Pain Management Procedures

Pain management procedures: The basics.

  • Pain management procedures (PMPs) are usually not a cure for chronic pain.
  • However they can provide an effective way to improve your overall pain management.
  • PMPs provide pain relief so other long-term pain treatments have a better chance of working: please see the PainHealth website.
  • PMPs allow you to reduce pain medications & engage more effectively in physiotherapy & behavioural therapies.
  • Sometimes pain procedures can actually ‘switch off’ sensitive nerves & produce long-term pain relief.

Low back pain

  • Facet joint steroid injection
  • Facet joint (medial branch) nerve block
  • Facet joint neurotomy
  • Cluneal nerve block
  • Sacroiliac joint steroid injection
  • Sacroiliac joint neurotomy

Leg pain (sciatica)

  • Epidural steroid injection (nerve-root injection)
  • Epidural steroid injection (caudal catheter technique)

Neck pain & whiplash

  • Facet joint (medial branch) nerve block (C5/6)
  • Facet joint (medial branch) neurotomy (C5/6)
  • Muscle trigger point injections
  • Thoraco-cervical epidural catheter steroid injection

Headaches & facial pain

  • Occipital nerve block, pulsed radiofrequency treatment or cryoneutotomy (freezing nerve)
  • Facet joint (medial branch) nerve block (C2/3)
  • Facet joint (medial branch) neurotomy (C2/3)
  • Sphenopalatine ganglion block
  • Stellate ganglion block
  • Trigeminal nerve branch (of the face) blocks and pulsed radiofrequency treatment.
  • Botox injection

Knee pain

  • Knee joint steroid injection
  • Knee joint viscotherapy injection
  • Knee infrapatellar nerve block
  • Adductor canal saphenous nerve block
  • Knee genicular nerve blocks & neurotomies

Hip, thigh & buttock pain

  • Hip joint steroid injection
  • Hip joint obturator nerve branch block
  • Hip joint obturator nerve branch neurotomy
  • Greater trochanteric bursa steroid injection
  • Piriformis injection and pulsed radiofrequency treatment

Shoulder pain

  • Shoulder joint steroid injection
  • Suprascapular nerve block & pulsed radiofrequency treatment
  • Suprascapular nerve block and cryoneurotomy (nerve freezing)

Abdominal wall pain

  • Anterior cutaneous nerve entrapment syndrome (ACNES) block
  • Anterior cutaneous nerve (phenol) chemical neurotomy

Pelvic & tailbone (coccyx) pain

  • Pudendal nerve block and pulsed radiofrequency treatment
  • Ganglion impar block and pulsed radiofrequency treatment
  • Peri-coccygeal steroid injection

Nerve pain

  • Intercostal nerve block, chemical (phenol) or cryoneurotomy (ribs pain)
  • Ilioinguinal or genitofemoral nerve blocks & pulsed radiofrequency treatment (groin or testicle pain)
  • Lateral cutaneous nerve to thigh block & pulsed radiofrequency treatment (pain in outer thigh)
  • Capsaicin (8%) patch therapy (chilli pepper)
  • Botox A subcutaneous field injection
  • Percutaneous Electrical Nerve Stimulation (PENS)

Leg pain (poor blood circulation)

  • Lumbar sympathectomy

Facet joint steroid injection

  • Facets joints are small stabilizing joints on the outside of the spine.
  • Up to 30% of back & neck pain cases may be due to facet joint arthritis.
  • Using an x-ray machine a small amount of local anaesthetic & steroid (cortisone) is injected into the facet joint.
  • Facet joint injections (FJIs) may reduce back or neck pain for weeks-to-months, but their effects are variable.
  • 1-in-5 patients report a good reduction in pain following FJI.
  • FJIs are more effective in patients over 60 years of age.

Facet joint nerve block

  • Local anaesthetic is injected around the medial branch nerves coming from the facet joints, to test if these joints are the source of  person’s back or neck pain.
  • If the pain settles after the local anaesthetic injection (usually 4 hours or so) it’s likely the facet joints are causing the pain.
  • Click here for patient information about facet joint procedures from the Faculty of Pain Medicine.

Facet joint (medial branch) neurotomy

  • Using an x-ray machine a small needle is placed near the medial branch nerves going to the facet joint.
  • Via this needle a tiny electric charge is used to heat (cauterize) the nerve.
  • This procedures is called a facet joint neurotomy (FJN).
  • A FJN may produce long periods (months) of back-or-neck pain relief in 1-in-4 patients.
  • Before performing a FJN, a patient must first report good pain relief after a facet joint injection or nerve block.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.
  • Click here for more detailed information about facet joint neurotomies.

Cluneal nerve block

  • Low back & buttock pain may be caused by compression of the cluneal nerves as they pass over the top of the hip bone (iliac crest).
  • Using an x-ray machine the cluneal nerves are blocked with a local anaesthetic & steroid injection as they pass over the hip bone.
  • Cluneal nerve blocks may provide back pain relief lasting for months in 1-in-4 patients.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.

Sacroiliac joint steroid injection

  • Sacroiliac joints (SIJ) are the largest joints in the body.
  • SIJs may cause low back & buttock pain in 20% of cases.
  • Using an x-ray machine local anaesthetic & steroid is injected into the SIJ.
  • SIJ injections may help patients with back pain due to inflammatory arthritis (e.g. ankylosing spondylitis).
  • SIJ injections are less effective in patients with joint ‘wear & tear’ or after an injury (e.g. after childbirth).

Hip joint injections & nerve blocks

  • Hip pain may be treated by injecting local anaesthetic & steroid into the joint using an ultrasound or x-ray machine to place the needle.
  • The obturator nerve going to the painful hip can be blocked by performing a neurotomy (cauterizing the nerves) via a fine needle placed near the nerve using an ultrasound or x-ray machine.

Sacroiliac joint neurotomy

  • Using an x-ray machine small needles are placed near the nerves going to the sacroiliac joint (SIJ).
  • Via these needles a tiny electric charge is used to heat (cauterize) the nerves.
  • This may produce long periods (months) of pain relief (for low back & buttock pain) in 1-in-4 patients.
  • Before performing a SIJ neurotomy a patient must first report good pain relief from a SIJ injection.

Muscle trigger point injection

  • Sometimes neck, shoulder or low back pain is associated with tight muscle knots called trigger points.
  • Injecting these trigger points with local anaesthetic via a fine needle is sometimes helpful for muscle pain.

Epidural steroid injection

  • A protruding spinal disc may irritate a nearby nerve causing leg pain (sciatica).
  • Using an x-ray machine a fine needle is placed into the epidural space next to the irritated nerve.
  • A small amount of local anaesthetic & steroid (cortisone) is injected around the nerve, via the needle.
  • Epidural steroid injections may reduce leg pain (sciatica) for weeks-to-months in 1-in-4 patients.
  • Epidural steroid injections DON’T treat low back pain, only leg pain.
  • Click here for more information about epidural steroid injections from the Faculty of Pain Medicine.
  • Click here for more information about caudally-directed epidural steroid injections.

Occipital nerve block

  • Many headaches are associated with sensitivity of the nerves in the back of the scalp called the greater & lesser occipital nerves.
  • These nerves are blocked with a local anaesthetic & steroid injection just under the skin of the scalp at the back of the head.
  • Some patients report excellent relief of headaches lasting for months & it’s a relatively low-risk procedure.
  • We sometimes perform C2/3 facet joint steroid injections or nerve blocks in the upper neck to treat headaches.
  • Pulsed radiofrequency treatment: the nerves are temporarily blocked by electrical pulses sent down the needle.
  • Click here for more details.