Treatments

Pain can consume your life. It can be debilitating, a source of stress, and can prevent you from doing the things you love the most. Whether you’re dealing with chronic pain, post-op complications, or non-operative issues, Dr. Rich and the team will work to uncover the root cause of your pain and provide you with an appropriate treatment pathway.

We’ll use our expertise and ongoing education and training to give you options and avoid the use of ongoing or lifelong medication.

For patients that cannot have surgery or are not looking for surgical options, our Peripheral Nerve Stimulation treatment is especially effective in treating and/or eliminating pain.

Explore Treatments & Relief Options

Back Pain

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General Lower Back Pain

Medial Branch Block:

Under the guidance of an X-ray, your doctor will inject a long-acting local anesthetic to determine if the facet joint is the cause of your back pain. This procedure can offer considerable relief for a few hours or days after injection and is largely helpful in identifying the source of your pain, making it an important part of your treatment path.

Radiofrequency Ablation:

This non-surgical procedure sends an electrical current, produced by a radio wave, to heat a small area of nerve tissue that can decrease pain signals from targeted areas, possibly in your neck, back, or general muscle discomforts. With little downtime, quick relief, and improved mobility Radiofrequency Ablation can help with your chronic pain.

Epidural Steroid Injection:

A common and effective injection guided by X-ray can reduce inflammation that causes low back, leg, neck, and arm pain as well as relieve pain stemming from herniated discs. Epidural steroid injections have been performed for decades and allow many patients to experience long-lasting pain relief and improved function, increasing their quality of life.

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Compression Fracture / Disc Herniation

Kyphoplasty :Kyphoplasty is a minimally invasive surgery used to treat spinal compression fractures using X-ray guidance and a narrow tube. By making space in the bone that was lost and then filling the area with a solid, cement-like mixture your doctor can relieve pressure and pain that may have been caused by osteoporosis, tumors, or other stressors. Many patients experience pain relief and a stabilized vertebra that is restored to its normal height.

Epidural Steroid Injection:

A common and effective injection guided by X-ray can reduce inflammation that comes from the pain associated with herniated discs or compression fractures. Epidural steroid injections have been performed for decades and allow many patients to experience long-lasting pain relief and improved function, increasing their quality of life. An ESI can also help determine whether surgery might be beneficial for pain associated with a herniated disc.

Discography:

During this procedure, your doctor will inject X-ray dye into various discs to identify ones that are leaking and causing pain. This can help diagnose whether discs in your spine are damaged or not and causing neck or back pain. You will communicate whether you feel pain and the severity of the pain throughout the procedure as this information can help your doctor identify the source of your pain. Benefits include finding the root cause of your pain and providing a more clear treatment path to relieve your pain in the future.

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Degenerative Joint Disease / Spinal Stenosis

Vertiflex Procedure:

A minimally invasive spinal implant system that is a popular new treatment option for patients suffering from mild to moderate spinal stenosis. Your doctor will place a small device in the back part of the spine through a half-inch incision, which can preserve motion in the lower back and relieve pressure on the nerves affected by spinal stenosis. The implant is expandable and designed to protect tissue in the back; it’s designed to allow for optimal fit in a patient’s unique anatomy.

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Post-Surgery / Failed Surgery

Spinal Cord Stimulation:

A small device is implanted under the skin and deliver slight electrical impulses that can mask or change pain signals before they reach your brain. Spinal cord stimulation can improve function, increase activity and mobility, reduce the use of opioids, and offer relief for patients dealing with a failed surgery and neuropathic pain.

Hip Pain

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Sciatic / Sacroiliac Pain

SI Joint Injection:
This quick procedure requires no downtime involves your doctor injecting a local anesthetic for immediate pain relief followed by an anti-inflammatory medication that can help reduce pain in the long-run (typically, for several months). This injection is successful in confirming that pain is coming from the sacroiliac joint and can be repeated up to three times a year to help you maintain your level of function, with less pain.

SI Joint Block:

SI joint blocks use the guidance of an X-ray to insert a needle in the sacroiliac joint to inject lidocaine and an anti-inflammatory steroid to diagnose pain associated with the SI joint. This injection may provide temporary relief and plays a significant role in identifying a clear treatment path for your pain.

SI Joint Radiofrequency Ablation:

Using radio waves, Radiofrequency Ablation can heat and destroy nerves carrying pain signals from an injured SI joint to the brain. This procedure is helpful for patients who have experienced short-term pain relief from injections but had unsuccessful results with later therapy. Symptom relief ranges from 6 months to one year, and many patients see improvement within two weeks of the procedure.

