INJECTIONS AND INTERVENTIONAL PROCEDURES
Injections and interventional procedures are often recommended as part
of a comprehensive pain medicine strategy.
These procedures are often
diagnostic in that they can help determine whether or not a particular structure
is causing pain. If injecting a specific target eliminates or dramatically
reduces pain (even temporarily), it lends support to the concept of that
structure being the cause of or at least s significant contributor to
an individual’s pain. If a targeted injection provides no benefit
whatsoever, not even temporarily, it becomes less likely the individual’s
pain is coming from that structure. Dr. Williams is objective in the interpretation
of results to avoid or lessen the likelihood of false positives or false
negatives. Typically, the patient is provided a Pain Diary and asked to
document their response over the course of hours to days in real time,
then return to discuss the objective numbers and information from the
diary. This strategy reduces dependence on memory, which can be less accurate
than one might think, and helps with a determination as to whether an
individual derived benefit from local anesthetic, steroid, both, or neither
(based on the pattern of findings seen in review of the diary).
Injections and interventional procedures may also be
therapeutic. Although local anesthetic and steroid can “wear off”, it’s
quite possible that a patient’s pain will go away and stay away,
or be dramatically reduced for prolonged periods of time). Injections
may relax muscles and improve blood flow in the affected area, reduction
in pain may result in improved movement/mobility, advance an individual’s
ability to benefit from physical therapy and rehabilitation, or reduce/eliminate
inflammation and assist with regenerative processes in the area of interest-all
of which can provide prolonged or permanent therapeutic benefit.
These interventional procedures are typically performed under direct visualization,
which is valuable for a number of reasons. Ultrasound guided procedures
are often performed in clinic, and provide visualization of soft tissues,
blood vessels, and other structures of interest without the need for radiation.
Ultrasound can be performed dynamically, allowing movement of an extremity
to reproduce symptoms under direct surveillance. Patients can visualize
the anatomy along with me and gain better insight regarding the nature
of their symptoms. And the visualization allows Dr. Williams to confirm
that the medication is spreading precisely to the targeted area. Other
times, procedures are performed in the surgery center using ultrasound
or fluoroscopy (live x-ray) for visualization and targeting. In these
scenarios, patients may benefit from sedation and completion of procedures
in a sterile surgical environment.
Injections can help patients maintain function and continue with other
treatments, such as physical therapy, or even enjoy travel and special
events without having to deal with constant pain. They can also help to
reduce the need to use analgesics. Sometimes, as mentioned, they can even
avoid the need for surgery, delay the need for surgery, or significantly
improve post-operative pain and speed rehabilitation/recovery.