What is radiofrequency ablation?

Radiofrequency ablation is a minimally invasive procedure that uses heat to disrupt the pain signals that travel between your brain and body. The radiofrequency energy damages the nerve cells that are sending the pain signals, effectively relieving your pain. The treatment is relatively quick and provides almost immediate pain relief.

What conditions improve with radiofrequency ablation?

Dr. Villanueva suggests radiofrequency ablation to address pain in your cervical (neck), thoracic (middle), and lumbar (lower) spine as well as your knees and other joints. For example, if you have arthritis in your spine or other joints in your body, the treatment interrupts the pain messages created by inflammation and irritation in your joints.

If you’ve had nerve blocks in the past that temporarily alleviate your pain, radiofrequency ablation may be a suitable method of providing long-lasting relief. Dr. Villanueva can treat several nerves during the same procedure.

What happens during radiofrequency ablation?

Dr. Villanueva provides a comprehensive exam and consultation to ensure radiofrequency ablation is right for you before scheduling your procedure. He may order diagnosing imaging studies such as MRIs and X-rays to confirm the condition causing your pain.

During your treatment, you wear a hospital gown and lie on an X-ray table. Dr. Villanueva prepares you for your radiofrequency ablation by providing a local anesthetic and a mild sedative to ensure you stay comfortable and relaxed. He also injects a contrast dye to create clear X-ray images.

Then, Dr. Villanueva uses fluoroscopy, a special type of X-ray, to insert a thin, hollow needle into the precise location of your pain. When the needle is in place, he releases the radiofrequency current, which heats your malfunctioning nerve for approximately 90 seconds and creates a small burn called a lesion. The lesion stops the pain signals from traveling to your brain.

What should I expect after radiofrequency ablation?

You should be able to get up and walk around immediately after your radiofrequency ablation treatment. You’ll spend a little time in recovery as your sedative wears off before Dr. Villanueva releases you and a friend or family member can drive you home.

You may have some tenderness at the injection site, but any discomfort fades quickly and will be less disruptive than the pain that led to your treatment in the first place.

Call Dr. Villanueva or schedule a consultation online today to find out if radiofrequency ablation is right for you.

What is spinal cord stimulation?

Spinal cord stimulation is a neuromodulation treatment that provides relief for chronic pain in your cervical, thoracic, and lumbar spine caused by a wide range of injuries and conditions. The treatment involves an implantable device, including a wire, placed at a precise location in your spine, which delivers a mild electrical current, disrupting pain messages before they can travel to your brain.

Spinal cord stimulation is a drug-free treatment that can prevent the need for surgery or provide relief when previous operations have failed.

Am I a good candidate for spinal cord stimulation?

Spinal cord stimulation might be right for you if you have chronic back pain that doesn’t respond to other treatments. In most cases, Dr. Villanueva recommends spinal cord stimulation if your back pain has persisted for three months or more and is affecting your quality of life.

Dr. Villanueva provides thorough consultations before recommending spinal cord stimulation and will refer you for a psychological assessment. The best way to find out if spinal cord stimulation is right for you is to schedule an appointment with Dr. Villanueva to talk about your pain and possible solutions.

What is the process for placing a spinal cord stimulator?

Spinal cord stimulation is provided in two stages. The first stage is a trial period that lasts for approximately a week to ensure the treatment effectively relieves your pain. Dr. Villanueva implants the wire into your spine, but the device that provides the electrical current stays outside of your body.

If spinal cord stimulation relieves your pain and restores your mobility and function, Dr. Villanueva will schedule an appointment to permanently implant the spinal cord stimulation device in your back.

What should I expect after spinal cord stimulator implantation?

You should be able to go home on the same day as your procedure or the next morning. You should avoid lifting, bending, or twisting your back for approximately six weeks while your back heals. If you have any tenderness at the implantation sites, apply ice for 15-20 minutes three or four times a day. You should also get up and walk around for up to 10 minutes every three or four hours and increase your walking time as you’re able.

Call Dr. Villanueva or schedule a consultation online today to find out if spinal cord stimulation is right for you.

What are PRP injections?

Your blood is full of tiny solid particles, including your white and red blood cells and your platelets. Your platelet’s primary job is to clot your blood when you have an injury to stop you from bleeding to death. Your platelets are also rich in the proteins and growth factors your body needs to repair and generate new cells. PRP injections harness the power of your platelets to stimulate your body’s natural healing response.

