block

A lumbar sympathetic block involves injecting local anesthetic into or around the sympathetic nerves in the lower back. These nerves regulate functions like blood flow and can carry pain signals from peripheral tissues to the spinal cord. The block helps manage pain in certain conditions.

Lumbar Transforaminal Epidural Steroid Injections

A transforaminal injection delivers long-acting steroids into the opening (foramen) at the side of the spine where a nerve root exits. This procedure targets the epidural root sleeve, just outside the spinal canal, to relieve pain. It is also referred to as a root sleeve block, root block, or transforaminal epidural block.

Occipital Nerve Block

An occipital nerve block involves injecting medication around the greater and lesser occipital nerves, located at the back of the head just above the neck. This procedure helps relieve pain in the head and neck region.

Platelet Rich Plasmapheresis (PRP)

Platelet Rich Plasmapheresis (PRP) is a regenerative injection therapy that uses the patient’s own bioactive proteins (growth factors) to repair and regenerate tissue. PRP is created by concentrating a small sample of the patient’s blood, which is then injected into the pain site to enhance healing. PRP has been used for over 20 years in various medical fields to treat conditions like tennis elbow, plantar fasciitis, rotator cuff tears, osteoarthritis, and chronic back or neck pain.

Sacroiliac Joint Injections

Sacroiliac (SI) joint injections, also called SI joint blocks, are used to diagnose and treat low back pain and sciatica caused by SI joint dysfunction. These injections can help identify the source of pain and provide therapeutic relief. Diagnostic and therapeutic injections are often combined into one procedure.

Shoulder Joint Injections

Shoulder joint injections are used for both diagnostic and therapeutic purposes. Common substances injected include corticosteroids, which reduce inflammation and swelling. These injections are often combined with physical therapy and other treatments to address conditions like subacromial impingement syndrome, AC joint pathology, and inflammatory arthritis.

Spinal Cord Stimulation

A spinal cord stimulator (SCS) is a device surgically placed under the skin to deliver mild electrical currents to the spinal cord. The stimulation interrupts pain signals from reaching the brain, providing relief that feels like a mild tingling in the affected area. This treatment is used for chronic pain management.

Splanchnic Nerve Block

A splanchnic nerve block involves injecting medication to relieve upper abdominal pain, often caused by cancer or chronic pancreatitis. The splanchnic nerves, located on either side of the spine, carry pain signals from abdominal organs to the brain. Blocking these nerves can alleviate abdominal pain.

Stellate Ganglion Block

A stellate ganglion block involves injecting local anesthetic into the sympathetic nerve tissue in the neck. This procedure blocks sympathetic nerves that go to the arms and, to some extent, the face. It can reduce pain, swelling, and other symptoms in the upper extremity and is used to treat conditions like Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain Syndrome, and shingles affecting the arm, head, or face.

Trigger Point Injections

Trigger point injections (TPI) treat painful areas of muscle caused by knots or tight bands that fail to relax. These knots, often felt under the skin, can twitch involuntarily when touched. TPIs help relieve pain by targeting these trigger points.