Frequently Asked Questions About Pain Management and Interventional Treatments
Living with chronic pain often raises as many questions as it does symptoms. You may know where you hurt without knowing why, or you may have already tried physical therapy, medications, injections, or surgery without finding enough relief to return comfortably to the activities that matter to you.
My name is Dr. John Villanueva. At my practice, the Villanueva Institute of Pain and Spine (VIPS), I take the time to understand your diagnosis, review relevant imaging, and consider how pain affects your mobility and function before recommending treatment. As a physician double board-certified in Physical Medicine and Rehabilitation, or PM&R, and Pain Medicine, I offer a range of diagnostic and interventional options for spine, nerve, joint, and chronic pain conditions.
The FAQs below answer common questions about our Burbank practice and several of the treatments I perform most often, including epidural steroid injections, medial branch blocks, radiofrequency ablation, headache injections, nerve blocks, regenerative medicine, spinal cord stimulation, Intracept®, and the mild® procedure.
To schedule a consultation, call VIPS at (818) 669-8895 or contact our Burbank office.
General Pain Management FAQs
Who is Dr. John Villanueva?
I am a physician double board-certified in Physical Medicine and Rehabilitation and Pain Medicine. My training allows me to approach pain from both an interventional and rehabilitative perspective, with attention to the spine, nerves, muscles, joints, movement, and overall function. I am proud to bring the additional expertise of a Certified Life Care Planner to my work. Along with my double-board certifications, this specialized training enables me to assess the long-term medical, rehabilitation, and future care needs of individuals with complex injuries and disabilities.
At VIPS, I treat patients with chronic back and neck pain, nerve pain, arthritis, sciatica, CRPS, failed back surgery, headaches, joint pain, spinal stenosis, and other musculoskeletal and neurological conditions.
What happens during my first pain management consultation?
I begin by reviewing your history, previous treatment, symptoms, and the activities that pain is preventing you from doing comfortably. I perform a physical and neurological examination and personally review relevant MRIs, CT scans, or X-rays whenever the actual images are available.
From there, we can determine whether you need additional testing or whether there is enough information to begin discussing treatment. My aim is for you to understand what may be causing your symptoms and why I am recommending a particular next step.
Do I need to know exactly what is causing my pain before making an appointment?
No. Determining the source of pain is one of the reasons patients come to a pain management physician.
Several conditions can produce very similar symptoms. Back and leg pain, for example, may arise from a spinal nerve, disc, facet joint, sacroiliac joint, or another structure. A careful evaluation helps distinguish among these possibilities before treatment begins.
Does every patient who sees a pain doctor need an injection?
No. An interventional procedure is appropriate only when I believe it has a reasonable chance of helping the problem we have identified.
Some patients benefit from continued rehabilitation, medication management, further diagnostic testing, or evaluation by another specialist. If I believe surgery or another form of care is more appropriate than an injection, I will tell you.
Why do you personally review MRI and other imaging?
A radiology report is valuable, but it does not always tell the entire story. Imaging frequently reveals changes that may or may not be responsible for a patient’s symptoms.
I prefer to compare the actual images with your examination, symptom pattern, and neurological findings. That helps me determine whether something seen on the scan is clinically meaningful rather than treating an imaging abnormality simply because it is there.
Do you perform EMG and nerve conduction studies?
Yes. I can perform EMG and nerve conduction studies when additional information is needed about nerve or muscle function. These tests may be useful when symptoms include numbness, tingling, weakness, radiating pain, or other signs of possible nerve involvement.
Epidural Steroid Injection FAQs
What is an epidural steroid injection?
An epidural steroid injection places anti-inflammatory medication into the epidural space near irritated spinal nerves. Depending on the location of the problem, I may perform an epidural injection in the cervical, thoracic, or lumbar spine.
The purpose is to reduce inflammation around the affected nerve and, for appropriate patients, improve symptoms such as radiating pain, numbness, or tingling.
What conditions can epidural steroid injections treat?
I may consider an epidural steroid injection for conditions such as:
- Herniated discs
- Cervical or lumbar radiculopathy
- Sciatica
- Degenerative disc disease
- Spinal stenosis
- Certain forms of persistent nerve pain following spine surgery
The diagnosis and location of the symptoms help determine whether an epidural injection is appropriate and which approach should be used.
Are all epidural injections performed the same way?
No. Epidural injections can be performed through different approaches depending on the anatomy and the location of the suspected problem.
A transforaminal approach allows me to direct medication toward a particular spinal nerve. Interlaminar and caudal approaches enter the epidural space from different locations. I select the technique according to your symptoms, imaging, previous surgery, and the area that needs to be treated.
How quickly does an epidural steroid injection work?
A local anesthetic may produce temporary improvement shortly after the injection, while the anti-inflammatory medication generally takes longer to have an effect.
