Pain Management | WVU Medicine Camden Clark

If you are receiving injections for pain, you must bring a driver with you. Your procedure will be cancelled if you do not have someone to drive you home.  You must be free of any infection in order to have an injection of any type. If you become ill, please call the clinic at 304-865-5530 to reschedule your injection. Your injection will be cancelled if you are presently on any antibiotic treatment for infection.

You may take your scheduled medications, including pain, blood pressure, and heart medications, unless otherwise advised. Please notify the pain clinic if you are on any blood thinners, such as: Plavix, Ticlid, Coumadin, Pletal, Lovenox, Aggrenox, or any other anticoagulant. These medications require special instructions.

Diabetic patients: Please be sure to check your glucose level on the morning of your injection. Also, you will need to check your glucose levels more frequently for the first 2 or 3 days following your injection. Some patients may notice an increase in their glucose levels after their procedure.

No solid food for at least 6 hours prior to your scheduled procedure time. You may have small amounts of clear liquids up to 2 hours prior to the procedure.

If you feel you are having an allergic reaction to medicine, go to the nearest emergency room.

Signs of an allergic reaction may include:

• severe itching
• chest pain
• red or bloody welts
• swelling (on any body part)
• difficulty breathing
• seizures
• unconsciousness

Signs of infection at the site of the injection may include:

• redness
• increase in pain at the puncture site, not to be confused with an increase in pain of your diagnostic problem for which the injection was given
• swelling at the puncture site that cannot be relieved by elevation of the body part or with application of ice at the site
• drainage of fluid from the site that is foul smelling, has color that may be white, yellow, gray, or green
• fever greater than 100.5 degrees by mouth and lasting longer than one day
• increase in warmth to touch around the puncture site associated with these symptoms

If you have questions, please call the Pain Clinic between the hours of 8 am and 4 pm Monday through Friday at 304-865-5530. After hours or holidays, go to the nearest emergency department.

An epidural steroid injection is placement of a dose of corticosteroid medication (with or without local anesthetic) into the epidural space in the spine. The epidural space is the area around the spinal nerves, next to the tough covering that surrounds them, called the dura.

The goals of an epidural steroid injection are:

• To reduce and possibly eliminate pain
• To increase function
• To possibly eliminate the need for surgery

Corticosteroids decrease inflammation and swelling that can cause pain and limit function. To achieve the most benefit with the least side effects, the amount of corticosteroid in an epidural steroid injection is carefully monitored. You will be limited to no more than three of these procedures in a six-month period.

During an epidural steroid injection, you will remain awake for the procedure. An intravenous (IV) line may be started prior to the injection. Once in the procedure suite: You will be positioned lying face down. The area for the injection will be washed with an antiseptic solution and covered with sterile drapes. A local anesthetic will be used to numb the injection site. – You will be asked to remain as still as possible. IV contrast dye may be used to confirm the correct needle position. You may feel pressure while the medication is injected into the space.  The entire procedure lasts about 10 minutes.  After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.

You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A stellate ganglion block is an injection of local anesthetic that temporarily interrupts activity in the sympathetic nerves in the neck. The stellate ganglion nerves are located in the neck next to, but not in, the spine. These nerves influence and help control the size of blood vessels and thus the flow of blood to the arms, head, and neck.

The goals of a stellate ganglion block are:

• To provide diagnosis
• To reduce and possibly eliminate pain
• To increase function

A stellate ganglion block temporarily interrupts activity of stellate sympathetic nerves. This interruption will improve pain as well as improve blood flow. You may require repeated injections for optimal pain relief.

During a stellate ganglion block, you will remain awake for the entire procedure. An intravenous (IV) line will be started prior to the injection. The procedure lasts about 15 minutes.

Once in the procedure suite:

• You will be positioned lying face up.
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic may be used to numb the injection site.
• You will be asked to remain as still as possible.
• You will be asked to use non-verbal cues during the procedure.
• You may feel pressure while the medication is injected.

After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.

You may temporarily experience:

• droopy eyelids
• red or bloodshot eyes
• stuffy nose
• hoarse voice or “lump” in your throat
• warmth or tingling in your arms

You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A lumbar sympathetic block is an injection of local anesthetic that temporarily interrupts activity in the sympathetic nerves in the lower back. These nerves influence and help control the size of blood vessels, and thus, the flow of blood to the legs.

The goals of a lumbar sympathetic block are:

• To provide diagnosis
• To reduce and possibly eliminate pain
• To increase function

A lumbar sympathetic block temporarily interrupts activity of lumbar sympathetic nerves. This interruption will reduce pain as well as improve blood flow. You may require repeated injections for optimal pain relief.  You will remain awake for the entire procedure. An intravenous (IV) line will be started prior to the injection.

Once in the procedure suite:

• You will be positioned lying face down.
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic will be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The entire procedure lasts about 25 minutes.  You will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.  You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A diagnostic facet nerve block is used to determine if your back pain is being caused by the facet joints. Facet joints are the joints between the vertebra, which are present on both sides of the spine and provide flexibility to the spine. The joints are supplied by facet nerves (also called medial branch nerves).

