Medial Branch Blocks
Medial Branch Blocks are a type of diagnostic and therapeutic procedure used to treat and evaluate facet joint pain in the spine. A medial branch block involves the injection of a local anesthetic (and sometimes a steroid) near the medial branch nerves. These nerves provide sensation to the facet joints in the spine, which can cause pain if they become irritated or inflamed. The goal of the block is to temporarily "numb" these nerves and provide pain relief. Medial Branch Blocks are performed in the cervical, thoracic, and lumbar regions of the spine.
Radiofrequency Ablations
If a medial branch block provides good pain relief, a more semi-permanent solution known as radiofrequency ablation (RFA) may be offered.Radiofrequency Ablation (RFA) is a minimally invasive procedure used to reduce pain by using heat generated from radiofrequency waves to destroy the tissue surrounding specific nerves that are transmitting pain signals to the brain. It is commonly used for treating chronic pain conditions, particularly those affecting the spine, joints, and soft tissues. RFA is considered a long-term solution to pain management (often lasting 6–12 months or more) and may be repeated as needed.
Genicular Nerve Block
A Genicular Nerve Block is a minimally invasive procedure used to treat knee pain, particularly pain that arises from osteoarthritis (OA), inflammation, or other joint-related conditions. The procedure targets the genicular nerves, which are sensory nerves that provide pain sensation to the knee joint. By blocking these nerves, the procedure can provide significant pain relief. It can also serve as a diagnostic tool to identify the genicular nerves as the source of pain. For those who experience significant relief, the procedure can lead to further treatment options, such as radiofrequency ablation, for more long-term pain management.
Genicular Radiofrequency Ablations
Genicular Radiofrequency Ablation (RFA) is a minimally invasive procedure used to provide long-term pain relief for patients suffering from chronic knee pain, particularly pain associated with osteoarthritis (OA), inflammation, or joint degeneration. The procedure involves using radiofrequency (RF) energy to target and destroy the genicular nerves that are transmitting pain signals from the knee joint to the brain. By disrupting these nerve signals, genicular RFA helps alleviate pain and improve function in the knee.
Lumbar Sympathetic Block
A Lumbar Sympathetic Block is a medical procedure used to treat certain types of chronic pain conditions that are related to the sympathetic nervous system in the lower back and legs. The procedure involves injecting a local anesthetic, sometimes combined with a steroid, near the sympathetic nerves in the lumbar (lower back) region to block pain signals and reduce inflammation. This can provide relief for conditions such as complex regional pain syndrome (CRPS), vascular disease, and certain types of chronic lower back pain.
Intercostal Nerve Block
An Intercostal Nerve Block is a medical procedure in which an anesthetic (and sometimes a steroid) is injected near the intercostal nerves, which are the nerves that run between the ribs. This block is primarily used to treat pain that originates from the chest or rib cage area, including conditions such as rib fractures, post-surgical pain, and certain types of chronic pain syndromes. By blocking the intercostal nerves, this procedure helps to interrupt pain signals from the chest wall and provides pain relief.
Stellate Ganglion Block
A Stellate Ganglion Block (SGB) is a procedure used to treat various types of chronic pain and certain autonomic dysfunctions by targeting the stellate ganglion, which is a collection of nerves located in the neck usually near C6 and C7 vertebrae. By injecting a local anesthetic (sometimes with steroids) into or near this ganglion, the procedure helps block nerve signals, providing relief for specific conditions that involve sympathetic nerve dysfunction.
Cluneal Nerve Block
A Cluneal Nerve Block is a medical procedure used to provide pain relief by targeting the cluneal nerves, which are sensory nerves that supply sensation to the skin in the lower back, hips, and upper thighs. The cluneal nerves can sometimes become irritated or compressed, leading to pain or discomfort in these areas. The procedure involves injecting a local anesthetic, and sometimes a steroid, around the cluneal nerve to block pain signals and provide relief from conditions that cause pain in these regions.
Transversus Abdominis Plane (TAP) Block
The TAP block involves the injection of a local anesthetic into the transversus abdominis plane, a potential space between the transversus abdominis muscle and the internal oblique muscle. Ultrasound is commonly used for real-time visualization of the needle placement to ensure that the anesthetic is deposited in the correct space. By blocking these nerves, the TAP block provides analgesia to the abdominal wall, reducing pain. Indications for a TAP Block are abdominal surgeries, trauma, and chronic pain.
Femoral Cutaneous Nerve Block
A Femoral Cutaneous Nerve Block is a regional anesthesia technique that targets the femoral cutaneous nerve, a sensory nerve that provides sensation to the skin over the anterior (front) and medial (inner) aspects of the thigh. This block is typically used for pain management in various medical conditions or procedures involving the thigh area. Indications for a femoral cutaneous nerve block are post-operative pain management after surgeries, chronic pain, trauma, and diagnostic purposes.
