Discography Treatments in Pinellas Park, FL

The inter-vertebral disc, the primary weight bearing structure of the spine, is recognized as a common source of low back pain. Initially, chronic low back pain was thought to be caused by nerve root compression. However, MRI scans failed to show compression of nerves even in the presence of sciatica. Such sensitivity has been documented by eliciting pain by pressing on the back wall of the disc during lumbar surgery in an awake patient. Such sensitivity has also been documented during pressure-controlled discography, leading to the identification of a low pressure sensitive disc.
At times, MRI scans can show tears in the outer wall of the disc, called high intensity zones (HIZ). This may indicate a greater potential of a pain sensitized disc. Many studies have shown the presence of irritating chemical substances within the outer wall of the disc that could cause sensitization of the disc to mechanical weight bearing. It has been demonstrated that nerves supplying the outer disc wall can grow into disc tears or areas of injury causing the disc to become sensitive and painful.
The discogram procedure begins when the skin is anesthetized using a local anesthetic such as Novocain or Lidocaine. A needle introducer is advanced under x-ray guidance into the center of the disc. A solution of dye is injected very slowly into the disc and pressures are measured. During the injection phase the patient is asked to inform the doctor of any discomfort. Several of the discs are usually tested, including one disc that appears to be normal that is used as a control, or comparison level. It is anticipated the patient will not be aware of any feeling when the dye is injected into a normal disc.

If the disc is abnormal the patient will begin to feel some discomfort. Based on the patient's response and the internal pressure of the disc recorded during the procedure, a diagnosis can be made. Once discomfort is felt, the test of that disc is stopped. The concept is to identify an abnormal disc, not to measure pain tolerance. After a brief time of observation, the patient is released from the center. The procedure is considered minimally invasive and done on an out-patient basis. In patients with dye allergies, saline can be substituted for the dye.

Scar Tissue Removal in Pinellas Park, FL

Percutaneous epidural adhesiololysis, also known as the removal of scar tissue, is used to treat patients with refractory low back pain caused by scarring. Epidural scarring can occur as the result of a previous tear in the disc which inflamed the nerves, the inflammation may resolve, but scarring may persist without prior surgery.
Blood clot formation may occur in the epidural space during to the post-op period. After spine surgery, scar tissue may adhere to the nerve roots. Scar tissue around the nerve can inhibit nutrients from reaching the nerves, causing hypersensitivity. Mechanical compression can also occur. The scar tissue is formed in the epidural space. The potential space located in between the spinal cord and spinal canal.
The procedure is performed under x-ray guidance. After local anesthesia is administered to the skin, a needle is advanced to the proper anatomical location. A specialized catheter is advanced through the needle. Contrast dye is administered to outline the scar tissue. There have been numerous alternatives to the next sequences of the treatment forms. Initially hypertonic saline was infused daily for three days to “break up” the scar tissue. Initial studies were promising, but unfortunately could not be reproduced.
Dangerous side effects were seen and the technique was abandoned. A special medication, Hyaluronidase, was then used to break down the scar. This procedure was also questioned with conflicting outcomes. Now the catheter is manipulated through the scar when possible, and subsequent steroids are administered to decrease inflammation around the area of scar disruption. The patient is returned to the recovery room and observed for a short period, and discharged home the same day.

Epidural Spinal Injections in Pinellas Park, FL

Epidural steroid injection offers the potential of pain relief to people with neck, mid-back and lower back pain with or without arm or leg pain. Two different routes of administration are available for steroid placement within the epidural space: transforaminal, or the area of exiting nerve from the spinal cord, and interlaminar, or the area behind the spinal canal.
In the neck area of the spine, interlaminar injection is generally considered safe with reports of minor complication rate of less than one percent. In the lower back area, interlaminar injection is considered safe with low complication rates nationally.