The goals of a diagnostic facet nerve block are:

• To diagnose the cause of pain
• To determine the possibility of treatment with frequency ablation (rhizotomy)
• To reduce and possibly eliminate pain
• To increase function
• To possibly eliminate the need for surgery

The diagnostic facet nerve block is an injection of local anesthetic medication. If the block relieves the pain, the diagnosis of pain coming from the facet joints can be made. The degree and duration of pain relief will determine if radiofrequency ablation, also called rhizotomy (a procedure to deaden the nerves using heat), is an option.

You will remain awake for the procedure. Once in the procedure suite:

• You will be positioned lying face down (face up for upper cervical).
• The area for the injection will be washed with an antiseptic solution and covered with sterile drapes.
• A local anesthetic may be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The entire procedure lasts about 10-15 minutes. After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.  You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A therapeutic facet nerve block is a diagnostic and possibly therapeutic procedure to determine if your back pain is being caused by the facet joints. Facet joints are the joints between the vertebra, which are present on both sides of the spine and provide flexibility to the spine. The joints are supplied by facet nerves (also called medial branch nerves).

The goals of a therapeutic facet nerve block are:

• To provide diagnosis
• To determine the possibility of treatment with frequency ablation (rhizotomy)
• To reduce and possibly eliminate pain
• To increase function
• To possibly eliminate the need for surgery

The therapeutic facet nerve block consists of a mixture of local anesthetic and corticosteroid medications. The local anesthetic helps to diagnose the pain is coming from the facet joints. The corticosteroid medication decreases inflammation and swelling that can cause pain and limit function.

You will remain awake for the entire procedure.  Once in the procedure suite:

• You will be positioned lying face down (face up for upper cervical).
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic may be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The procedure lasts about 10-15 minutes.  After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.  You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A trigger point injection is the injection of a small amount of medication into the area of a muscle where you have pain and tenderness. Trigger points are focal areas of pain and tenderness due to “knots” or tight bands of muscle.

The goals of a trigger point injection are:

• To reduce and possibly eliminate pain
• To increase function

The trigger point injection consists of local anesthetic with or without corticosteroids. The injection breaks up the trigger points and decreases the pain.

You will remain awake for the entire procedure. Once in the procedure suite:

• You will be positioned sitting or lying face down.
• The areas of tenderness will be located and marked.
• The area of the injection will be washed with an antiseptic solution.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The procedure lasts about 10 minutes.  After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you. The day after your procedure, you may resume your normal daily activities. You will need to do stretching exercises to the affected area and/ or attend physical therapy sessions.

A sacroiliac joint injection is a diagnostic and possibly therapeutic procedure to determine if your pain is being caused by the sacroiliac joint. The sacroiliac joint is a large joint between the sacrum and ilium in the low back and buttock region.  The injection consists of a mixture of local anesthetic and corticosteroid medication into the sacroiliac joint.

The goals of a sacroiliac joint injection are:

• To diagnose the cause of pain
• To reduce and possibly eliminate pain
• To increase function
• To determine the possibility of treatment with frequency ablation (rhizotomy)

The sacroiliac joint injection consists of a mixture of a local anesthetic and corticosteroid medications. The local anesthetic helps to diagnose if the pain is coming from the sacroiliac joint. The corticosteroid medication reduces inflammation and swelling that can cause pain and limit function.

You will remain awake for the entire procedure. Once in the procedure suite:

• You will be positioned lying face down.
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic may be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The procedure lasts about 10 minutes. After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.  You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

A celiac plexus block is an injection of local anesthetic that temporarily interrupts activity in the sympathetic nerves in the abdomen. The celiac plexus is a group of nerves located in the abdomen, next to, but not in the spine. This group of nerves is part of a larger system of nerves call the autonomic nervous system. These nerves influence and help control the size of blood vessels and thus the flow of blood to the abdomen, particularly nerves that come from the pancreas, liver, gall bladder, stomach, and intestine.

What are the goals of a celiac plexus block?

• To reduce and possibly eliminate pain
• To increase function

The celiac plexus block temporarily interrupts the activity of celiac plexus nerves and provides pain relief. This procedure blocks the nerves that come from the pancreas, liver, gall bladder, stomach and intestine. You may require repeated injections for optimal pain relief.

You will remain awake for the entire procedure. An intravenous (IV) line will be started prior to the injection.  Once in the procedure suite:

• You will be positioned lying face down.
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic will be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure during the needle placement and while the medication is injected.

The entire procedure lasts about 25 minutes. After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you.  You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.

Rhizotomy is a procedure in which radiofrequency waves are used to generate heat that interrupts and destroys nerves.

The goals of a rhizotomy are:

• To reduce and possibly eliminate pain
• To increase function

Rhizotomy is a therapeutic procedure designed to decrease and/or eliminate pain symptoms. The procedure involves destroying nerves that are present in the affected joints with highly localized heat generated with radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken.

You will remain awake for the entire procedure. Once in the procedure suite:

• An intravenous (IV) line may be started prior to the injection.
• You will be positioned lying face down.
• The area for the injection will be washed with an antiseptic solution.
• A local anesthetic will be used to numb the injection site.
• You will be asked to remain as still as possible.
• You may feel pressure while the medication is injected.

The procedure lasts about 25 minutes. After the procedure, you will be monitored for approximately 15 minutes, because the medication takes some time to act. A nurse will review discharge and follow-up instructions with you. You will need to carefully monitor the degree and duration of your pain relief. The day after your procedure, you may resume your normal daily activities.