



After a comprehensive review of the patient’s history and current health, a care plan is developed that may include a wide array of interventional pain management procedures & techniques including these below….


Nerves function as a transport system for electrical impulses as they pass from one area of the body to the brain, where they are translated into sensations such as pain or pleasure. Because nerves pass through the spinal cord, conditions such as bone spurs, disc herniation, spondylolysis, thickening of ligaments, and joint cysts that affect the back can also affect nerves and the areas they represent. These conditions can cause areas in the back through which nerves pass to narrow, causing the nerves within to become inflamed. The inflamed nerves send the brain pain signals, which are interpreted as pain in the area to which the nerve corresponds, such as the leg or arm.

Epidural steroid injections can be used to reduce the leg or arm pain that may accompany neck-related or lower back-related conditions. Steroids can be injected into the epidural space (an area within the spine that is close to the inflamed nerve) to decrease the inflammation of the nerve, thereby reducing pain. Local anesthetic may be added to the steroid to have an immediate effect on the pain. It can take anywhere from a few days to a week to feel the full benefits of the steroid, but patients will continue to feel reduced pain and improved function for several months following the injection.

Usually, we use epidural steroid injections to temporarily relieve the patient of their pain while the underlying cause of the pain is treated through physical therapy or other methods.


The term “nerve block” applies to any injection of medication, including local anesthetics, steroids, and opioids, into or around a nerve. A nerve block can be used for a variety of purposes, such as diagnostic, prognostic, therapeutic, and preemptive.

A nerve block may be used diagnostically to determine the source of a patient’s pain. By performing a series of injections to different areas and noting the amount of pain reduction that correlates with each area, a physician can determine where a person’s pain is coming from. The nerve blocks then function prognostically, as well; since the doctor knows what is causing the pain, they are better able to predict the outcome of different treatment methods.

A nerve block may also be used therapeutically to diminish a patient’s pain. For instance, a person may be given a nerve block before a surgery, so that they are unaware of the associated pain. A person may also be given a nerve block to soothe an inflamed nerve that is causing the person to experience pain, or to treat chronic pain that has not been amenable to drugs or other treatments.

Lastly, a nerve block may be used to address pain expected to occur after a surgery, such as the phantom limb pain that often follows an amputation.

When dealing with pain related to a single nerve or group of nerves, nerve blocks have a variety of functions that can help people become manage their pain.


When muscles are constantly tense, they may begin to form knots that can be felt through the skin, called trigger points. Tender to the touch, trigger points may cause  inhibited motion or increased weakness of the muscle they affect. The knots may also negatively affect the nerves surrounding the muscle, causing pain to manifest in other areas of the body. A person is more likely to develop trigger points if they do not exercise regularly, have poor posture, perform repetitive motions, sleep irregularly, or do not maintain balanced levels of vitamins. Additionally, those with myofascial pain syndrome or fibromyalgia are more likely to have trigger points.

Trigger point injections are highly effective when it comes to relieving the pain associated with tensed muscles. A needle is inserted into the trigger point, and a local anesthetic and/or steroid is shot into the area. The injection helps to relax the muscle, decrease pain, and improve motion in related areas. When combined with other treatments, such as therapeutic stretching of the tense area, trigger point injections can help to provide long-term relief.


Joint and nerve injections are commonly used for both diagnostic and therapeutic purposes. When applied diagnostically, joint and nerve injections consist of a local anesthetic that is given to different areas in the body that could be causing the pain. By paying attention to whether the patient experiences a decrease in pain when an area is injected, the doctor can estimate the amount of culpability that area holds for the pain. When used therapeutically, joint and nerve injections typically consist of both local anesthetic and a steroid geared toward reducing pain or inflammation of the targeted joint or nerve. The inflammation, which can be caused by a variety of conditions, usually causes intense pain at the site of the inflammation or in associated areas. The steroid contained in therapeutic joint and nerve injections is shot into or around the inflamed joint or nerve, causing the inflammation to subside and diminishing the pain.

