• Periradicular infiltration therapy
The pain therapy method is used to treat pain resulting from irritation due to pressure exerted on a nerve root by a herniated intervertebral disc that does not require surgery. This method is also used to treat degenerative stenoses of the intervertebral foramina. Monitored with x-ray or CT imaging equipment, a thin needle is introduced into the vicinity of the affected nerve root. Once the needle is correctly positioned, the nerve root is flushed with a mixture of painkilling and anti-inflammatory drugs, i.e. a local anesthetic and a drug containing cortisone. This technique ensures that a high concentration of active substances actually arrives at the origin of the pain. This treatment is then repeated several times over a 3-week period depending on the intensity of the symptoms. Due to the effect of the local anesthetic, a feeling of weakness or numbness may occur in the arm or leg, though this is of brief duration.
• Trigger point blocks
Trigger points are tissue areas that react sensitively to pressure with pain. Myofascial trigger points are points in muscles, muscle fasciae and tendons up to 1 cm in size that may cause pain. Pain can be ”projected” into other regions from these trigger points. This type of pain is frequently observed in the back of the head (occiput), the back, the nape of the neck and the shoulders. Tender trigger points may set off chain reactions, especially in muscle tissue. Overloading or favoring a muscle in response to muscle pain causes the affected muscle to contract and tense up, resulting in a localized circulation deficiency in the muscle tissue. The patient may respond by favoring this area to ease the pain, causing other muscle groups to tense up, producing more trigger points and exacerbating the pain. To interrupt this cycle, the trigger points are localized in an examination and blocked by the targeted infiltration of a local anesthetic. This treatment quickly lowers local pain
levels.
• Sympathicus block
The vegetative nervous system (sympathicus) features a number of vegetative centers with sensitive nerve fibers that influence, among other things, pain centers and pain-conducting fibers. Sympathicus blocks are set along the cervical spine (at the ganglion stellatum) and lumbar spine (at the lumbar sympathetic trunk). In this method, local anesthetic is injected at these neural structures, resulting in increased circulation to the tissues controlled by these nerve centers. Improved muscle circulation relaxes the muscle fibers, thus reducing pain.
• Facet block
A facet block is an injection treatment of the facet joints, or small vertebral joints. Under computer tomographic control, a local anesthetic is accurately injected at the small vertebral joints, resulting in rapid pain relief.
Invasive pain therapy
• Facet denervation
Chronic pain arising from the small vertebral joints can be reduced by interrupting the conduction of neural signals, and thus of pain conduction, from the facet joints. In this method, a probe is inserted into the nerve branches supplying the affected facet joint under computer tomographic control. Once the probe is correctly positioned, 80-90°C of heat created by a high-frequency or laser source is applied to the nerve branches, destroying them. In most patients, pain is significantly reduced after this treatment.
• Epidural spinal cord stimulation
This method is used for the treatment of severe therapy-resistant neuropathic pain or rhizopathies (root irritations) following intervertebral disc surgery. Under local anesthesia, an electrode is inserted between the spinal cord sheaths and the vertebral arches. Stimulation of the electrode allows it to be placed with great accuracy. A pulse generator implanted under the skin of the chest (”neural pacemaker”) stimulates the electrode by sending electrical impulses through a connecting cable to the electrode and thence to the spinal cord. These electric pulses interrupt the conduction of pain signals in the spinal cord, effectively reducing pain.
