Minimally Invasive Solutions for Pain
Chronic pain is unfortunately common with 1 in 5 people in the U.S. having chronic pain. It is more common in women, veterans, and people who are older. Often people struggle for years to determine the cause of their pain and what to do about it. Medications can help but tend to cause problems of their own, particularly opiates which can be addictive and require more and more to get similar relief over time. Other things that can help some people include meditation, physical therapy, acupuncture, and other alternative approaches that we can discuss.
There are minimally invasive treatments for some causes of pain. It is often challenging to immediately determine the cause, so it may require some trial and error. It is also often impossible to completely get rid of the pain, but we can work together to try to make it more manageable.
NERVE BLOCKS AND NEUROLYSIS
Sometimes a certain nerve or group of nerves get injured causing chronic stabbing, burning, and/or sharp pain. When the nerve is only responsible for feeling rather than say movement of a muscle, it can be safely destroyed to help with the pain. We first do a block where medication is injected on the nerve to temporarily numb/paralyze it to see whether that is the problem. If it is, we can then destroy the nerve with a skinny wand that creates an ice ball at the tip to freeze and reset/kill the nerve.
What are the risks and recovery?
These are generally safe procedures where you go home the same day without any specific recovery related to the procedure itself. The risks vary depending upon the nerve being destroyed and what other structures are around it that we want to avoid damaging.
Embolization for Joint Pain
Joint pain is common, particularly knees, hips, and shoulders. Often physical therapy, medications, and joint injections are tried first, but the pain can come back. The gold standard is to then have surgery to replace the joint but some people are not healthy enough for surgery or want to try to avoid surgery until they are older or all together. The pain tends to be caused by inflammation, causing extra small blood vessels to grow, causing more inflammation in a vicious cycle. These abnormal vessels can be blocked off, decreasing the inflammation and pain through a pinhole at the top of the thigh, no incision or stitches.
What are the risks and recovery?
This is a generally safe procedure where you go home the same day. It tends to first make the pain worse for about a week, so I will give you medications to help with this. The procedure will then help with the pain in about 6 in 10 people. If it doesn’t help, we can also try zapping some of the nerves going to the joint. Sometimes the nerves are the issue more than the blood vessels, but I prefer trying the blood vessels first.
PELVIC CONGESTION SYNDROME
Pelvic congestion syndrome is an old but common term for dilated abnormal veins in the pelvis of women that allows blood to pool there. It can cause chronic deep pelvic pain and pressure/heaviness that tends to be worse at the end of the day, while standing, after sex, and/or during periods. It tends to be under-diagnosed despite being common. There are however other common causes of chronic pelvic pain that should be excluded first.
What can be done for pelvic congestion syndrome?
The veins can be destroyed through a pinhole at the base of the neck or top of the thigh, no incision or stitches. Other more superficial veins can be directly punctured with a needle. You don’t need the abnormal veins, so they can be safely destroyed, helping the pain and pressure. The veins are destroyed by injecting a material that scars them closed. Little metal coils or medical grade glue is also used to block the veins so they don’t come back. Check out this DocuSeries about pelvic congestion syndrome and what can be done to treat it.
What are the risks and recovery?
This is a generally safe procedure where you go home the same day without any specific recovery related to the procedure itself. About 1 in 10 women can have mild temporary pain or even a low grade fever for a couple days afterwards. Other complications such as infection, bleeding, or the material/coils traveling someplace unintended are very rare. The procedure does not affect menstruation or the ability to can pregnant in the future.
Varicoceles and Testicular Pain
Varicoceles are dilated abnormal veins in the scrotum that can cause pain, heaviness, and even infertility. The veins can be destroyed through a pinhole at the base of the neck or top of the thigh, no incision or stitches. You don’t need the abnormal veins, so they can be safely destroyed, helping the pain. The veins are destroyed by injecting a material that scars them closed. Little metal coils or medical grade glue is also used to block the veins so they don’t come back.
What are the risks and recovery?
This is a generally safe procedure where you go home the same day without any specific recovery related to the procedure itself. Some people have some mild pain for a couples days, but otherwise complications such as bleeding, infection, or the material/coils traveling someplace unintended are very rare.
BACK PAIN AND FRACTURES
One cause of back pain is a fracture in the spine. This tends to happen when the bones get thin and an otherwise minor slip or fall causes a bone in the spine to break. Through a pinhole in the back, we can fill the fracture with cement, stabilizing it and helping with the pain. In fact, up to 9 in 10 people have complete pain relief with the treatment when the fracture is acute and 7-8 in 10 people when the fracture is older. This can also be done in the tailbone called “sacroplasty.”
What about other causes of back pain?
Other common causes of back pain include inflammation in joints around the spine (facet joints) as well as bone spurs and slipped discs pinching nerves. Some people end up needing surgery to help decompress things, but we can also trial injecting medications to help with the pain by decreasing the inflammation.
What are the risks and recovery?
These are generally safe procedures where you go home the same day without any specific recovery related to the procedure itself. Complications such as infection or the cement going some place unintended and causing a problem are very rare.