What conditions may improve with PRP injections?

Dr. Villanueva suggests PRP injections for a wide range of injuries and degenerative conditions. For example, PRP may help with:

• Osteoarthritis
• Muscle strains and tears
• Ligament strains
• Tendonitis
• Post-surgical recovery
• Sports injuries

PRP injections flood injured tissue with the nutrients it needs to heal. It could be an effective treatment for a wide range of conditions.

How do PRP injections work?

Your body has a natural ability to repair and generate new cells. PRP injections stimulate and accelerate this response by flooding in your injured tissue with a serum that’s dense with platelets and the nourishing proteins and growth factors they carry. The injections also create micro-injuries which trigger the healing process.

What should I expect during a PRP injection treatment?

Your PRP treatment begins with a blood draw. Dr. Villanueva separates your blood sample in a centrifuge before combining your platelets and plasma to create a serum that contains up to 10 times more platelets than a normal blood sample. Then when the serum is ready, Dr. Villanueva injects the serum into your damaged tissue.

Depending on the extent of your injury or tissue damage, you may need a series of PRP injections for optimal healing. It’s also common to have a brief period of inflammation directly following your injections as your PRP injection kicks in and stimulates your body’s ability to heal itself.

Dr. Villanueva often combines PRP injections and other regenerative medicine therapies with other pain management services to offer a multidisciplinary approach to pain.

If you want to know more about PRP injections and if they’re right for you, call Dr. Villanueva or schedule a consultation online today.

What is an epidural?

You may have come across the term epidural before in relation to childbirth. The epidural injection given during labor anesthetizes the woman’s lower body completely, should she be in severe pain or need an emergency C-section.

Epidurals aren’t just for childbirth though, and in fact, the word epidural means "around the spinal cord," so epidurals aren’t exclusive to women in labor. Epidural injections are also a useful treatment option for chronic pain conditions.

Why might I need an epidural?

If you have chronic back pain, Dr. Villanueva starts your treatment program with a complete medical assessment, followed by physical therapy, recommendations for lifestyle changes, and specific therapies that target the cause of the pain. In many cases, this successfully resolves the problem, but some people find their pain doesn’t respond.

An epidural is one of a range of treatment options Dr. Villanueva can employ to relieve pain that isn’t responding to initial approaches. If your back pain persists despite previous interventions, Dr. Villanueva may recommend an epidural to relieve your pain.

An epidural injection contains corticosteroid medication and an anesthetic. The corticosteroid helps reduce inflammation in the joints and soft tissues, and the anesthetic numbs the pain, providing temporary relief from your symptoms.

What kind of back pain is suitable for epidural treatment?

Two types of back pain respond particularly well to epidural injections:

Nerve damage

Nerve damage is most often found in the neck or lower back, causing shooting pains that migrate from the back down one or both legs, or from the neck into the arm.

Spinal stenosis

Stenosis is a narrowing of the spine, often caused by a herniated disc or a bone spur, or in a few cases, a tumor. Spinal stenosis causes pressure on the nerves in the spine, so typically you have pain in your buttock or leg, but not always your back.

An epidural injection can relieve the symptoms of these types of common back pain in the short term and help to reduce inflammation in the longer term. Dr. Villanueva uses cervical epidurals for the neck, thoracic epidurals for the upper back, and lumbar epidurals for the lower back.

If you’re experiencing chronic pain in your back or other parts of your musculoskeletal system, call John Villanueva, MD, Pain and Spine Management today, or book an appointment online.

What are trigger points?

Trigger points are knotted muscle fibers that can occur in any muscle, causing irritation of the surrounding nerves that leads to pain radiating out from the knot. You can feel a trigger point under the skin, where the muscle fibers form uncomfortable knots.

Some people develop trigger points sporadically, which they can manage with the benefit of physical therapy or massage. However, other people have trigger points that are chronically disabling and require trigger point injection therapy.

What are trigger point injections?

Trigger point injections are a treatment option for managing pain in patients who have trigger points in their muscles that cause chronic or debilitating pain. They’re also helpful for treating patients who have muscle tension because of chronic pain conditions, including:

• Fibromyalgia
• Myofascial pain syndrome
• Chronic tension headaches

The injections contain corticosteroids and a local anesthetic to reduce inflammation and relieve the pain. You can receive trigger point injections wherever you have muscle pain, but the most common areas requiring treatment are the groups of muscles in the neck, lower back, arms, and legs.

