Pain Center at Sibley Memorial Hospital
If you suffer from chronic pain, chances are your physician will refer you to a pain center that offers a wide variety of services to help you live a more pain-free life.
The Sibley Memorial Hospital Pain Center provides the latest in minimally invasive treatment options for relieving pain associated with everything from sports injuries to chronic arthritis. The field of pain management is filled with new, minimally invasive pain treatment modalities that are replacing oral narcotics as the standard of care, giving more pain management options to patients. The Pain Center’s staff focuses on pain treatment and has a wide range of tools to tailor pain treatments to the many causes of chronic pain. Sibley’s specialists have brought a hugely improved quality of life to many people who have been dealing with persistent pain for years.
Patient Forms
New and returning patients should print, complete and bring a medication reconciliation form to the appointment.
What to Expect
When you come to the Pain Center for your appointment, please:
- Leave any valuables or jewelry at home
- Bring your insurance card and photo ID
For many of our procedures, you will need to arrange for transportation home. Your physician will let you know if you will be able to drive home when you discuss the procedure.
Most major insurance plans cover pain medicine services. But insurance policies vary, so please check with your insurance carrier.
Conditions We Treat
Chronic Back and Neck Pain
- Degenerative disc disease
- Radiculopathy
- Cervical and lumbar strain
- Facet disease
- Post-surgery pain
Nerve Related Pain
- Complex Regional Pain Syndrome (also known as Reflex Sympathetic Dystrophy)
- Peripheral or diabetic neuropathy
- Phantom limb pain/post-amputation pain
- HIV-related pain
- Peripheral nerve injury
- Central pain syndromes after stroke or spinal cord injury
- Post-herpetic neuralgia and herpes zoster
- Headaches (occipital neuralgia, migraines, tension headache, cluster headache)
- Facial pain — TMJ, neuromas (trauma), atypical facial pain
- Musculoskeletal pain
- Myofascial pain syndrome
- Chest wall pain
- Piriformis Syndrome
- Arthritis and joint pain
Other Types of Pain
- Abdominal/pelvic pain
- Whiplash-associated disorders
- Cancer pain: treatments include intrathecal pumps (implanted and controlled by the patient)
- Sacroiliac joint pain
Our Approach
At Sibley, we provide a comprehensive set of approaches to improving your quality of life. Care begins with a comprehensive evaluation of each patient to determine the best treatment possible, which may include referrals to other specialists. The end result is an individualized plan for your particular situation, and connections to the right provider, whether they specialize in neurosurgery, orthopaedic surgery, neurology, physical therapy, occupational therapy or psychological services.
As there are many types of pain, there are many ways to treat it. Ideally the cause of the pain is treated, but when the cause is not immediately treatable a pain management team may use a number of other methods.
- Physical methods, such as physical therapy and massage, can be used to strengthen the body and reduce pressure on nerves in affected areas.
- Interventional procedures are used to disrupt or alter the transmission of pain in the body; common methods include nerve blocks, facet joint injections and nerve stimulation.
- Psychological methods involve teaching coping techniques that allow a person with persistent pain to process and reduce the effects of pain.
- Medications range from over-the-counter non steroidal anti-inflammatory drugs such as acetaminophen to extremely powerful opiate painkillers; due to the possibility of addiction and potential side effects, medication must be carefully managed by the team.
Pain Testing Services
- Appropriate testing (MRI, CAT scan)
- Comprehensive evaluation (medical, rehabilitative, psychological, functional capacity/vocational assessment, disability determination)
- Special studies (diagnostic nerve blocks)
- Medical and pharmacologic management
- Anesthesia-related treatments (nerve block injection therapy, intraspinal infusions, radiofrequency neuroablation, myofacial injections)
- Transcutaneous electrical nerve stimulation (TENS)
- Referrals for physical and occupational therapy, psychological consultations, relaxation and stress management training and acupuncture
Interventional Pain Procedures
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Epidural steroid injections are used to deliver medication close to the site of injury or pathology within the spine. Steroids act to reduce inflammation, decrease pain and possibly improve function.
Techniques we use include:
- Interlaminar epidural injection: This technique typically delivers medication to the posterior epidural space, which is guided by a fluoroscope (a type of real-time X-ray). This procedure is especially useful in the treatment of diffuse spinal disorders like spinal stenosis.
- Caudal epidural injection: This approach utilizes an access point at the tailbone. This technique is commonly chosen for pain in the lower spine or coccyx. It is particularly useful in patients with previous spinal surgery where the interlaminar approach is less reliable. This injection is also performed under fluoroscopic guidance.
