Diagnostic & Therapeutic

Transforaminal Epidural Steroid Injections

This procedure is usually performed for someone with acute leg pain due to an irritated nerve in the low back. This method of performing the injection maximizes the dose of anti-inflammatory medicine where the irritation of the nerve is greatest.

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Medial Branch Block and Medial Branch Denervation

This procedure is used to assess whether pain in the neck or back is coming from arthritis of the Facet Joint. These joints develop arthritic pain, just like any other joint in the body. The purpose of this nerve block is to inject local anesthetic specifically near the nerve supply for the joints, and then to find out if doing so reduces pain reproduced by movement.

If a patient has a successful series of Medial Branch Blocks, they may be offered a long-term treatment, called Medial Branch Denervation. Most  patients who have a successful series of diagnostic injections for this problem have a similar degree of pain relief for the long term (about 12 to 18 months) after the denervation. The denervation procedure is similar to the diagnostic blocks, but instead of injecting local anesthetic (numbing) medicine, the doctor uses a device that generates radiofrequency energy to heat the tissue just at the end of the needle.

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Peripheral and Sympathetic Nerve Blocks

Peripheral nerves are the nerves outside of the brain and spinal cord. These nerves transmit sensation and are responsible for some of your movement. These nerves can be damaged or their function altered by trauma, surgery, scar tissue or illness. Blocking some of these nerves can help provide relief.

Chronic pain conditions can often involve changes in function of the sympathetic nerves. These nerves regulate blood flow, sweating and glandular function. Sometimes blocking these nerves can provide diagnostic information as to what is causing your pain and provide pain relief


Botulinum toxin is produced by Clostridium botulinum, a gram-positive anaerobic bacterium. Botulinum toxin can be useful for certain types of pain, such as headaches (migraines especially), piriformis syndrome, myofascial pain (muscle pain) and some other types of pain problems. Often Botulinum toxin is not covered by insurance so we will work for insurance authorization but in some cases Botulinum toxin injections is not an option secondary to cost.

Spinal Cord Stimulation

A spinal cord stimulator (SCS), also known as a dorsal column stimulator (DCS), is an implantable medical device used to treat chronic neurological pain. An electric impulse generated by the device produces a tingling sensation that alters the perception. The device is implanted into the epidural space either by percutaneous approach or by surgical laminectomy or laminotomy. A pulse generator or RF receiver is implanted in the abdomen or buttocks. A wire harness connects the lead to the pulse generator. This device may be done for several different types of pain syndromes. Your provider at the Comprehensive Pain Center will be able to provide you with more information.

Click here to view an animation of the procedure.