Pain Referral Guidelines / Mission Statement
Introduction
  The specialty of “Pain Management” has progressed significantly in the last 20 years through a better understanding of anatomy and physiology and through advances in pharmacology and technology. Anesthesiology has taken the lead in the field of pain management through extensive research, specialized training and board certification.
The staff at the Interventional Pain Medical Group are now able to make a real difference in the lives of our patients, families and their physicians. The group provides an invaluable service to society by helping patients return to a more functional and productive state. The doctors and staff of the Interventional Pain Medical Group work together with the patients’ physicians to promote the best possible treatment. We have found that in cooperating with colleagues, the group is able to achieve a much higher success level. Medical reports are complete, concise, appropriate and timely.
The Interventional Pain Medical Group is a group of physicians, expertly trained in the art and science of Pain Management. The group represents a team of multi-disciplinary, interventional pain management specialist who specifically understand, diagnose and treat a wide variety of pain conditions. This guide will briefly review the type of patient that is appropriate for referral to the Interventional Pain Medical Group.
Patients Appropriate for Referral
 Pain management specialists are trained to relieve pain arising from any type of conditions. The Interventional Pain Medical Group treats all types of pain. Using applications of orthopedists neurologists. anesthesiologists, chiropractors and massage and physical therapists, the Group strives to coordinate the care of individuals suffering fro pain conditions. Our services include diagnoses and recommendations for general pain treatment and specific interventional procedures, which may aid in the diagnosis and treatment of the condition.
Appropriate and early referral to IPMG will result in significant relief of suffering.
Examples of Pain Diagnoses, by region suitable for referral include:
-
Lumbar Region
- Acute and Chronic Low Back Pain/ Strain Lumbago
- Post-Laminectomy Pain
- Pre-Surgical Epidural Trial
- Spinal Stenosis and Lumbar Neuralgia-Arachnoiditis
- Spondylolisthesis
- Epidural Scarring
- Mechanical Low Back Pain
- Facet Joint Pain
- Sacroiliac Pain
- Myofascial Pain
- Ligamentous Back Pain
- Discogenic Pain
- Degenerative Disc Disease
- Lumbar Disc Protrusion with Lumbar Neuralgia
- Vertebral Compression Fx Fracture
- Lumbar Spinal Trauma
- Metastatic Cancer to the Lumbar Region
- Sacro-Coccygeal Pain
-
Cervical -Thoracic Region
- C-T Strain/ Sprain
- Cervicalgia
- Cervical Muscle Spasm Pain
- Facet Disease with Myofascial Pain
- Fibromyalgia Pain
- Neuropathy
- Disc Disease
- Cervical Trauma
- Cervical Spinal Stenosis
- Shingles
- Vertebral Compression Fracture
-
Head Pain
- Headaches of multiple origin
- Closed or Open Head Trauma with Headache Sequelae
- Cervical Muscular Headache
- Myofascial Headache
- Facial Neuralgia
- Occipital Neuralgia
- Shingles
- Cancer Pain
- Post Stroke Associated Pain
- Trigeminal Neuralgia
-
Arthritis\Tendonitis\ Arthropathy
- Arthritic Joint Pain
- Peripheral Neuralgia
- Epicondylitis
- Bursitis
- Ligamentous Pain
- Post-Knee Joint Replacement Pain
- Post-Hip Joint Replacement Pain
-
Sympathetic Dystrophy Pain
- Reflex Sympathetic Dystrophy
- Causalgia
- Complex Regional Pain Syndrome
- Peripheral Neuropathy
- Spinal Cord Injury Trauma
- Acute Herpes Zoster
- Multiple Sclerosis
- Shingles
- Post Herpetic Neuralgia
-
Sports Injury Pain
-
Cancer Pain
-
Pelvic Pain
- Chronic Post-Hernia Surgery Inguinal Pain
- Intractable Sympathetic Pelvic Pain
- Various other Reproductive, Gastrointestinal, Urologic, Sympathetic, Musculoskeletal and Neuromuscular disorders
Services Provided
- Pain Management Consultation and Recommendations
- Injection Techniques are used in the diagnosis and treatment of acute and chronic pain syndromes. There targeted injection procedures, help diagnose the source of pain and additionally provide relief. Patients report great satisfaction in achieving relief from pain. Most patients receive permanent or prolonged quality pain relief. This period of relief is the window during which ongoing physical therapy is most effective.. Continued medical therapy during this time is crucial to success.
Patients may receive a series of one or more injection procedures. Each time an injection is performed, your doctor will more accurately understand your pain condition. Failure of pain injections to treat your pain may indicate that the pain originates elsewhere. Once your doctor knows the precise pain generator, he or she can then design a long-term treatment plan.
Relief is dependent on several factors:
- Proper indication of procedure
- Correct technique and exact placement of injection using fluoroscopy and x-ray
- Location of the pain generator
- Drug choices and volume of medicine delivered to pain generator
- Anatomic considerations very large herniated disc, extensive scar tissue, etc.
- Psychological factors (include central pain syndromes such as somatization disorder and mental illness)
- Examples of Common Injection Techniques
- Epidural injections with x-ray
- Cervical, thoracic, lumbar, caudal, epidural steroid injection with or without x-ray
- Epidurogram provides an x -ray anatomical picture of the epidural space guiding treatment.
- Epiduroscopy gives a video anatomical picture of the epidural space guiding treatment.
- Epidural neuroplasty catheter techniques for precise treatment of intractable pain of multiple spinal levels
- Selective nerve root blocks
- Transforaminal epidurals
- Tunneled epidural infusion therapy
- Epidural opiate trial for intrathecal opiate pump implantation
- Joint Injections with x-ray
- Cervical, thoracic, lumbar facet joint blocks with X ray guidance
- Sacroiliac joint blocks with x-ray guidance
- Peripheral joint blocks ie. shoulder , hip and knee etc.
- Discograms
- Cervical, thoracic, lumbar provocative-diagnostic intra-discal injections with x-ray
- Percutaneous discectomy-nucleoplasty, dekompressor, laser and I.D.E.T.
- Sympathetic Blocks with x-ray
- Ganglion blocks of stellate, thoracic, celiac, lumbar, hypogastric, ganglion impar plexus
- Intravenous sympathetic blocks, I.V. bier block regional sympathectomy
- Peripheral Nerve Blocks and Myofascial Trigger Point Injections
- Prolotherapy: highly effective, non-steroid alternative injection treatment plan with x-ray
- Advanced Pain Management Therapies
- Spinally administered opioid pump implantation (eg. Intrathecal opioid pump)
- Spinally administered baclofen pump implantation
- Spinal cord stimulation implant
- Radiofrequency neuro-oblative techniques
- Spinal Endoscopy looking in to the spinal canal using video technology
- Percutaneous discectomy- nucleoplasty, dekompressor, laser discectomy for discogenic pain
- Low intensity laser therapy for healing of tissues
- Pain Management combined with chiropractic manipulation under anesthesia
- Surgical procedures may be considered to treat chronic pain with appropriate specialist referrals made
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