Responses vary. Some patients experience substantial improvement, some have partial relief, and others may not respond enough to justify repeating the treatment. I consider both symptom reduction and functional improvement when evaluating the result.
Are epidural steroid injections performed with imaging guidance?
Yes. I use fluoroscopy for appropriate spinal injections so that I can visualize the anatomy and carefully guide treatment to the intended area.
Medial Branch Block and Radiofrequency Ablation FAQs
What is a medial branch block?
A medial branch block is a diagnostic injection used to determine whether one or more facet joints may be contributing to neck or back pain.
Small medial branch nerves carry pain signals from the facet joints. By temporarily numbing selected nerves, I can evaluate whether the patient’s usual pain decreases and whether movements that normally cause discomfort become easier.
What does facet joint pain feel like?
Facet-related pain is often experienced as an ache or stiffness in the neck or back. It may become worse with standing, twisting, extending the spine, or remaining in one position for a long period.
Since disc, nerve, muscle, and facet joint problems can overlap, symptoms alone are not enough to establish the diagnosis.
What does it mean if a medial branch block works?
Meaningful temporary improvement suggests that the targeted facet joint and its medial branch nerve may be contributing to the pain.
If the response supports the diagnosis, I may recommend radiofrequency ablation as a longer-lasting treatment for that same pain pathway.
How does radiofrequency ablation work?
Radiofrequency ablation uses controlled energy to create a small treatment area along a selected sensory nerve. This reduces the nerve’s ability to carry pain signals from the affected facet joint.
The procedure does not remove the joint or alter the structural anatomy of the spine.
How long can radiofrequency ablation relief last?
Relief may continue for several months and, for some patients, considerably longer. The treated medial branch nerves can regenerate with time, which is one reason symptoms may eventually return.
If an initial radiofrequency ablation was clearly beneficial and the same pain later returns, repeat treatment may sometimes be considered.
Headache Injections FAQs
What types of headaches can pain management treat?
Interventional treatment may be appropriate for certain patients with chronic migraines, occipital neuralgia, cervicogenic headaches, or other headache patterns.
The correct treatment depends on where the pain begins, how it travels, associated symptoms, headache frequency, and whether another condition involving the neck or nerves may be contributing.
What injections do you offer for headaches and migraines?
Depending on the diagnosis, I may use treatments such as:
- Botox® injections for appropriate chronic migraine patients
- Occipital nerve blocks
- Sphenopalatine ganglion, or SPG, blocks
- Other targeted nerve blocks when clinically appropriate
These treatments work differently, which is why identifying the headache pattern is important.
How do occipital nerve blocks help headaches?
The occipital nerves travel from the upper neck across the back of the scalp. When one of these nerves becomes irritated, pain may begin near the base of the skull and travel toward the top or front of the head.
An occipital nerve block places medication near the affected nerve to reduce irritation and may also provide diagnostic information about where the pain originates.
How do I know whether Botox® is appropriate for my migraines?
Botox® is generally considered for patients who meet criteria for chronic migraine rather than occasional headaches. I review headache frequency, duration, associated symptoms, previous treatments, and other medical factors before recommending it.
Nerve Block FAQs
What is a nerve block?
A nerve block places medication near a selected nerve or nerve group to interrupt or reduce pain signals.
Some nerve blocks are primarily therapeutic, while others can also provide diagnostic information. The location of the block depends on the condition being treated and the suspected source of pain.
What kinds of nerve blocks do you perform?
My practice includes several specialized nerve blocks for appropriate conditions, including:
- Lumbar sympathetic blocks
- Ganglion impar blocks
- Superior hypogastric plexus blocks
- Celiac plexus blocks
- TAP blocks
- Occipital nerve blocks
- Other targeted nerve injections
These procedures are used for very different pain conditions, so candidacy depends on a careful diagnosis.
Are nerve blocks used for CRPS?
Certain patients with Complex Regional Pain Syndrome may benefit from sympathetic nerve blocks as part of a broader treatment plan.
For lower-extremity CRPS, a lumbar sympathetic block may be considered when clinical findings support sympathetic nervous system involvement. Treatment is individualized and may also include rehabilitation, medication, and other approaches.
How long does a nerve block last?
The duration depends on the nerve being treated, medications used, underlying condition, and individual response. Some blocks provide relatively short-term relief but still offer valuable diagnostic information, while others may provide a longer period of symptom improvement.
PRP and Regenerative Medicine FAQs
What is PRP therapy?
Platelet-rich plasma, or PRP, is prepared from a sample of your own blood. The blood is processed to concentrate platelets and other components that are then injected into an injured or degenerative area.
At VIPS, regenerative treatments are used selectively rather than as a universal answer for pain.
What conditions may be treated with PRP?
