Treatments & Procedures

What we actually do, why we choose it, and what it is like. Every procedure here is image-guided. We confirm where the needle is. We do not guess.

How treatment is chosen here

Nothing on this list is a default. The order is history, then exam, then imaging if it will change something. Then comes a targeted procedure if the exam points to one structure. If a step will not change the plan, we say so and skip it. If we cannot find the source with confidence, we say that too.

Much of what we do is diagnostic (to find the cause) before it is therapeutic (to treat it). A block placed under image guidance answers a question imaging cannot. With this structure switched off, does the pain go? That answer is what makes a longer-lasting procedure worth doing. It is also the step most often missing when patients come to us after a series of injections that did nothing.

Will I need a driver after a pain procedure?

Rarely. Nearly every procedure on this page is done under local anesthetic with no sedation, so you stay awake, alert and fit to drive yourself home. The numbing medicine works where the needle goes, not on your brain.

Two exceptions are real. If an epidural or a selective nerve root block leaves an arm or leg heavy or numb, someone else drives until that wears off, which takes a few hours. Sacroiliac joint fusion is a minimally invasive stabilization, not an injection, and it needs a driver and help at home for the first days. Staying awake is deliberate: during a transforaminal epidural you report what you feel as it happens, a safety check a sedated patient cannot give.

The three groups below

The procedures fall into three groups. Diagnostic blocks show which structure is to blame. Therapeutic injections calm inflammation around an irritated nerve or joint. They buy time for the body to heal. Longer-lasting procedures, radiofrequency ablation and neuromodulation (nerve signal control), are saved for cases where a diagnostic step has already confirmed the target.

Next to those sit a medicine review and physical therapy matched to the real diagnosis. There is also metabolic care, which works on the body conditions that tissue has to heal in. Most lasting results come from a mix, not from any one procedure.

Diagnostic

Spine injections

Radiofrequency and ablation

Neuromodulation

Stabilization

Nerve blocks

Joint and soft tissue

Non-procedural

Sources

• Qaseem A et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 2017. PubMed 28192789
• George SZ et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. The Journal of orthopaedic and sports physical therapy, 2021. PubMed 34719942
• Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional anesthesia and pain medicine, 2020. PubMed 32245841
• Finnerup NB et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet. Neurology, 2015. PubMed 25575710