Sphenopalatine Ganglion Block
The sphenopalatine ganglion block (nasal approach) is a highly effective, non-invasive procedure used to treat a variety of headaches and facial pain syndromes, such as cluster headaches and migraines. It provides rapid relief with minimal side effects, making it a valuable treatment option for patients who suffer from severe, recurrent pain.
Ganglion Impar Block
The Ganglion Impar block is a medical procedure used to treat pelvic pain that arises from the perineal region and pelvic organs. By blocking the ganglion impar, the procedure can help alleviate pain related to various conditions that affect the pelvic region, such as chronic pelvic pain, perineal pain, cancer pain, or pain related to conditions like hemorrhoids and prostatitis.
A migraine headache is a form of a headache that is often severe and accompanied by other symptoms such as sensitivity to light and sound and nausea or vomiting. At times, a migraine is described as an intense throbbing or pulsing pain. It is common for a migraine to be felt on only one side of the head.
Trigeminal Neurolagia
Trigeminal Neuralgia is due to irritation of the trigeminal nerve located on the face. This condition causes brief, but extreme episodes of shooting pain. If you’re suffering from severe, chronic pain of this category due to trigeminal neuralgia and seeking relief, the pain specialists at Cleaver Medical Group can help.
Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements. The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia) or all parts of your body (general dystonia).
Formerly referred to as Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by severe burning pain, most often affecting one or more of the extremities. CRPS most often occurs after an injury or severe physical strain such as a stroke or heart attack. If you’re struggling with CRPS following one of these events, there is help.
Suprascapular Pain and Neuropathy
Suprascapular neuropathy is caused by a compression of the suprascapular nerve, a motor nerve that controls two of the main muscles in the shoulder blade. This condition results in shoulder instability, which can make it difficult to perform simple tasks and live life the way you enjoy it. If left untreated, suprascapular neuropathy can lead to more severe problems.
Hip, Knee, Shoulder Osteoarthritis
Osteoarthritis, also known as OA or degenerative joint disease, occurs when the cartilage that is located at the end of the bone begins to wear down. This form of chronic arthritis is one of the most common conditions of the joints and can appear in any joint, although it is commonly found in the knee, hips, lower back, neck, and smaller joints of the fingers and toes.
Peripheral Neuropathy
Neuropathy is severe pain that is the result of a damaged nerve. Although it is possible to obtain a damaged nerve anywhere in the body, peripheral neuropathy often affects the feet. The cause of this condition is often unknown, although at times it can be the result of an underlying medical condition; those living with diabetes are particularly susceptible.
Piriformis Syndrome
Piriformis syndrome is a condition caused by irritation of the sciatic nerve. Most patients who are diagnosed with piriformis syndrome experience pain or numbness that radiates the length of the nerve, from the buttocks down through the legs.
Phantom Limb Pain
Phantom limb pain, or PLP, refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, however the pain is real. The onset of this pain most often occurs soon after an amputation procedure has been performed.
Epidural Steroid Injections
An epidural steroid injection (ESI) is a medical procedure in which a corticosteroid (a type of anti-inflammatory medication) is injected into the epidural space of the spine. The epidural space is the area surrounding the spinal cord and nerve roots. The purpose of this injection is to reduce inflammation and swelling, which can help alleviate pain, especially in cases of conditions like herniated discs, spinal stenosis, sciatica, or radiculopathy. This can be done in the cervical, thoracic, lumbar, and caudal regions of the spine.
Sacroiliac Joint injection
A sacroiliac (SI) joint injection is a medical procedure where a local anesthetic and corticosteroid is injected into the sacroiliac joint, located at the junction where the sacrum (the triangular bone at the base of the spine) meets the iliac bones of the pelvis. This joint plays a crucial role in absorbing shock and stabilizing the pelvis. When there's inflammation or dysfunction in the SI joint, it can cause pain in the lower back, buttocks, and legs.
Trigger Point Injections
A trigger point injection (TPI) is a medical procedure used to treat painful areas of muscle tissue known as "trigger points." These are tight knots of muscle fibers that can develop when a muscle is overworked, injured, or stressed. Trigger points can cause localized pain, as well as referred pain (pain felt in other areas of the body). The injection typically contains a combination of a local anesthetic (to relieve pain) and a corticosteroid (to reduce inflammation), and is aimed at relaxing the affected muscle and providing pain relief.