PRP may be considered for certain cases of osteoarthritis, tendon injuries, ligament injuries, muscle injuries, or other musculoskeletal conditions.
Whether PRP makes sense depends on the tissue involved, severity of the condition, previous treatment, imaging findings, and your overall health.
Are regenerative treatments the same as steroid injections?
No. Steroid injections are intended primarily to reduce inflammation, while regenerative and orthobiologic treatments use components derived from the patient’s own blood with a different therapeutic rationale.
One is not automatically better than the other. The appropriate treatment depends on the condition being treated and what we are trying to accomplish.
Spinal Cord Stimulation FAQs
What is spinal cord stimulation?
Spinal cord stimulation uses mild electrical signals to change the way certain pain signals are transmitted through the nervous system.
Thin leads are placed near the spinal cord and connected to a small generator. Rather than repairing a disc or changing the structure of the spine, the system modifies pain signaling.
What conditions may be treated with spinal cord stimulation?
Spinal cord stimulation may be considered for selected patients with conditions such as:
- Persistent pain following spine surgery
- Chronic neuropathic pain
- Complex Regional Pain Syndrome
- Persistent back and leg pain
- Other difficult-to-treat nerve-related pain conditions
Not every form of chronic pain responds to neuromodulation, so careful patient selection is essential.
What is a spinal cord stimulator trial?
One advantage of spinal cord stimulation is that you can test the therapy before deciding whether to receive a permanent implant.
During the trial, temporary leads are placed and connected to an external system. I want to know not only whether your pain decreases, but also whether you are able to walk, sleep, sit, work, or participate in meaningful activities more comfortably.
What happens if the spinal cord stimulator trial does not help?
The temporary leads are removed, and a permanent system is not implanted.
That is an important part of the trial process. It allows us to evaluate the treatment in your actual daily life before you make a decision about permanent implantation.
Does VIPS use one specific spinal cord stimulator brand?
No. I remain device agnostic and evaluate available FDA-cleared systems according to the patient’s anatomy, pain pattern, lifestyle, and treatment needs rather than routinely directing every patient toward one manufacturer.
Intracept® FAQs
What is the Intracept® procedure?
Intracept® is a minimally invasive procedure designed to treat certain cases of chronic vertebrogenic low back pain.
The procedure targets the basivertebral nerve within the vertebral body, which can become a source of pain when specific changes occur along the vertebral endplates.
How is vertebrogenic back pain different from other back pain?
Lower back pain can come from many structures, including discs, nerves, facet joints, muscles, sacroiliac joints, and vertebral endplates.
Vertebrogenic pain refers specifically to pain associated with the vertebral endplates and basivertebral nerve. MRI findings and the overall clinical picture help determine whether this diagnosis is likely.
Who may be a candidate for Intracept®?
Intracept® may be considered for selected patients with chronic low back pain and characteristic MRI findings who have not improved enough with appropriate conservative treatment.
It is not intended for every person with chronic back pain, which makes accurate diagnosis particularly important.
Does Intracept® involve a spinal implant?
No. The procedure treats the basivertebral nerve and does not leave behind a permanent spinal implant.
Mild® Procedure FAQs
What is the mild® procedure?
The mild® procedure is a minimally invasive treatment for selected patients with lumbar spinal stenosis caused in part by thickened ligament tissue.
Through a small access point, excess ligament tissue is removed to create more room within the spinal canal and reduce pressure contributing to symptoms.
What symptoms may improve with the mild® procedure?
Lumbar spinal stenosis often causes pain, heaviness, weakness, numbness, or fatigue in the lower back and legs, particularly during standing or walking.
Patients frequently notice that symptoms improve when sitting or leaning forward. This pattern is sometimes called neurogenic claudication.
Is the mild® procedure the same as lumbar spine surgery?
No. The mild® procedure is a minimally invasive decompression treatment and does not involve a large surgical incision, spinal fusion, or placement of a permanent implant.
It may provide an option for appropriately selected patients who need more than conservative treatment but may not require or want more extensive surgery.
How do you decide whether mild® is appropriate?
I review your symptoms, examination, treatment history, and lumbar imaging to determine what is producing the spinal narrowing.
The procedure specifically addresses certain forms of stenosis associated with thickened ligament tissue, so it is not appropriate for every cause of lumbar spinal stenosis.
Schedule a Consultation
At VIPS, I begin with a thorough evaluation, personally review relevant imaging whenever possible, and explain why I believe a particular treatment may or may not be appropriate. My focus is not simply on lowering a pain score. I want to help you improve the function that pain has taken away, whether that means walking farther, returning to exercise, sleeping more comfortably, working, or simply participating more fully in everyday life.
To schedule a consultation at VIPS in Burbank, call (818) 669-8895 or contact our office.