Onabotulinumtoxin A (BOTOX®) is FDA approved for the treatment of chronic migraines, spasticity and cervical dystonia in adults. It is a medicine that is injected into the affected muscle(s). BOTOX® is the most common neurotoxin derived from the toxin Clostridium botulinum, the same bacterium that causes food poisoning. While this bacterium may be fatal in large doses, in small, medically regulated doses, it has been found to be an effective therapeutic tool in relieving chronic pain.
In regards to chronic migraine headaches, eligible patients must have 15 or more days each month with headache, lasting 4 or more hours each day. BOTOX has been studied to reduce headache days every month, preventing up to 9 headache days a month (PREEMPT trial).
The positive effects of BOTOX injections may be felt for several months, but they are not permanent. When these injections are helpful, it is usually recommended that they be repeated every 3 or 4 months for continual relief of symptoms. Physical therapy is often recommended after injections to restore flexibility and muscle function.
Bursa Injections are used to deliver medications to inflamed, painful bursas, for the treatment of bursitis. These injections are used to reduce inflammation & swelling, and may in turn reduce pain.
A discogram/discography is a diagnostic test to identify which disk(s) are abnormal and may be the source of chronic pain in the spine. A discogram will not treat a damaged disc, it is a test. This test is often performed prior to spinal fusion surgery.
Epidural Steroid Injection (ESI)
An epidural steroid injection is an injection performed to treat pain due to irritation of a spinal nerve(s) in the spine. The injection typically contains numbing medicine (lidocaine) and anti-inflammatory medicine (steroid) that are injected into the epidural space of the spine, around the affected nerve(s), with the goal of reducing inflammation of the nerve(s) and therefore the symptoms. The epidural steroid injection will be given according to the site where suspected nerve irritation occurs in your spine.
These injections are typically performed when the patient has trialed conservative (non-surgical) treatments that have failed in the past and as an attempt to reduce pain and avoid surgery if possible. The administration of such injections can also allow time for healing to occur in the damaged area. If the symptoms (pain, tingling, and weakness) are no longer present, further injections are not indicated.
These injections are performed under fluoroscopic guidance (x-ray) to ensure safe delivery of medication to the intended site.
Facet Joint (Medial Branch) Diagnostic Nerve Block
If facet joints of the spine are a suspected source of pain, a diagnostic or “test” injection is performed to determine/diagnose if the facet joints in the spine are a significant reason for your pain. This is called a medial branch block, an injection where the medial branches are numbed to “block” the nerve transmission from the targeted facet joint(s). This test only provides temporary information, if the facet joints are a significant source of your pain or not. If the medial branch block provides significant, yet transient relief, you may be a candidate for a procedure that may provide long term relief of facet joint pain. Radiofrequency neurotomy treatment is indicated for patients who receive at least a 50% reduction of the pain in question- typically for a couple of hours.
Intradiscal Electrothermal Therapy (IDET)
Intradiscal Electrothermal Therapy (IDET) is a minimally invasive treatment for spinal disc related chronic low back pain. This type of persistent disc pain is thought to be caused by nerve fibers that have grown from their normal location in the outer layers (annulus), or from an injury to the disc, causing the material in the middle of the disc (nucleus pulposus) to move into the outer layers of the disc (annulus) where nerves are, causing pain. Under x-ray guidance a thin flexible catheter is introduced into the problematic disc, and heats up. The proposed mechanism is that the heat causes contraction of the collagen fibers that may seal up painful tears and destruction of the painful nerve fibers, and stimulation of new collagen formation.