Lumbar Transforaminal Epidural Steroid Injections
A Lumbar Transforaminal Epidural Steroid Injection (TFESI) is a medical procedure used to treat pain in the lower back and legs caused by inflammation around the spinal nerve roots. Transforaminal refers to the method of delivering the medication into the epidural space through a specific path — the foramen, which is the opening where the nerve roots exit the spine. The procedure involves injecting a combination of corticosteroid (to reduce inflammation) and a local anesthetic (to provide immediate pain relief) into the epidural space near the affected nerve root. It’s typically used to treat conditions like lumbar radiculopathy, sciatica, herniated discs, or spinal stenosis.
Platelet-Rich Plasma Injections
Platelet-Rich Plasma (PRP) Injections are a form of regenerative medicine used to promote healing and reduce pain, particularly in musculoskeletal conditions like tendon injuries, arthritis, and soft tissue damage. The treatment involves using a person’s own blood to create a concentrated mixture of platelets, which are rich in growth factors that promote tissue repair and regeneration.
Botox Injections for Migraines
Botox has been FDA-approved for the treatment of chronic migraines in adults who experience headaches for 15 or more days a month, with at least 8 of those days involving migraines. It’s used as a preventive treatment to reduce the frequency and severity of migraines. These injections may prevent the activation of migraine-associated nerves and reduce inflammation around the nerves. Botox is injected into 31 sites around the head and neck every 12 weeks.
Botox Injections for Dystonia
Botox has been shown to be an effective treatment for various forms of dystonia, such as cervical dystonia (also called spasmodic torticollis), blepharospasm (eye twitching), and limb dystonia. Botox works by temporarily paralyzing the overactive muscles responsible for the abnormal movements and postures. By blocking the release of acetylcholine, Botox reduces the muscle contractions that cause the involuntary movements or spasms. This procedure can be performed every 8-12 weeks.
Intra-Articular Steroid Injections
Intra-articular injections are a type of medical procedure in which a substance is injected directly into the joint to relieve pain, reduce inflammation, or promote healing. The injection typically contains a combination of a local anesthetic (to relieve pain) and a corticosteroid (to reduce inflammation). These injections are often used to treat conditions such as osteoarthritis, rheumatoid arthritis, and other joint-related issues. Common joints treated with this injection include: knees, hips, shoulders, elbows, and ankles
Zilretta Knee Injections
Zilretta is an FDA-approved injectable medication used for the treatment of osteoarthritis (OA) pain, specifically for knee osteoarthritis. It is a brand name for triamcinolone acetonide, a type of corticosteroid that is formulated in a way that allows for sustained release. Zilretta provides longer-lasting pain relief compared to traditional steroid injections. This injection can be performed every 12 weeks.
Greater Trochanteric Bursa Injections
A Greater Trochanteric Bursa injection is a medical procedure where medication is injected directly into the bursa located near the greater trochanter of the femur (thigh bone) to relieve pain and inflammation associated with conditions like trochanteric bursitis or other hip-related issues.The injection typically contains a combination of a local anesthetic (to relieve pain) and a corticosteroid (to reduce inflammation).
Miranda Reed Cleaver, D.O. is a Georgia native. She grew up in Chatsworth, Georgia and attended the University of Georgia in Athens. She graduated from the University of Georgia with a Bachelor of Science in Biology in 2006. After college, Dr. Cleaver continued her education and attended medical school at the Philadelphia College of Osteopathic Medicine, Georgia Campus located in Suwanee, Georgia. She then went on to complete her four years of training in Anesthesiology at McLaren Oakland Hospital, part of the Michigan State University Statewide Campus System, in Pontiac, Michigan, a suburb of Detroit. Following the completion of her residency training, Dr. Cleaver then completed her Fellowship in Pain Management at McLaren Oakland Hospital, part of the Michigan State University Statewide Campus System, in Pontiac, Michigan.
During her fellowship training, she performed numerous interventional procedures in all areas of pain management. Once her training was complete, Dr. Cleaver then went on to establish a pain management practice for two hospitals located in Northern Missouri. Despite a thriving practice, Dr. Cleaver always wanted to make it back to her home state, thus inspiring the creation of the Cleaver Medical Group based in Cumming, Georgia. Her professional interests include low back pain, cervical pain, complex regional pain syndrome, thoracic pain, knee and shoulder pain, discogenic pain, osteoarthritis, and spinal cord stimulators.
Her main reason for pursuing a pain management fellowship was to help alleviate the chronic pain and improve the quality of life of many of the patients that she saw in the hospital on a daily basis. She cannot promise a pain free life, but certainly will reduce the overall pain burden, and help improve the patient’s quality of life. Her main goal is to get each and every patient back to their previous daily functioning and activities. She has always been a bulldog at heart, whose main hobbies include spending time with family cheering on the University of Georgia Bulldogs.