What happens during the trigger point injection procedure?

Dr. Villanueva carries out trigger point injection procedures in-office, so they’re a quick and convenient form of treatment. You may need several injections during one treatment session depending on the severity of your symptoms and how many trigger points you have. The injections only take a couple of minutes to complete, using a very fine needle to keep discomfort to a minimum.

After the injections, pressure on the muscle helps it to relax. You may find the injection site feels a little sore after you have a trigger point injection, but this should wear off after a few days. You can go home and carry on as normal, but avoid strenuous activities after treatment.

You should experience immediate relief from the trigger point pain as the anesthetic takes effect; the length of time the injection lasts can vary considerably between patients, and you may need further trigger point injections in the future to maintain the results.

If you have painful, knotted muscles or chronic pain that affects your soft tissues, trigger point injections could provide you with some much-needed relief. Call John Villanueva, MD, Pain and Spine Management today to schedule a consultation, or book an appointment online.

Epidural Steroid Injection Success Rates

An epidural steroid injection is generally successful in relieving lower back pain for approximately 50% of patients. While the effects of the injection tend to be temporary (one week to one year), an epidural can be very beneficial in providing relief for patients during an episode of severe neck pain and allows patients to progress in their rehabilitation.

Frequency for Epidural Steroid Injections

There is no definitive research to dictate the frequency of the epidural steroid injections; however, a limit of 3 – 4 injections per year is generally considered reasonable. There is also no general consensus in the medical community as to whether or not a series of three injections need always be performed. If one or two injections resolve the patient’s neck pain, some physicians prefer to save the one or two additional injections for any potential recurrent neck pain.

Facet Joint (Medial Branch Nerve) Block for Back Pain Management

In cases where the medial branch nerves from the facet joint itself are the pain generator, a facet block injection can be performed to alleviate the pain. Similar to SNRBs, facet (medial branch nerve) block injections are a diagnostic tool used to isolate and confirm the specific source of neck pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.
The facet joints are paired joints in the neck that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.
In a facet block procedure, a physician uses fluoroscopy (live X-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.
If the facet block procedure is effective in alleviating the patient’s neck pain, it is often considered reasonable for the procedure to be done up to three times per year. There are very few risks associated with this technique.

Selective Nerve Root Block (SNRB) for Diagnosis and Back Pain Management

In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the neck pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root.
Success rates vary depending on the primary diagnosis and whether or not the injections are being used primarily for diagnosis. While there is no definitive research to dictate the frequency of SNRBs, it is generally considered reasonable to limit SNRBs to three times per year.
Technically, SNRB injections are more difficult to perform than epidural steroid injections and should be performed by experienced Board-Certified Pain Management Physicians, like Dr. John Villanueva, M.D. Since the injection is outside the spine, there is no risk of a wet tap (cerebrospinal fluid leak). However, since the injection is right next to the nerve root, sometimes an SNRB will temporarily worsen the patient’s leg pain.

Did you know?

• When sacroiliac joint injections are used to diagnosed SI pain, a numbing medication is administered to the injection site to determine that the SI joints are the source of a patient’s discomfort. If patients experience relief from the numbing medication, slow release anti-inflammatory steroids will be administered to reduce inflammation and provide extended pain relief. A patient can undergo additional SI joint injections as needed – up to three in a six-month period.

Frequently Asked Questions

Am I a candidate for sacroiliac joint injections?

• An SI injection may be right for you if you have chronic or radiating pain stemming from some type of injury or agitation in the sacroiliac joints. Injections are generally reserved for patients who have not achieved significant pain relief from more conservative treatment measures. You should not undergo an SI injection if you are currently taking anti-coagulant medications or if you are suffering from any type of injection or illness at the time of your scheduled procedure. The only way to know for sure whether an SI injection is right for you is by scheduling a consultation with your doctor.

What should I expect during my sacroiliac joint injection?

• You will be awake during an SI injection although the injection site will be anesthetized and you’ll have the option of being lightly sedated. Your doctor will use x-ray imaging to carefully guide a fine needle into the sacroiliac joint and administer the numbing or anti-inflammatory medication. The procedure takes just minutes to complete and is performed on an outpatient basis. You’ll need to rest for the remainder of the day at home but can likely return to work soon after.

What types of results can I expect from a sacroiliac joint injection?

