Pain Therapy – Treatment Options
Back pains are the most common reason for visiting a doctor. With younger patients, the complaints mostly appear due to a functional disturbance of the facet joints caused by improper or excessive stress. At an older age, it is primarily the spinal column showing the effects of wear and tear (e.g. arthrosis). False posture or unilateral stress of the spinal column can lead to disc prolapse. Mostly, as a result, inflammations, long-lasting pain and impaired movement can occur. Image-guided back pain therapies like periradicular therapy (PRT) or facet-joint infiltration (FJI) make it possible to perform a targeted and effective treatment of back pain directly at the site of action. These microtherapies are often applied as alternatives to surgical intervention. The treatment is directly targeted at the site of pain [the small facet joints (FJI) or the nerve roots (PRT)] using a medication cocktail, consisting of a local anaesthetic, pain reliever and a cortisone preparation.
Contrary to the common non-guided injection methods the major advantage of the CT-guided pain therapy is the precise navigation and millimetre accurate administration of medication which offers the best treatment effects.
In comparison to analgesics, PRT and FJI can bring about a lasting relief of symptoms by targeting the cause of pain specifically. However, to eliminate the pain completely, a number of treatment sessions will usually be necessary, which can be performed one or several weeks apart.
About eighty percent of the patients undergoing a PRT or FJI either show a significant improvement of their disorders or even the total elimination of their symptoms.
Pain Therapy – Fields of Application
Periradicular therapy (PRT) and facet-joint infiltration (FJI) are predominantly applied for diseases which cause painful irritations of spinal nerve roots or facet joints.
PRT and FJI are used in the following cases:
- acute or chronic disc protrusion
- spinal canal stenosis (narrowing of the spinal canal)
- acute or chronic pain in the lumbar spine (lumbago)
- sciatica (sciatic neuralgia syndrome)
- arthrosis of the facet joints (wear and tear of the facet joints)
- degenerative spinal diseases
- foramen stenosis (narrowing of the foramen)
Pain Therapy – Process of Examination
Before starting the pain therapy a CT scan will be performed offering basic information for the treatment planning. During CT scanning you will lie in prone position on a soft examination table that slides slowly into the wide circular opening of the CT scanner. The huge ring of the device offers enough space, so that you’ll feel comfortable inside. Throughout the whole process of examination our medical staff is at your side, monitoring you from the control room. Via microphone you can get into contact with our assistants during the whole procedure. After the preoperative planning we mark the exact position of the puncture site. After a thorough disinfection of the skin, the puncture needle is placed as close as possible to the facet joint or nerve root without injuring them. The punctures are performed under sterile conditions and CT-guidance. Afterwards, a medication cocktail, consisting of a local anaesthetic and a low-dosed cortisone preparation, is injected. After removing the needle and applying an adhesive bandage the treatment is finished. The procedure usually takes 5 to 10 minutes. After the puncture, you should stay in our practice for at least 30 minutes. As a result of the pain therapy – mainly of the local anaesthetic – you won’t be allowed to participate in traffic for at least 6 hours after treatment.
Pain Therapy – Physiological Effects of Medication
On the one hand, the local anaesthetic has a pain-relieving effect, on the other hand the low-dosed cortisone preparation offers anti-inflammatory effects and reduction of the nerv swelling. That’s the way, PRT and FJI bring about a lasting relief of symptoms.
About eighty percent of the patients undergoing a PRT or FJI show a significant and long-lasting improvement of their disorders. It usually lasts somewhere between several weeks or months. However, to eliminate the pain completely, a number of treatment sessions will usually be necessary.
Pain Therapy – Risks and Side Effects
Despite our utmost medical care complications might occur in individual cases:
Often (1 %): a temporary numbness/muscle weakness in your arm/leg
Rarely (0,01 % – 0,1 %): minor allergic reactions to the medication, itching, exanthema
Very rarely: (< 0,001 %): strong allergic reaction with circulatory shock, heart failure or respiratory stress
Very rarely: (< 0,001 %): haematoma formation, injury or damage of nerves, inflammation, long-lasting nerv disorders, meningitis/spinal meningitis
Hardly ever (< 0,0001 %): stroke, paraplegia
Pain Therapy – Contraindications
Taking blood thinners is a relative contraindication to PRT or FJI. Moreover, hypersensitivity to one or several components of the medication cocktail can lead to a relative or absolute contraindication. Pregnant women should not undergo PRT or FJI at all.
For this reason, we inform you about the risks, possible side effects and our effort to minimise them prior to treatment.
CT-guided pain therapies are offered at the following locations of RUHRRADIOLOGIE: Our practices in Dortmund, Witten and Ennepetal.