Medication Management

Medication can ease pain, help you sleep, or treat other symptoms. We will use one or multiple medications to target specific needs. While medications are part of pain management for many people, they should not be the only part of your plan. Pain medications can have side effects and risks, which can increase when they are taken for a long period of time. There are a number of complications to avoid when using these medications. When we begin medication treatment we follow up with you to determine how you are responding and if there are changes that need to be made.

Interventional Procedures

For some types of pain, procedures may be recommended to help diagnose what’s causing the pain, to treat the pain, or both. These minimally invasive and non surgical procedures are done using needle therapy, using imaging (Ultrasound, Xray or CT guidance) to identified specific areas of injury.  Injection therapy usually requires more than one intervention. 

Diagnostic Injections: The first injection is usually done to determine the specific source of your pain. A local anesthetic is injected in the proximity of the suspected source of pain, also known as pain generator. Most diagnostic injections provide  short term relief but this is an important initial component of the process which helps determine the treatment plan to follow. 

Therapeutic Injections: These subsequent injections are done in an attempt to provide long term relief. They are usually done once the source of pain has been identified. Common injectates we use include local anaesthetic, anti-inflammatories or your own plasma.

The most common techniques we use are:

EPIDURAL STEROID INJECTION

An epidural steroid injection is a very effective, low risk, minimally invasive treatment used to treat pain that is caused by an inflamed spinal nerve(s) that can result in neck, arm, back and leg pain. 

Brochures for common types of Epidural Steroid Injection

1. Cervical Epidural Injection 

2. Lumbar Steroid Injection

3. Thoracic Steroid Injection 

FACET JOINT INJECTIONS

Facet joint injections are given where two vertebrae join together. These joints allow the spine to bend and twist. This is a common source of pain in our patients and there are multiple ways to treat pain originated from this hard working joints.

Brochures for common types of Facet Joint Injections:

1. Lumbar Facet Injection

2. Cervical Facet Injection

3. Median Branch Nerve Block/ RFA for neck, head and Shoulder pain

4. Median Branch Nerve Block/ RFA for Lower back pain

RADIOFREQUENCY TREATMENT  

Radiofrequency can be used to lesion or stun nerves that can not stop sending pain signals to the brain. Used for the management of nerve pain, and joint pains. Radiofrequency ablation (RFA) refers to a thermal energy used to deaden tiny nerve endings and uses a special type of needle to apply radio waves to a painful nerve. By lesioning nerves, we interrupt the transmission of pain signals to the brain. At Bermuda Pain Relief Center, we do hundreds of these treatments per year with very high success rates. 

Brochures for common types of Radiofrequency Ablation (RFA):

1. Radiofrequency Ablation for the treatment of Lower Back Pain

2. Radiofrequency Ablation for the treatment of neck, head and shoulder

3. Radiofrequency Ablation for the treatment of Sacroiliac Joint RFA

4. Radiofrequency Ablation for the treatment of knee pain

5. Pulsed Radiofrequency

6. Radiofrequency Ablation for the treatment of hip pain

NERVE BLOCKS AND SYMPATHETIC GANGLION BLOCKS:

Nerves are little cable like structures that transmit pain from different parts of the body to the brain. We are able to block this pathway by injection numbing medication into specific nerves or in gangling stations. Anesthesiologists have been using these techniques for decades to help surgeons to perform certain interventions safely. To prolong pain relief, we use different techniques like pulsed radiofrequency, chemical, or radiofrequency ablation.

Common types of Nerve Block and Sympathetic Ganglion Blocks:

1. Nerve Blocks: Occipital Nerve Block; Suprascapular Nerve Block; Brachial Plexus Block; Abdominal Nerve Blocks (Intercostal Nerve Block; Ilio-inguinal & Genito-Femoral Blocks; TAP, Abdomen Cutaneous Nerve & Rectal Sheath Block), Femoro-cutaneous Nerve Block; Pudendal Nerve Block; Spermatic Cord Nerve Block; Genicular Nerve Blocks.

2. Sympathetic ganglion blocks: Stellate Ganglion for upper extremity CRPS, Celiac Plexus for pancreatitis and pancreas cancer pain, Lumbar Plexus for intrabdominal visceral pain, Hypogastric Plexus for pelvic organs associated pain, Ganglion Impar Block for genital pain and coccydinea.

NEUROMODULATION

SPINAL CORD STIMULATION

Spinal cord stimulation is one treatment for chronic pain. A small device, similar to a pacemaker, delivers electrical pulses to the spinal cord. These signals keep the chronic pain messages from being sent to your brain. Instead, you may feel tingling from the electrical signals.  It helps people better manage their chronic pain and reduce their use of opioid medications. Learn More About Spinal Cord Stimulation

Brochure for Spinal Cord Stimulators

PERIPHERAL NERVE STIMULATION

Peripheral nerve stimulation, frequently referred to as PNS, is a commonly used approach to treat chronic pain. It involves placing an implantable small electrical lead (a wire-like electrode) next to one of the peripheral nerves that is causing the pain. The external pulse transmitter device (EPT) sends electrical signals through the skin to the implanted lead to disrupt pain signals. A wireless connection between the patient programmer and EPT allows patients to easily turn stimulation on/off, increase/decrease stimulation intensity, and select custom stimulation programs.

Brochure for Peripheral Nerve Stimulation

MUSKULOSKELETAL INJECTIONS

Joint pain (knee, shoulder, hip) is a very common pain and can be caused by a multitude of factors: osteoarthritis, rheumatoid arthritis, previous surgery, torn ligaments or cartilage and wear and tear over time. A diagnostic ultrasound, followed by a guided injection into the affected structure can help relieve some of this pain and is known to be the traditional method. Components of your own blood can be use to treat your discomfort.

REGENERATIVE MEDICINE

PRP involves injecting platelet enriched plasma extracted from a patient’s blood into their own body’s tissues. The result is a quicker alleviation or reduction in pain and recovery rate from an injury, including those from a surgical procedure. Besides aiding in healing by speeding up the process of clotting, platelets also help in Pain Management.

Brochure for Platelet Rich Plasma (PRP)