• SI joint injections involve the use of slow-release medications that may take several days to begin taking effect. Once pain begins to subside, most patients can expect to experience several weeks or even months of pain relief. Although SI joint injections cannot cure injuries or complications of the sacroiliac joints, they can significantly improve the quality of life for a person suffering from chronic pain.

Epidural Injections Help Reduce Inflammation

• Injecting around the dura sac with steroid can markedly decrease inflammation associated with common conditions such as spinal stenosis, disc herniation, or degenerative disc disease. It is thought that there is also a flushing effect from the injection that helps remove or “flush out” inflammatory proteins from around structures that may cause pain.

Epidural Steroid Injection Success Rates

• An epidural steroid injection is generally successful in relieving lower back pain for approximately 50% of patients. While the effects of the injection tend to be temporary (one week to one year), an epidural can be very beneficial in providing relief for patients during an episode of severe back pain and allows patients to progress in their rehabilitation.

Frequency for Epidural Steroid Injections

• There is no definitive research to dictate the frequency of the epidural steroid injections; however, a limit of 3 – 4 injections per year is generally considered reasonable. There is also no general consensus in the medical community as to whether or not a series of three injections need always be performed. If one or two injections resolve the patient’s low back pain, some physicians prefer to save the one or two additional injections for any potential recurrent low back pain.

Facet Joint (Medial Branch Nerve) Block for Back Pain Management

• In cases where the medial branch nerves from the facet joint itself are the pain generator, a facet block injection can be performed to alleviate the pain. Similar to SNRBs, facet (medial branch nerve) block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient. The facet joints are paired joints in the back that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain. In a facet block procedure, a physician uses fluoroscopy (live X-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected. If the facet block procedure is effective in alleviating the patient’s low back pain, it is often considered reasonable for the procedure to be done up to three times per year. There are very few risks associated with this technique.

Selective Nerve Root Block (SNRB) for Diagnosis and Back Pain Management

• In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root Success rates vary depending on the primary diagnosis and whether or not the injections are being used primarily for diagnosis. While there is no definitive research to dictate the frequency of SNRBs, it is generally considered reasonable to limit SNRBs to three times per year. Technically, SNRB injections are more difficult to perform than epidural steroid injections and should be performed by experienced Board-Certified Pain Management Physicians, like Dr. John Villanueva, M.D. Since the injection is outside the spine, there is no risk of a wet tap (cerebrospinal fluid leak). However, since the injection is right next to the nerve root, sometimes an SNRB will temporarily worsen the patient’s leg pain.

Steroid (aka, Corticosteroid, cortisone) Injections:

Steroid injections can be given into a bursa, joint, or tendon.
BURSA
A bursa is a sac filled with fluid that acts as a cushion between tendons, bones, and joints. Swelling in the bursa is called bursitis. Using a small needle, your provider will inject a small amount of corticosteroid and a local anesthetic into the bursa.
JOINT
Any joint problem, such as arthritis, can cause inflammation and pain. Your provider will place a needle in your joint. Sometimes ultrasound or an x-ray machine may be used to see where exactly the location is. Your provider may then remove any excess fluid in the joint using a syringe attached to the needle. Your provider will then exchange the syringe and a small amount of corticosteroid and a local anesthetic will be injected into the joint.
TENDON
A tendon is a band of fibers that connects muscle to bone. Soreness in the tendon causes tendonitis. Your provider will put a needle directly adjacent to the tendon and inject a small amount of corticosteroid and a local anesthetic.
You will be given a local anesthetic along with the steroid injection to relieve your pain right away. The steroid will take 5 to 7 days or so to start working.

HYALURONIC ACID INJECTIONS:

Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.
Hyaluronic acid is similar to a substance that occurs naturally in the joints. It works by acting like a lubricant and shock absorber in the joints and helps the joints to work properly.
This medicine is to be administered only by or under the immediate supervision of your doctor.
The presence of other medical problems may affect the use of hyaluronic acid injections. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy to bacterial proteins, gram positive or
• Allergy to hyaluronate preparations or
• Skin or knee joint infections or other problems at the place where the injection is to be given—Should not be given in patients with these conditions.
• Joint effusion (too much fluid in the knees)—Patients with this condition should be treated first before receiving this medicine

Platelet-rich Plasma (PRP) Injections

Platelet activation plays a key role in the body’s natural healing process. Platelet-rich plasma (PRP) therapy, uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.
PRP injections are prepared by taking anywhere from one to a few tubes of the patient’s own blood and running it through a centrifuge to concentrate the platelets. The activated platelets are then injected directly into the injured or diseased body tissue, releasing growth factors that stimulate and increase the number of reparative cells.
Ultrasound imaging is sometimes used to guide the injection.
The side effects of PRP injections are very limited, since a the body does not reject a person’s own blood. Learn more about PRP injections by making an appointment with Dr. John Villanueva.