The physicians at the Pain Relief Centers complete all procedures with the benefit of x-ray guidance. Blinded epidurals (those done without x-ray guidance) have shown the greatest risk and less positive outcomes than epidurals done using fluoroscopy. Blinded epidurals are done with the assumption the injected steroids will spread to the sites of pathology. Studies of epidural steroid injections without x-ray guidance show the injected medications fail to reach the target site at a significant rate with a consequent lack of benefit. There was also an increased risk and a potential increased incidence of surgery.
Epidural steroid injections (ESI's) are primarily used to relieve pain from a mechanical irritation or inflammation that affects the nerves leaving the spinal cord to the arms and legs. This procedure targets specific administration of steroids to help suppress the inflammation caused by discs which have herniated, protruded, torn or have been disrupted by other causes.
Other indications for epidural steroid injections include pain from herpetic neuralgia and a multitude of arthritic changes, such as spinal stenosis.

Epidural steroids injections may be repeated if partial improvement occurs. Repeated injections are not recommended if there was either no relief or full relief after the procedure.

Nerve Block Issues in Clearwater, FL

The facet joint is formed by the attachment of one vertebra to the vertebra above and the vertebra below. This forms the protective back wall of the spinal column. The joint is a true joint containing hyaline cartilage, a synovial membrane/sac, a fibrous capsule and nocioceptive fibers (pain nerves). The nerves can transmit painful signals to the brain. The pattern of pain appears to overlap considerably with the presentation of pain due to other causes.
Under normal biomechanics, the joint limits motion between vertebras and assists in weight bearing. Following injury, osteoarthritis and a multitude of other spine related disorders the joints can become painful as a result of increased weight bearing. There is no correlation between facet joint pain, x-rays, MRIs or CT scans. The diagnosis and treatment is determined by facet joint block or blocking the nerve to the joint under x-ray guidance.
The joint approach (facet joint injection) entails placing dye, local anesthetic and steroid into the synovial sac of the joint. If the pain is improved for the duration of the local anesthetic on the day of injection, this is considered diagnostic. If severity and duration of relief is determined diagnostic the steroid may help reduce the pain in 2-5 days.
The nerve approach (diagnostic facet nerve block, diagnostic medial branch block) involves placing a local anesthetic agent on to the nerve under fluoroscopy guidance. Patient response is evaluated by duration and amount of pain reduction. If diagnostic, a confirmatory block is then performed. Ultimately the nerve signal may be disrupted using radiofrequency waves.

Degenerative Spinal Joint Treatment in Pinellas Park, FL

The prevalence of chronic lumbar joint pain ranges from 15% in younger patients to as high as 40% in elderly patients. The prevalence of neck pain ranges from 25-66%. The only proven treatment for facet pain is radiofrequency rhizotomy.
The procedure involves placing an electrode, via a small needle, through the anesthetized skin to rest parallel to the target nerve under x-ray guidance. A group of muscles called the mulitifidus muscle is stimulated, causing a mild contracting sensation at the target site. Painless muscle contraction and fluoroscopic guidance is used to confirm proper placement of the electrode.

Once confirmed, the nerve is anesthetized, and a radiofrequency lesion is performed. This stops the nerve from sending pain signals from the joint to the brain.

Since the joint's role is to limit motion by anatomical barriers, the radiofrequency treatment does not stop the joint from protecting the spine or potential harm by movement without pain signals. Pain relief is usually appreciated within 6 weeks in the majority of the patients.

The duration of effectiveness is 6 months to 2 years in the general population. The majority of patients appreciate pain relief lasting 1 year. With careful selection of patients, 60% of patients can expect at least 90% reduction in pain lasting 12 months.
Neck and back pain can be caused by multiple pain sources. The greater the role one specific pain source is, the better response to a specific therapy can be expected. Patients benefit greatly, and experience the best outcomes when receiving treatment in a practice capable using multiple modalities to treat the different sources of pain.