SI Joint Peripheral Nerve Stimulation:

After identifying pain in the SI joint, your doctor can implant a compact and tiny device under the skin that can offer permanent pain relief. The device uses electrodes to block pain signals from reaching your pain, allowing you to get back to your life.

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Post Spinal Fusion of Sacrum

Cluneal Nerve Stimulation:

Targeting one or more of your nerves with a small amount of electrical current, your doctor will implant a small stimulator and electrodes as a method of reducing chronic pain in the lower back and buttocks. Many patients experience an improved quality of life and pain reduction. This procedure is non-destructive and reversible.

SI Joint Fusion:

For patients with significant low back, hip, or groin pain, instability in the lower back/pelvis, or stiffness and limited mobility in these areas an SI joint fusion may be the answer. Your doctor will make a small incision and perform a minimally-invasive procedure that encourages bone growth over the SI joint to create one immobile unit that can effectively reduce pain and instability.

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Degenerative Joint Disease

Sacroplasty:

An orthopedic cement is injected into fractured bone through a needle to form a sort of internal cast that can stabilize the weakened or damaged bone. Many patients experience pain relief as well as improved mobility and the ability to reduce pain medication.

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Post Hip Replacement Pain

RFA of the Hip – Radio Frequency Ablation:

This non-surgical procedure sends an electrical current, produced by a radio wave, to heat a small area of nerve tissue that can decrease pain signals from targeted areas in your hip. With little downtime, quick relief, and improved mobility Radiofrequency Ablation can help with your chronic pain.

Hip Injection:

Hip injections use a small needle that is guided into the joint area while your doctor follows the placement on an X-ray screen. A small amount of dye is injected so we can see where to place the medicine, a steroid is slowly injected into the joint to help relieve pain and inflammation and may also aid in diagnosis the source of hip pain.

Knee Pain

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General Knee Pain

Musculoskeletal Ultrasound Evaluation:

Musculoskeletal ultrasounds allow for a detailed evaluation of tendon, ligament, and nerve disorders that may be present and causing your knee pain. This procedure is an excellent alternative to an MRI and can allow us to establish a treatment plan immediately.

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ACL / MCL Injury Pain

For injuries to the knee or ligament tears in and around that joint, there are several treatments that help to bring relief.

Peripheral Nerve Stimulation of the knee:

One of the most common causes to pain that makes a patient walk into an orthopedic or neurosurgeon’s office is knee pain. Steroid injections, although effective at times, are not always long lasting or quit working. Peripheral Nerve Stimulation is an option that allows the patients to get very good results in pain reduction for a longer period of time.

Steroid Injections & Pain Blocks

Simple and effective injections with corticosteroids (sometimes called cortisone shots) or with hyaluronic acid can often provide months of pain relief. This treatment is most effective when the wear and tear on the joint has caused degeneration of cartilage.

 

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Degenerative Joint Disease

Ultrasound Guided Injection:

This small interventional procedure involves injecting a steroid into the appropriate area using ultrasound to guide the needle. This injection is a therapeutic procedure, aiming to reduce musculoskeletal pain relating to tendons, tendon sheaths, or bursae. Many patients experience immediate pain relief and improved mobility, while others feel relief after a few days.

Genicular Nerve Block:

A low-risk and new cutting-edge procedure that involves injecting a local anesthetic to the Genicular nerves (sensory nerves that transmit pain signals to the brain) to relieve chronic knee pain. Patients typically experience immediate relief and require minimal downtime.

RFA of Genicular Nerves:

A convenient procedure that uses ultrasound guidance and introduces radiofrequency to diagnose pain source and/or block nerve pain in the knee. This pain relief is typically long-lasting and allows patients to get back to their daily life with improved function and mobility.

PNS of Genicular Nerves – peripheral Nerve Stimulation:

After identifying pain in the knee, your doctor can implant a compact and tiny device under the skin that can offer permanent pain relief. The device uses electrodes to block pain signals from reaching your pain, allowing you to get back to your life.

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Post Total Knee Replacement Surgery

Genicular Nerve Block:

Your doctor will inject a local anesthetic to block the nerves that transmit pain from the knee. The needle is guided by X-ray to ensure the proper placement and positioning so that your genicular nerve is adequately numbed. Multiple sites around the knee will be targeted so that you can live your life without pain after a total knee replacement.

RFA of Genicular Nerves:

Many patients still experience pain even after a total knee replacement. Radiofrequency Ablation of the genicular nerves can provide relief. This procedure involves selectively applying radiofrequency waves to the nerves surrounding the knee to provide pain relief without any injections.