What’s the latest information on using stem cell therapy to treat arthritis of the joints that causes excessive pain?

New efforts in regenerative medicine, including stem cell therapy, could dramatically affect orthopedic surgery over the coming years. Much of this hope is pinned on using stem cells to treat degenerative conditions such as shoulder arthritis. Although it shows promise, stem cell treatment for arthritis isn’t widely available at this time, as it’s still being researched.
Stem cells are the basic building blocks of all human tissue. Stem cells hold potential as treatment, in part, because they can communicate valuable information about tissue growth and healing to other cells in the body. Arthritis involves joint degeneration due to loss of the cartilage that cushions bones. Recently researchers have begun to look to stem cells for orthopedic conditions such as shoulder arthritis. Progress using stem cells to treat arthritis already has been reported, with the ultimate goal of using stem cells to regrow cartilage.
What the research into stem cells and arthritis shows is that there are opportunities for stem cell treatment to be used as injection therapy alone and in addition to orthopedic surgical procedures. Successful stem cell therapies thus far have resulted mostly in pain relief and improvement in function or quality of life. Only a few limited early studies have demonstrated improvement in new cartilage or bone formation needed to cure arthritis. Exactly how that cartilage regrowth occurs, or even how pain relief is achieved, is still unknown. That means if you have a stem cell procedure, it will be used to treat the symptoms of arthritis only. The ability to cure the disease entirely is not yet available.
No major research studies have specifically investigated stem cell treatment for shoulder arthritis. Much of what is known about stem cells in arthritis comes from research into knee degeneration. It’s not known if the successes treating knee arthritis will prove to be similarly beneficial when used for the shoulder. Therefore, current recommendations to treat shoulder arthritis remain the judicious use of gentle pain relievers, exercise and occasional steroid injections. In severe cases, shoulder replacement can provide long-lasting pain relief.
With demonstrable safety and mounting evidence of the effectiveness of stem cell therapy for some orthopedic conditions, potentially all orthopedic disease could be treated with stem cell therapy in the future. But, first, doctors and patients will have to wait until the scientific evidence catches up to the excitement around this promising option.

Botox for Migraines

Botox – the cosmetic formulation frequently used to help smooth lines and wrinkles – is effective in the treatment of chronic migraine headaches. Millions of Americans suffer from migraine headaches, many of which are debilitating. As an alternative to pain medications, which provide only temporary relief, Botox that is given at regular intervals, a few times a year, can reduce the frequency and intensity of future headaches over time.

Did you know?

Pain relieving medications have long been the standard of managing chronic headaches and migraines. But did you know that Botox has been approved for the prevention of chronic migraines by the Food and Drug Administration? The National Institute for Health and Clinical Excellence conducted controlled trials to test the efficacy of Botox for migraine headaches in comparison to placebos. In each trial, Botox significantly out-performed the placebo, producing a noticeable reduction in headache frequency.

Frequently Asked Questions

I have chronic migraines. Am I a candidate for Botox treatment?
Botox is generally not the first line of treatment for migraine headaches. Instead, it is reserved for patients who have been unresponsive to headache medications. You may be a candidate for Botox for migraines if you have headaches on at least 15 days each month, with more than half of them being migraines. The only way to know for sure if Botox could help alleviate your headaches is by scheduling a consultation with your doctor.
What should I expect during a migraine Botox treatment?
Your Botox treatments will be administered in your doctor’s office. Most sessions take only 5 to 10 minutes, during which time a fine needle is used to inject small amounts of Botox into 7 key areas of the head. There is a total of 31 injections, which may induce mild discomfort. You’ll be allowed to return home the same day and resume normal activities soon after.
What types of results can I expect after getting Botox for my headaches?
Botox can provide significant pain relief for chronic headaches, but results vary from person to person. Keep in mind that it may take several weeks and more than one treatment before your headaches begin responding to Botox injections. Botox is not effective for the treatment of existing headaches.
Occipital Nerve Block
Occipital nerve blocks are shallow scalp injections used for the purpose of diagnosing or treating pain stemming from the greater and lower occipital nerves. The occipital nerves are located along the back of the head just above the neck. By injecting a numbing or anti-inflammatory medication, it is possible to reduce swelling and inflammation in the tissues surrounding the nerves that can cause pain. Patients who respond best to occipital nerve blocks are generally those who report sharp or stinging head pain.
Did you know…
that occipital nerve blocks double as diagnostic tools? If you have symptoms that could suggest occipital nerve pain, your doctor may recommend a trial injection that doubles as a diagnostic procedure. When patients achieve pain relief from initial injections, doctors can confirm that the occipital nerves are the source of discomfort. When symptoms continue despite injections, the occipital nerves will be ruled out as the cause of chronic head pain.