Preferred Pain Management is committed to offering the most effective and technologically advanced techniques for administering injections, so many of our joint and nerve injections are directed by ultrasound. When ultrasound technology is used, the doctor is able to visualize the exact position of the needle, as well as the exact location of the targeted joint or nerve, allowing for a significant increase in accuracy. Additionally, the greater visibility and accuracy allow for a smaller needle to be used, which means less discomfort for the patient. Furthermore, unlike when CTs or other imaging methods are used to guide injections, costly and sometimes detrimental ionizing radiation is not used.


Chronic pain can be difficult to bear. Sometimes, it is necessary to enlist the help of medications when battling chronic, or sometimes even acute, pain. Yet, there are so many types of medicine directed at relieving pain, it can be overwhelming to try to figure out which is most appropriate given a person’s health history and individual needs. The staff of Preferred Pain Management is trained to determine whether medication is an appropriate response to your pain and to help you identify what medicine will work best for you.

Some of the most commonly used pain medicines are described below.

Acetaminophen/Paracetamol (better known as Tylenol)- Acetaminophen can be effective for reducing mild or moderate pain that is not caused by inflammation, as acetaminophen does not have any anti-inflammatory properties. Though it is an over-the-counter drug, caution must still be exercised when ingesting acetaminophen, as it may cause liver damage or may have other serious side-effects if used unsafely with other medicines.

Non-Steroid Anti-Inflammatory Drugs (NSAIDs)- In contrast, non-steroid anti-inflammatory drugs, or NSAIDs, can help reduce pain by reducing inflammation and swelling. They can be particularly useful when treating cramps, arthritis, and muscle strains, though should not be consumed regularly or without first speaking to a doctor, as stomach problems may follow overuse.

Muscle Relaxants- Muscle relaxants are often used to address chronic pain conditions that result in muscle spasms or acute muscle problems. As with any other drug, side-effects may persist if used improperly.

Corticosteroids- Corticosteroids can help reduce inflammation and can effect positive change on the underlying condition causing pain. When intense pain strikes, corticosteroids may also be used to subdue the pain. They may be swallowed or injected.

Local Anesthetic- Often used with corticosteroids, local anesthetic may supply patients with a brief respite from pain until other treatments such as steroids kick in. Local anesthetic can enter the body through patches on the skin or injection.

Anti-Convulsants- Anti-covulsants can be used to treat fibromyalgia and pain that results from nerves. By altering or reducing signals sent from nerves to the brain, anti-convulsants can greatly reduce pain. Because anti-convulsants effect change on the central nervous system, it is important not to combine them with other drugs or substances that affect the central nervous system.

Narcotics- Narcotics are often used to diminish chronic or powerful pain. It is imperative that those consuming narcotics are aware of the ease with which a person can become addicted to narcotics and are aware of the high likelihood that they will develop a tolerance for their medicine.


Chronic pain felt in the lower back or neck and pain that results from arthritic joints or nerve-related conditions may be amenable to radiofrequency ablation, even if other treatment techniques, such as nerve blocks, have been ineffective. Radiofrequency is an option for most people with relevant conditions, as long as they do not have an infection at the time of treatment and as long as they are not pregnant.

Before radiofrequency ablation is performed, diagnostic techniques (usually nerve blocks) are used to determine the exact location of the pain generator. During radiofrequency ablation, the patient is given local anesthetic and intravenous (IV) medicine to minimize discomfort. X-ray technology is then used to guide a needle into the area causing the pain. A small electrode is then inserted through the needle, through which a radiowave is produced that sends an electric current through the problematic area. The electric current heats up nerve tissue in the designated area, causing enough damage to moderately inhibit any pain signals sent to the brain from that area. The patient does not experience pain while the electric current is affecting the nerve tissue.

Pain relief typically lasts longer than that achieved with injections, prolonging relief anywhere from four to twelve months.