Sacroialiac Joint Injection Arthrogram in Pinellas Park, FL

Lumbar disc, facet joints and sacroiliac joints are 3 major sources of lower back pain. These structures can result in pain in the lower back, buttocks, leg, groin, hip or even the abdomen.
The Sacroiliac joint is a large fluid filled joint formed by the junction of the sacrum and ileum. The joint allows a small amount of rotation and forward and backward movement. The greatest amount of movement occurs when individuals rise from a sitting or lying position to standing position. In middle age and beyond, fibrous adhesions (scar tissue) and degenerative changes result in gradual loss of the synovial cavity which occurs in both sexes. This occurs earlier in men, and after menopause in women. The joint can dysfunction as a result of injury, abnormal weight bearing, leg length discrepancies, fractures, changes in walking patterns, pregnancy, and a host of other arthritic disorders. Pain can also be referred to the area by the lumbar discs.

To diagnose pain from the sacroiliac joint, a physical exam can be helpful, but it is not always reliable. Imaging studies such as x-rays, CT scan and MRI can be normal in patients who have problems from this area. Therefore, diagnosis of the offending joint requires intra-articular diagnostic block of the sacroiliac joint under fluoroscopy.
The procedure begins by numbing the skin with a local anesthetic. A needle is then placed under fluoroscopic guidance into the sacroiliac joint. A numbing medicine, such as Novocaine, is placed into the joint. This will help the physician identify the joint as the source of pain. Typically Cortisone is also injected into the joint for the inflammation as well to provide extended pain relief.

Once the pain is controlled, a trial of physical therapy or manual therapy is prescribed to correct the underlying mechanical problems.

Spinal Cord Stimulators in Pinellas Park, FL

Spinal Cord Stimulation therapy has been used since the 1960s. It is a technology which sends gentle electrical stimulation to the spinal cord to stop the nerves in painful areas, from sending the pain signals through the spinal cord and to the brain. The pain signal is replaced with a gentle vibration sensation in the painful areas, such as the arms, legs, neck, or back.
This technology has been used to successfully treat Post-Laminectomy Syndrome, Failed Back Syndrome, cervical/ lumbar radiculopathy, neuropathic pain syndromes (CRPS/RSD, causalgia, and diabetic peripheral neuropathy), and vascular disorders such as angina and peripheral ischemia.

Most patients who may be candidates for this therapy have unsuccessfully been treated with conservative measures. These include medications, spinal injections, and physical therapy. Also, further surgical interventions have been ruled out. Initially a “test” or “trial” is done, in which an electrode is placed into the epidural space, under x-ray guidance. The electrode extends outside of the body and is connected to a remote. The patient can increase or decrease the level of stimulation according to his/her pain level. The “trial” can last between 3- 7 days, depending on the preference of the physician. The patient is told to conduct his/her normal activities in order to get the best assessment of their pain relief.

If the trial is successful then a completely enclosed system is implanted, permanently. As with the trial, the electrode is placed into the epidural space, however, now the opposite end is tunneled to a generator which is under the skin. There is still a remote that is used to adjust the level of stimulation based on the pain level. Both the trial and implant are typically done on an out- patient basis. In addition, the patient is instructed to take several days of antibiotics, which decreases the chance for an infection.

Sympathetic Block in Pinellas Park, FL

The sympathetic nervous system is a collection of nerves that control multiple functions throughout the body. It originates from the spinal cord and generally helps control temperature, blood flow and sensitivity. In addition, branches of those nerves combined with other nerves form the spinal cord that play a role in pain perception and transmission (sympathetically mediated pain). The most classic entity associated with the sympathetic nervous system is the pain from RSD (reflex sympathetic dystrophy). The most current state is known as complex regional pain syndrome. The pain is usually described as a burning in quality and usually involving the distal portions of the extremities (arms, hands, legs, knees, ankles or feet). However other pain descriptions such as deep, aching, throbbing or stabbing pain are common. Pain with light touch or pain with exposure to cool temperatures that are usually not painful may occur.
Autonomic changes, such as changes in skin color, temperature, or sweating are frequently seen. Muscle disorders such as tremors, weakness and decreased coordination can develop if the disease becomes progressive. The symptoms may spread beyond the region of initial discomfort.