Frequently Asked Questions

How can I find out if I am a candidate for an occipital nerve block?
You may be a candidate for an occipital nerve block if you have chronic or recurring head pain that is predominately located in the back of the head and only on one side. The only way to find out if an occipital nerve block is right for you is by scheduling a pain management consultation with your doctor.
What should I expect during an occipital nerve block procedure?
If you and your doctor decide that an occipital nerve block is right for you, you’ll be scheduled to return to your doctor’s office at a later date for treatment. The injection will be administered while you are seated or lying down. Prior to the treatment, your doctor will prepare the injection site with an antiseptic and may also numb the injection site using a local anesthetic to minimize discomfort. A very fine nerve block needle is injected into the scalp, where a combination of numbing medication and steroids is applied near the greater and lesser occipital nerves. The entire injection takes just minutes from start to finish, and you are likely to be allowed to return home immediately after.
What types of results should I expect from this treatment?
Results from occipital nerve blocks vary from person to person but typically do not appear until between 3 and 5 days after the injection. Many people achieve significant pain relief after the first injection. But because results are temporary in nature, repeat injections are necessary to continue managing occipital nerve pain.

SPHENOPALANTINE GANGLION (SPG) INJECTIONS

The sphenopalatine ganglion (SPG) is a collection of nerve cells that is closely associated with the trigeminal nerve, which is the main nerve involved in various headache disorders. It contains autonomic nerves and sensory nerves. Autonomic nerves are specialized nerves that control organ functions, including gut and bladder movements, beating of the heart, sweating, salivation, tearing and other secretions. In the SPG, these autonomic nerves supply the lacrimal glands (which produces tears) and the inner lining of the nose and sinuses (which produces nasal discharge or congestion). The SPG is located just behind the bony structures of the nose.
A Sphenopalatine Ganglion nerve block is a procedure to stop pain transmission through anesthesia to the nerve. In a SPG block, an anesthetic agent is administered to the collection of nerves in the ganglion. The least invasive way to access the SPG is through the nose.The risks of the procedure are typically minimal. They include discomfort during and after the procedure, a numb sensation when swallowing, bitter taste from the anesthesia, bleeding from the nose, and light-headedness. These side effects typically resolve within minutes to a few hours. There is a very small risk of seizures, infection and allergic reactions.

TRIGGER POINT INJECTIONS

What are trigger points?
Trigger points are areas in muscle that are very irritable, show a band of tightness in the area of muscle itself, and, when pressed, produce a twitch within the affected muscle. A trigger point may produce not only pain in the affected muscle, but in a distant area, including locations in the head and neck, called referred pain. Trigger points may develop because of trauma, injury, inflammation, or other factors.
Can trigger points cause headaches or trigger migraines?
Trigger points within muscles of the head, neck, and shoulders can cause headache by themselves, and this type of condition is often called myofascial pain. In addition, trigger points can be present in patients with migraine, tension-type, post-traumatic, and other headache disorders, and can be worsening or perpetuating factors for the underlying headache condition.
How do trigger point injections work?
The anesthetic medication will be injected into the muscle and will block pain receptors within the nerves surrounding the muscle, and, in turn, reduce the pain signals sent to the brain. If steroid medication is used, it reduces the inflammation and swelling of tissue around the nerves, which may help reduce pain. The needle without medication may even provide independent benefits mechanically. The needle separates, relaxes and lengthens the muscle fiber to provide further pain relief. This approach is called “needling” and may be used in patients with allergies to anesthetic medication.