Sometimes, all attempts at treating back and extremity pain- from the minimally-invasive to the maximally-invasive, from physical therapy to spine surgery- can be exhausted with negligible positive results for the patient. Fortunately, even after that happens, there is another technique that has proved effective for people who have not previously had any luck. This technique is called spinal cord stimulation.

Spinal cord stimulation involves implanting a generator and a number of leads, or electrical wires. Once implanted, the generator, at the command of the patient, produces an electrical current that travels through the leads, blocking pain signals to the brain. The staff at Preferred Pain Management trains patients on how to used the spinal cord stimulator at varying intensities, in order to use the equipment optimally and achieve the greatest possible pain relief.

One unique benefit of spinal cord stimulation is that the device can be temporarily implanted to determine whether or not the patient will derive any benefits from the system. If the patient finds that spinal cord stimulation is ineffective for them, then the device can be removed without exacting any long-term damage. If, on the other hand, the patient obtains marked pain relief from the stimulator, then the temporary device is removed and a more permanent stimulator is implanted.

There is a wide variety of types of spinal cord stimulators, so the patient has options when determining what is best for them, given their particular needs and condition.

Though the basic concept of spinal cord stimulation is similar to another stimulation technique, called transcutaneous electrical nerve stimulation (TENS), there are a few major differences. First, with TENS, the stimulators remain on the skin, whereas with spinal cord stimulation, the stimulators are implanted within the body. Additionally, spinal cord stimulation operates primarily on the spine, whereas TENS deals more with the nerves and only part of the spine.


Transcutaneous Electrical Nerve Stimulation, or TENS, can help to relieve a wide variety of pain, including low back pain, myofascial (muscle related) pain, neurogenic (arising from the nervous system) pain, visceral pain (for example, pain resulting from irritable bowel syndrome), postsurgical pain, and joint pain (for example, bursitis or arthritis). It can be effective for both chronic and acute forms of pain, so long as the pain is not severe.

TENS uses a generator and two electrodes to send an electrical current through part of the nervous system. The electrodes are placed strategically on the skin of the patient, either over the area causing pain or in a related area that can be identified by a doctor. The generator is activated to produce the electrical current that is sent through the electrodes into the nervous system. The electrical current then stimulates an increase in the activity of endorphins, our bodies’ natural pain fighters. It also is thought to block the path of pain signals heading to the thalamus and cortex, the two parts of the brain that enable us to perceive painful sensations. If the signals from the nerves fail to reach the brain, as they do when TENS is operating, pain cannot be felt in the area targeted by the electrical current.

Typically, a one hour trial period of TENS is implemented in-office to ensure that the patient experiences pain relief from the system before they are supplied with one. If the trial is successful, the doctor trains the patient in how to adjust the settings of their stimulator. The amplitude (strength), duration, and frequency of the electrical current are at the command of the patient. In this way, TENS is a dynamic treatment option for patients, who can adjust their treatment according to their particular needs and lifestyle in order to achieve optimal results. Additionally, once the patient has been trained in how to use TENS, they can operate the system at home, at their convenience.

TENS tends to produce rapid relief. More than half of patients usually experience pain relief within the first half hour of stimulation, while almost all of the remaining patients feel their pain subside within an hour of stimulation. As with any other treatment, it is important to consult with the doctor about the proper use of TENS to help avoid negative side-effects, such as skin irritation.

Though the basic concept of TENS is similar to another stimulation technique, called spinal cord stimulation, there are a few major differences. First, with TENS, the stimulators remain on the skin, whereas with spinal cord stimulation, the stimulators are implanted within the body. Additionally, spinal cord stimulation operates primarily on the spine, whereas TENS deals more with the nerves and only part of the spine.