RSD/CRPS and sympathetic pain may occur following a traumatic injury, most commonly following ankle, knee and wrist injuries. The initial event may be mild to a severe trauma. It is thought that the initiating trauma may also be so slight it may go unnoticed and initiate the onset of the syndrome.
A sympathetic block may be used to help diagnosis the entity, improve the symptoms or even stop the over activity of the sympathetic system.

The sympathetic block is completed under x-ray guidance. The skin is anesthetized for the lumbar sympathetic block. The needle is advanced through the back to the anatomical location of the sympathetic chain at the L2-L3 vertebral level. Multiple views of the needle placement under fluoroscopy are obtained. After confirmation with contrast dye, a local anesthetic is applied through the needle. Following the procedure, the patient is taken to the recovery room and observed briefly. They are then discharged home the same day.

For upper extremity blocks a very small needle is advanced to the area on the neck, where the sympathetic nerves are located. Confirmation is obtained with fluoroscopy and contrast dye. A local anesthetic solution is injected through the needle to the target area. The patient is taken to the recovery room for a short course of observation and discharged home the same day.

Our services are available in Pinellas Park, Largo, St. Pete, Seminole, Clearwater, Dunedin, St. Pete Beach, Palm Harbor, Tarpon Springs, Safety Harbor, Macdill, Tampa, Bradenton, Palmetto, Parish and Sarasota.

Platelet Rich Plasma (PRP) Therapy in Pinellas Park, FL

Pain Relief Centers provides platelet rich plasma therapy to stimulate muscle, tendon, and ligament regeneration and healing. PRP therapy is 100% natural because the plasma is drawn from your own body. PRP therapy is also safe, effective, and non-surgical.

What is PRP?

PRP therapy is the process of drawing a sample of your own blood then injecting it into the areas of pain. The injection is high in platelets to increase cell growth and healing. There is not any risk of infection because your own blood is used for the injection.

After your treatment, recovery times may vary. Most patients see improvement within four to six weeks of their PRP treatment. You will continue to see pain improvement and increased mobility up to 12 months after the treatment.

Conditions Treatable with PRP

  • Acute & Chronic Pain
  • Back & Neck Pain
  • Arthritis
  • Foot & Ankle Pain
  • Tennis & Golfer's Elbow
  • Rotator Cuff Injuries
  • Ligament, Cartilage & Tendon Injuries

Regenerative Medicine in Pinellas Park, FL

Pain Relief Centers provides regenerative medicine treatments to help your body heal naturally. Regenerative treatments do not require surgery or hospital stays. Often patients are able to return back to their normal schedule and work the following day.

What Are Regenerative Medicine Treatments?

Regenerative therapy treatments use both stem cell therapy and allograft tissues to jump start the body's natural healing process. The treatments are safe because we use your own body's cells and platelets for the procedure. Stem cells are used to replace dying cells and damaged tissue and muscles. Stem cells can be derived from either fat deposit or bone marrow. On the other hand, allograft tissues also promote healing.

Benefits of Regenerative Medicine Treatments

Regenerative medicine treatments allow individuals, professionals, and athletes to heal more quickly and recover from injuries. Recovery times vary for each patient, however most see improvements within four to six weeks after their treatment and will continue to improve up to 12 months. Regenerative medicine treatments are ideal for those who experience:
  • Back Pain
  • ACL Injuries
  • Rotator Cuff Tears
  • Patellar Tendon Injury
  • Knee Pain
  • Arthritis of the Knee
  • Tennis Elbow
  • Plantar Fasciitis
  • Tendonitis
  • Hip or Shoulder Pain
  • Hip Bursitis
  • Achilles Tendon Injuries

Schedule a Regenerative Medicine Treatment today

Contact Pain Relief Centers today to schedule your regenerative medicine therapy.