Interventional Pain Procedures

Our physicians perform a comprehensive range of interventional pain procedures — all minimally invasive, most performed under fluoroscopic (X-ray) guidance, and typically completed in under 30 minutes. These procedures treat pain at its source rather than masking symptoms with medication alone.

Epidural Steroid Injections

• Cervical epidural steroid injection — targeted injection into the cervical (neck) epidural space to reduce inflammation around compressed or irritated nerve roots causing neck pain, arm pain, or cervicogenic headache
• Thoracic epidural steroid injection — injection into the thoracic (mid-back) epidural space for mid-back pain and thoracic radiculopathy
• Lumbar epidural steroid injection — injection into the lumbar (low back) epidural space, the most common interventional procedure for low back pain with radiculopathy
• Caudal epidural steroid injection — injection through the sacral hiatus, often used for patients with prior lumbar surgery or multilevel disc disease
• Transforaminal epidural steroid injection — highly targeted injection at the specific nerve root foramen where compression occurs, providing more precise delivery of medication to the affected nerve
• Interlaminar epidural steroid injection — injection between the vertebral laminae for broader epidural coverage

Facet Joint Procedures

• Facet joint injection — diagnostic and therapeutic injection directly into the facet joint to determine if it is a pain source and provide relief
• Medial branch block — injection of local anesthetic onto the medial branch nerves that supply the facet joints, used as a diagnostic test before radiofrequency ablation
• Cervical facet joint injection — facet treatment in the neck, often the cause of cervicogenic headaches and neck pain
• Lumbar facet joint injection — facet treatment in the low back, a common source of axial low back pain

Radiofrequency Ablation (RFA)

• Cervical radiofrequency ablation — using heat to interrupt the medial branch nerves in the neck, providing 6–12+ months of relief from facet-mediated neck pain and cervicogenic headache
• Lumbar radiofrequency ablation — interrupting medial branch nerves in the low back for long-lasting relief from facet joint pain
• Sacroiliac (SI) joint radiofrequency ablation — targeting the lateral branch nerves of the SI joint for chronic sacroiliac pain
• Genicular nerve radiofrequency ablation — ablation of the genicular nerves around the knee, providing months of relief from chronic knee pain without surgery
• Cooled radiofrequency ablation — advanced RF technology that creates larger lesions for improved nerve capture, particularly effective for SI joint and knee pain

Joint Injections

• Knee joint injection — corticosteroid or hyaluronic acid injection for knee osteoarthritis and knee pain
• Hip joint injection — fluoroscopy-guided injection for hip osteoarthritis, labral pathology, and hip pain
• Shoulder joint injection — injection for shoulder osteoarthritis, rotator cuff pathology, and adhesive capsulitis (frozen shoulder)
• Sacroiliac (SI) joint injection — fluoroscopy-guided injection for SI joint dysfunction, a commonly missed cause of low back and buttock pain
• Viscosupplementation (gel shots) — hyaluronic acid injection into the knee for osteoarthritis, supplementing the joint's natural lubrication

Nerve Blocks

• Occipital nerve block — injection at the base of the skull for occipital neuralgia, chronic migraine, and cervicogenic headache
• Peripheral nerve block — targeted injection of local anesthetic around specific peripheral nerves for localized pain
• Selective nerve root block — diagnostic injection at a specific spinal nerve root to determine if it is the source of radicular pain
• Genicular nerve block — diagnostic block of the genicular nerves around the knee, performed before genicular nerve RFA
• Suprascapular nerve block — for chronic shoulder pain
• Intercostal nerve block — for chest wall pain, rib fracture pain, and post-thoracotomy pain
• Ilioinguinal / Iliohypogastric nerve block — for groin pain and post-hernia repair pain
• Pudendal nerve block — for chronic pelvic pain, pudendal neuralgia, and perineal pain

