We perform minimally invasive pain management techniques with the support of x-rays or ultrasound real time imaging tools. Our aim is to provide an accurate diagnosis in order to implement appropriate non-surgical treatments.
We apply individually tailored therapies which are adapted to the patient’s condition, using the most advanced technology and a multidisciplinary approach to get positive results and tackle pain in all its dimensions: medical, nutritional, psychological and physiotherapeutic.
Interventions on the epidural space
This intervention helps us get to the root of pain by means of imaging-guided techniques with fluoroscopy or CT. A specific needle is used to inject one or more anti-inflammatory medications. The main indication is spine pain derived from disc pathologies, herniated intervertebral disc, stenosis, post-laminectomy fibrosis, etc.
Epidural injections can be performed at any level within the spine, but the technique will differ accordingly. Injecting medication as close as possible to the injured or inflamed area is of the utmost importance in epidural blocks.
As it is a minimally invasive technique, the patient can be discharged shortly.
Interventions on the epidural space:
- Interlaminar, transforaminal and caudal infiltrations
- Caudal neuroplasty
- Foraminal neuroplastia
Sympathetic nervous system blocks and neurolysis
When pain is produced or prolonged by the sympathetic nervous system, the treatment targets sympathetic ganglia, located in the cranium, neck, thorax, lumbar area and pelvis. The level of application will depend on the painful area.
These techniques are used to treat complex regional pain syndrome (CRPS 1 and CRPS 2), atypical facial pain, certain migraines or peripheral ischemia. They may also relieve headaches, neck, superior or inferior limbs pain, thoracic condition and visceral abdominal or pelvic pain. In this technique, x-rays are used to place the needle accurately. Patient assessment may be performed after the injections in order to check the effect of local anaesthesia and then, occasionally, proceed to treat a more final injury by heat therapy or chemical neurolysis.
Sympathetic nervous system blocks and neurolysis:
- Cervicothoracic ganglion (stellate ganglion)
- Thoracic sympathetic (T2-T3)
- Splanchnic and celiac plexus
- Sympathetic lumbar plexus
- Superior hypogastric plexus
- Ganglion impar
Radiofrequency is a safe procedure increasingly used to treat pain, especially cervical, dorsal or lumbar spine pain. It consists in producing micro-lesions dots from the thermal energy emitted by electrons flux in an electric circuit. It is usually performed using local anaesthesia or sedation.
There are different types of radiofrequency delivery:
- Thermal radiofrequency (RF):
It produces a heat lesion, which relieves pain, using a low-voltage high-frequency electric current (500,000 Hz). Temperature reached in this radiofrequency technique is 55 to 80 °C.
- Pulsed radiofrequency (PRF):
This procedure does not cause nerve destruction. Unlike thermal radiofrequency, based on continuous wave radiation, PRF displays pulses at a fixed time interval, and the maximum temperature reached is 40 to 42 °C. The main advantage of PRF is its non-destructive nature, and that is the reason why it may be recommended for neuropathic pain management or when conventional RF cannot be used.
Thermal radiofrequency (RF) treatments:
- Cervical facet rhizotomy
- Thoracic facet rhizotomy
- Lumbar facet rhizotomy
- Sacroiliac joint rhizotomy
- Genicular nerve rhyzotomy (knee articular branches)
- Rhizotomy of hip articular branches.
Pulsed radiofrequency (PRF) treatments:
- Sphenopalatine ganglion PRF
- Spinal ganglion PRF
This technique consists in the application of injections directly into the affected area: shoulder, knee, hip or sacroiliac joint. The aim of this procedure is disrupting sensory impulses from a specific body area, alleviating or even completely eliminating pain.
As in any other block procedure, a medicine (usually an anaesthetic or antiinflammatory one) is injected into the injured area, disrupting pain signals or reducing inflammation.
- Sacroiliac joint
Myofascial pain treatment
This therapy consists in the localization of painful nodules in the muscle tissue to perform an injection directly into the trigger point. The main indications are localized or low radiating pain and soft-tissues rheumatic conditions causing back, neck and shoulder muscular pain.
Myofascial pain may appear in response to altered biomechanics or other pathologies such as fibromyalgia.
Myofascial pain is characterized by a knot in the involved muscle called “trigger point”. When the back is affected, it may appear as a persistent pain in the lumbar area or gluteus, although it may affect any muscle. The most frequent causes are muscle fatigue, a repetitive motion with overstrain, or altered biomechanics due to osteoarthrosis or other degenerative musculoskeletal conditions.
The treatment, consisting in anaesthesia, antiinflammatory medication or botulinum toxin A injections, reduces or even stops pain. It is a minimally invasive technique, therefore recovery time is brief.
Myofascial pain treatment:
- Trigger point blocks
- Quadratus lumborum block
- Psoas block
- Piriformis block
Interventions on the intervertebral disc
Different techniques are used to diagnose and address discogenic pain, that is, pain originated in the intervertebral disc. Diagnostic discography consists in reproducing internal pressures within the disc, similar to those generated in painful activities, in order to identify and diagnose pain. Regarding treatment, radiofrequency annuloplasty is used to treat lumbar, dorsal or cervical pain derived from the intervertebral discs.
Sedation and local anaesthesia are required, although it is a minimally invasive technique where no surgical incision is performed. In this procedure, fluoroscopy-guided cannulas are inserted into the intervertebral disc originating the pain and controlled levels of thermal heat are applied during a pre-set time. The patient does not feel pain as the area under treatment is anaesthetised. Besides, more than one intervertebral disc can be addressed during the same session.
Discolysis, on the contrary, involves injecting ozone or other proteolytic substances into the intervertebral disc, at lumbar, dorsal or cervical level. It is specially recommended to treat radiating pain resulting from disc bulging, protruding or herniated disc.
Interventions on the intervertebral disc:
- Diagnostic discography
- Chemical discolysis (chemonucleolysis)
- Ozone discolysis
- Disc radiofrequency