PNS of Genicular Nerves peripheral Nerve Stimulation:

Many patients still experience pain, even after a total knee replacement. Peripheral Nerve Stimulation (PNS) of the genicular nerves involves implanting a small device that generates electrical stimulation to curb pain at the genicular nerve. The level of stimulation is controlled by a hand-held remote and has helped many total knee replacement recipients move on with life pain-free!

Shoulder Pain

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General Shoulder Pain

There are a myriad of reasons for general shoulder pain, but after a comprehensive exam, we can determine the best course of action and treatment. Whether it’s a rotator cuff strain or injury, an impingement on the joint, or another area of tissue causing reference pain in the shoulder, the pain can range from mildly annoying to almost debilitating.

It’s important to take action sooner, rather than later in order to avoid the issue getting worse over time.

Some symptoms that need to be explored:

  • A dull ache deep in the shoulder
  • Disturbed sleep, particularly if you lie on the affected shoulder
  • Difficulty reaching behind your back or above your head
  • Weakness down the arm
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Ligament / Rotator Cuff Injury

For injuries to the rotator cuff or ligament tears in and around that joint, there are several treatments that help to bring relief to a troubled shoulder.

Peripheral Nerve Stimulation of the Shoulder:

Shoulder Pain is a common problem and many times surgery is not an option or was an option and the patient is still in pain. Steroid injections and Shoulder Blocks may work for a while but many times patients have pain in the shoulder that simply will not go away or is limiting the patients ability to function. Suprascapular Nerve Peripheral Stimulators are a great way to resolve these problems.

Steroid Injections & Shoulder Blocks

Simple and effective injections with corticosteroids (sometimes called cortisone shots) or with hyaluronic acid can often provide months of pain relief. This treatment is most effective when the wear and tear on the joint has caused degeneration of cartilage.

 

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Degenerative Joint Disease

Ultrasound Evaluation of the Shoulder:

Musculoskeletal ultrasounds allow a detailed evaluation of your shoulder that can give quick answers and enable our team to establish a treatment plan at the time of the evaluation. Ultrasounds also make it easy to rule out rotator cuff or tendon tears when seeking the source of your shoulder pain.

Ultrasound Guided injection of the Shoulder:

This small interventional procedure involves injecting a steroid into the appropriate area using ultrasound to guide the needle. This injection is a therapeutic procedure, aiming to reduce musculoskeletal pain relating to tendons, tendon sheaths, or bursae. Many patients experience immediate pain relief and improved mobility, while others feel relief after a few days.

Shoulder Block:

Nerve blocks provide better pain relief than general anesthesia and opioids and are much more specific in addressing the source of shoulder pain. Your doctor will use the guidance of an X-ray to insert a needle and inject lidocaine and an anti-inflammatory steroid which allow for immediate pain relief and aid in the identification of the source of your shoulder pain.

PNS of the Shoulder – peripheral Nerve Stimulation:

After identifying pain in your shoulder, your doctor can implant a compact and tiny device under the skin that can offer permanent pain relief. The device uses electrodes to block pain signals from reaching your pain, allowing you to get back to your life.

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Post Shoulder Surgery Plan

PNS of the Shoulder – peripheral Nerve Stimulation:

Many patients still experience pain after surgery. Peripheral Nerve Stimulation (PNS) involves implanting a small device that generates electrical stimulation to curb pain at the genicular nerve. The level of stimulation is controlled by a hand-held remote and has helped many shoulder surgery patients move on with life pain-free!1. PNS of the Shoulder – peripheral Nerve Stimulation: Many patients still experience pain after surgery. Peripheral Nerve Stimulation (PNS) involves implanting a small device that generates electrical stimulation to curb pain at the genicular nerve. The level of stimulation is controlled by a hand-held remote and has helped many shoulder surgery patients move on with life pain-free!

Most Common Treatments

  • Epidural Steroid Injection
  • Peripheral Nerve Stimulation for Non-Operable Knee, Shoulder and Sacral Pain
  • Radiofrequency of the Knee and Hip for Knee and Hip Pain
  • Radiofrequency of the Spine for Chronic Back Pain
  • Sacroplasty for Sacral fracture
  • Spinal Cord Stimulation for Chronic Pain
  • Superion Vertiflex for Lumbar Spinal Stenosis
  • Sacroiliac Joint Dysfunction
  • Vertebroplasty Augmentation for Compression Fracture
  • Post Total Knee and Total Hip Pain Syndromes

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