Sympathetic Nerve Blocks

• Stellate ganglion block — injection at the stellate ganglion in the neck for CRPS of the upper extremity, PTSD, and long COVID symptoms
• Lumbar sympathetic block — injection targeting the lumbar sympathetic chain for CRPS of the lower extremity and peripheral vascular pain
• Celiac plexus block — targeting the celiac plexus for upper abdominal and visceral pain, including cancer-related pain
• Superior hypogastric plexus block — for chronic pelvic pain, endometriosis-related pain, and pelvic cancer pain
• Ganglion impar block — for coccydynia (tailbone pain), perineal pain, and rectal pain

Neuromodulation (Spinal Cord Stimulation)

• Spinal cord stimulation (SCS) trial — temporary placement of stimulation leads to evaluate whether SCS provides meaningful pain relief before permanent implantation
• Spinal cord stimulator implant — permanent placement of an implantable pulse generator and leads for chronic pain that has not responded to conservative treatment
• Dorsal root ganglion (DRG) stimulation — targeted neuromodulation of the dorsal root ganglion for CRPS, post-surgical pain, and focal neuropathic pain
• Peripheral nerve stimulation — stimulation of specific peripheral nerves for localized chronic pain
• SCS revision / reprogramming — adjustment or replacement of existing spinal cord stimulation systems
• High-frequency spinal cord stimulation (HF10) — paresthesia-free stimulation at 10,000 Hz for chronic back and leg pain
• Burst stimulation — advanced SCS waveform that mimics natural nerve firing patterns for improved pain relief

Trigger Point Injections

• Trigger point injection — injection of local anesthetic into myofascial trigger points for muscle pain, tension headaches, and myofascial pain syndrome
• Botox injection for chronic migraine — FDA-approved injection protocol for patients with 15+ headache days per month
• Botox for cervical dystonia and spasticity — targeted injection for muscle overactivity

Vertebral Augmentation

• Kyphoplasty — minimally invasive treatment for vertebral compression fractures, using a balloon to restore vertebral height followed by cement injection
• Vertebroplasty — cement injection into a fractured vertebral body for pain relief and stabilization

Minimally Invasive Spine Procedures

• Sacroiliac (SI) joint fusion — minimally invasive stabilization of the SI joint for patients with confirmed SI joint dysfunction who have not responded to injections or radiofrequency ablation. Performed through a small incision using fluoroscopic guidance.
• MILD procedure (minimally invasive lumbar decompression) — percutaneous treatment for lumbar spinal stenosis caused by ligamentum flavum hypertrophy. Removes small portions of thickened ligament and bone to restore space in the spinal canal without general anesthesia, implants, or stitches.
• Intracept procedure — targeted treatment for chronic vertebrogenic low back pain by ablating the basivertebral nerve within the vertebral body. For patients with Modic changes on MRI who have not responded to conservative treatment.
• Vertiflex/Superion interspinous spacer — minimally invasive implant placed between the spinous processes to treat lumbar spinal stenosis. Provides indirect decompression without removing bone or tissue.

Intrathecal Drug Delivery

• Intrathecal pump trial — trial of medication delivered directly into the spinal fluid to assess efficacy
• Intrathecal pump implant (pain pump) — permanent placement of an implantable pump that delivers medication directly to the spinal cord, providing pain relief with significantly lower systemic doses and fewer side effects
• Pump refill and dose adjustment — ongoing management of implanted intrathecal pumps

Diagnostic Procedures

• Provocative discography — diagnostic procedure to determine whether a specific disc is the source of pain by reproducing the patient's symptoms under controlled pressurization
• Diagnostic medial branch blocks — confirming facet joint pain before proceeding with radiofrequency ablation
• Diagnostic selective nerve root blocks — confirming the specific nerve root causing radicular symptoms

Other Procedures

• Sensory denervation — targeted nerve destruction for specific chronic pain conditions
• Bracing and durable medical equipment (DME) — prescription and fitting of back braces, TENS units, and other pain management devices

All procedures are performed at our Birmingham (Vestavia Hills) and Bessemer offices. Most procedures are covered by insurance. Specific procedure availability may vary by location and physician. Contact us to discuss your options.