- Transforaminal epidural injection: This technique is a very precise, fluoroscopically guided approach to delivering a small volume of medication to the site of the problem in the spine, typically located at the anterior epidural space. This method is also very effective in treating nerve root pain (extremity pain).
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The facet joints are located in the posterior aspect of the spine and are responsible for about 10 to 15 percent of the support of the body given by the spine. Because of this important role, the facet joints are common sources of pain. They are often affected by degenerative arthritis or acute injuries like whiplash. In the neck, pain referred from this joint might manifest as headaches, shoulder pain or upper back pain. These joints can cause low back, buttock or thigh and leg pain when originating in the lumbar spine.
During intra-articular injections, the joints are penetrated with a needle, followed by injection of contrast to confirm placement. Then, a combination of local anesthetic and steroid are injected.
Medial branch blocks involve the injection of a small amount of local anesthetic at the two small nerves that supply each facet joint. This highly specific procedure is diagnostic, often predicting success with radiofrequency ablation.
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In situations where pain originating from the facet joint can be fully isolated through medial branch blocks, these specific nerves can be selectively destroyed by delivering thermal energy through a procedure called radiofrequency ablation. This technology can also be used in sympathetic-mediated pain. This procedure involves the precise placement of radiofrequency needles along the appropriate nerves. Once placed, there are number of motor and sensory stimulation tests performed to confirm that the targeted nerves are the sources of the pain. This confirmation is followed by the delivery of thermal energy, which destroys the nerves and ends the transmission of pain.
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The sacroiliac joints are located at the junction of the spine and the pelvis. These paired joints are susceptible to stress, injury and arthritis, and are often the cause of chronic low back pain. They often respond to steroid injections under fluoroscopic guidance. Radiofrequency ablation is possible with the sacroiliac joints, and diagnostic injections with local anesthetic can predict its effectiveness.
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Provocative discography is a technique utilized to diagnose internal disc disruption and resulting pain. This procedure is divided into provocative and morphological components. The provocative portion is an attempt to reproduce the patient’s “typical” pain — by inducing the pain, the cause can be verified. Abnormal discs are identified and injected; adjacent control (normal) discs are also injected. Concordant pain is elicited when an abnormal disc is injected replicating the patient’s typical pain. Often disc morphology (the shape of the disc, which can result in affected nerves) can also be noted with injection of contrast material which makes it easier to see the mechanics of the disc and nerves. The morphology is also confirmed via a CT scan immediately following the procedure. The combination of the information gleaned from these two components of the study can be useful in identifying the causative agent in disc-related low back pain.
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Spinal cord stimulation can be effective for the treatment of persistent extremity pain (in the arm or leg), nerve-related pain, certain types of low back pain, specific cases of abdominal pain and other resistant cases of pain with multiple causes.
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The sympathetic nervous system, which is involved with the control of various nonvoluntary activities (pupil dilation, digestion, heart rate), has been implicated in the development of various pain syndromes. Interventions targeting sympathetic nervous system involve the injection of local anesthetic at the sympathetic ganglia in the cervical or lumbar spine. Furthermore, radiofrequency ablation, chemical neurolysis and spinal cord stimulation are other procedures targeting this system.
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The most common indications for peripheral joint injections include arthritis and joint effusion. These procedures are often performed based on anatomical landmarks in select joints (such as the hip or glenohumeral in the shoulder) using fluoroscopic guidance. Commonly, local anesthetic and steroids are injected. Joint fluid replacement is also utilized in appropriate situations to treat pain related to joint pathology.
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In rare situations following neck or low back surgery, scar tissue (adhesions) might develop around a nerve root that causes compression and severe pain. Using a steerable catheter placed via an introducer needle, these adhesions are destroyed or broken up. This treatment is reserved for those patients who have previously failed conservative treatments such as medications and epidural injections.
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Disc decompression can be effective for the treatment of small, contained disc herniations primarily causing lower extremity pain. This procedure involves using a needle to remove excess material from the center of the disc to reduce pressure on the nerve roots and to potentially resolve the disc protrusion. By removing material, the disc returns to a more circular shape and prevents pain by protecting the nerve.
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These procedures are utilized for the treatment of disc-related low back pain. Once discography has been used to determine which disc is causing pain, these procedures involve the delivery of thermal energy to the posterior aspect of the disc resulting in collagen formation, thereby “sealing” the ruptured disc as well as reducing aberrant nerve growth into the disc. IDET involves a single needle to provide energy, while transdiscal biaculoplasty uses two introducer needles to seal a larger area.
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In some instances, a specific muscle can become taut and cause pain, either as a primary process or as a result of an underlying trigger. These trigger points can be treated with injections of local anesthetic and steroids as part of a treatment plan which typically also includes physical therapy and stretching.