  1. Ledlie, J.T. and M.B. Renfro, Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits.Spine. 2006. 31(1): p. 57-64,

When a patient is experiencing pain, minimally-invasive therapeutic techniques can be used to try to treat the area that is thought to be causing the pain. However, these techniques can be ineffective if more drastic methods are necessary to fix the problem, or if the pain generator has not been accurately identified. A discography is a diagnostic tool used to gain a better understanding of whether discs are responsible for the pain the patient is feeling and, if so, which disc or discs in particular have become problematic. Once this procedure has been performed, doctors will have a better idea of where the problem is and will be able to more accurately predict the outcome of surgery.

During a discography, the patient is given local anesthetic and a sedative that calms the patient, but does not make them unconscious. A needle is guided via x-ray to a disc in the back. Liquid dye is injected through the needle and into the disc. CT scans are taken that track the movement of the dye. Depending on where the dye goes, the doctors can determine whether the disc is torn, bulged, or scarred. Because it can be difficult to ascertain whether the disc is the primary pain generator solely by its appearance, the patient is also asked to report whether they feel any pain when the liquid enters the disc. This process is repeated for each disc that is suspected to be problematic, based on the patient’s symptoms.

Because spine surgeries are risky and tend to have long recovery times, it is good idea to make sure that the outcome will be worth the risks involved. Diagnostic discography is a useful tool that helps establish what the outcomes of different surgeries will be.


Bracing can be used to help with acute pain, such as pain that results from an injury or surgery, or chronic pain, such as pain that results from a long-term condition. Braces reduce pain and help healing by providing support, stability, and limiting motion to a range of less painful movements. Bracing can be directed towards bones, joints, ligaments, or muscles.

Some patients who may find bracing to be beneficial include those with carpal tunnel syndrome, for whom a wrist brace worn at night or during part of the day can reduce pain and tingling; those suffering from low back pain as a result of degenerative disc disease or spondylolisthesis; those with a muscle strain or sprain; those experience spine-related neck pain, such as what might result from whiplash or a tumor; those with osteoarthritis or a compression fracture; those with rheumatoid arthritis; and those with a spinal cord injury.

In order to avoid the negative health effects that can accompany becoming accustomed to a brace, it is important to follow the doctor’s instructions pertaining to how and when a brace should be worn.






How it works






Prolotherapy techniques

Hackett-Hemwall Dextrose Prolotherapy



Platelet Rich Plasma Prolotherapy




Stem Cell Prolotherapy








  • Bruising in treatment area
  • Increased pain
  • Swelling
  • Stiffness
  • Joint effusion
  • Infection
  • Puncture of lung if treating spine
  • Tendon/ligament injury


RegenerAgeMDWe offer Platelet Rich Plasma Therapy through our regenerative therapies division, RegenerAgeMD. Platelet Rich Plasma Therapy (PRP) is a non-surgical therapy is an injection of a concentrated mixture of the patient’s own blood. PRP injections have been shown to relieve acute and chronic pain and accelerate healing of injured tissues and joints.

Can It Help Me?

Conditions that can be aided by PRP include plantar fasciitis, meniscus tears, osteoarthritis of the spine, hip and knee, ligament sprains, and rotator cuff tears.

Benefit of PRP

The limited blood supply and poor healing properties of ligaments, cartilage and tendons make treatment necessary after injury. Unlike physical therapy or medications that don’t treat the underlying cause of pain, PRP can accelerate the healing process – eliminating the cause of pain.

Collecting the Platelets

The PRP process begins by taking a small sample of the patient’s blood and placing it into Harvest Technologies’ Platelet Concentrate System. The sterile multi-chamber container is spun in a centrifuge to separate the blood into its primary components – platelets and white blood cells, plasma, and red blood cells.

Injecting the Solution

A portion of the plasma is removed. The patient’s concentrated platelets are mixed with the remaining plasma to form a concentrated solution. This platelet rich solution is then injected into and around the injured tissues.

The Body Reacts

The concentrated platelets release many growth factors that help promote a natural immune response. Macrophages – specialized white blood cells – rush in to remove damaged cells and prepare the tissue for healing.

The Healing Begins


Long-term Outcome