Dr. Kress attended Oglethorpe University where he received his bachelor’s degree in Biopsychology and Chemistry. He completed his medical degree at Lincoln Memorial University-DeBusk College of Osteopathic Medicine in 2014 and subsequently completed his Anesthesia Residency and Pain Management Fellowship at Michigan State University McLaren Oakland Hospital.
Clinical interests include:
Medication Management
Interventional Pain Procedures
Liz Sipple, NP-C is a board certified Nurse Practitioner who joined Cleaver Medical Group in November 2017. You might recognize her from all her work in the procedure room. Liz was born in a small town in Vermont, but moved around until she landed in Georgia. She graduated Magna Cum Laude from Brenau University in 2013 with her Bachelor's of Science in Nursing. She later graduated Summa Cum Laude from Brenau University with her Master's of Science Family Nurse Practitioner Degree. Liz has worked a wide variety of places including Medical Surgical hospital units, Short Stay surgical units, and more recently as a provider at an Urgent Care.
Liz enjoys spending time with her husband and family, running, and being outdoors with her two chocolate labs Lucy and Maggie.
Unfortunately all medications can have deleterious side effects on the human body. That is why at Cleaver Medical Group we make every effort possible to optimize treatment of the underlying cause of pain, while minimizing the risks to our patients. Our pain management services are currently offered at our Cumming location.
Chronic pain is pain that has persisted for greater than a three month time period. This type of pain can be related to:
Previous injuries
Underlying medical conditions
Cancerous pain causing damage to the body.
The aim of medication management in the treatment of chronic pain is to provide symptomatic relief and to help progressively increase an individual’s daily level of functioning and activities. Due to advances in modern medicine over the years, there are now many types of safe and effective medications that can help with just this. Medications used depend on the type of chronic pain that each patient is experiencing and can be non-narcotic and narcotic in nature. Some examples of medication classes that are non-narcotic include:
Our practice does not offer Suboxone.
New patients typically need to be referred by a primary care physician or other specialist. If you feel you would benefit from our services, ask your physician for a referral or contact our center and we may be able to assist you in obtaining a referral from your provider.
At this appointment you will meet with one of our practitioners for a comprehensive exam, where a personalized treatment plan will be developed for you.
*Please be aware that our providers do not prescribe controlled substances at your first visit, and any medication refills you need in the meantime would need to be coordinated with your prescriber.
1) Talk with your previous provider about how to safely taper your medications.
2) If you are already out of medication, talk with them about managing withdrawal symptoms.
3) Unfortunately we cannot take over your prescription medications in an urgent situation like this.
Opioids can be part of a treatment regimen, but often certain types of pain are not well treated with them and because of their safety profile they are often not the best option in the long term.
The good news is that medication is only one part of effective pain management. A combination of approaches is often the best way to manage your pain. Our practice uses a multidisciplinary approach to treating pain. The whole focus of multidisciplinary programs is to get people functioning again. One of the drawbacks of long-term opiate use is many people who take these drugs over a long period of time lose physical function. The goal is to restore physical function and to help people learn that chronic pain does not have to prevent them from living a full, active life.
When you have constant pain it seems natural to avoid doing things like walking, bending and moving around as they can make the feeling of pain worse. However our bodies are designed to move. When we decrease activity, we lose muscle strength – over time this means that even simple daily activities can become more difficult. Many people with pain fear exercise as they think it will cause more problems. However, regular stretching and exercise can actually decrease pain and increase your ability to function physically.
It is important to remember that chronic pain is not necessarily associated with ongoing damage to your body. This means that hurt doesn’t necessarily equal harm, and if no ongoing cause for the pain is found, you can slowly increase your physical activity despite a certain level of pain. This gradual approach to activity is called pacing.
Starting to exercise and learning new coping skills are important strategies to help improve your ability to function and reduce the impact of the pain. It is also important not to wait for the pain to be completely gone before starting normal activities, including work.
Withdrawal is a common effect of stopping opioids. It is uncomfortable but not life threatening and there are strategies to minimize this and help treat the symptoms.
Physical dependence occurs with any person that takes narcotics at a certain dose for a time, if the medication is stopped abruptly then there may be withdrawal symptoms such as nausea, diarrhea, feeling shaky and sweaty.
Addiction occurs in susceptible individuals, and there are ways to figure out who may be more susceptible. This may manifest as a craving for the medication and may include escalating dosages and drug seeking behavior.
Pain is an unfortunate part of everyday life for some people and is commonly defined as physical suffering or discomfort caused by an illness or an injury. Pain can be very extensive and multifactorial in nature lending its cause due to previous injury or a variety of underlying medical disorders either cancerous or non-cancerous in character. This is where a Pain Management physician can be of help.
Pain Management physicians can help alleviate daily chronic pain through multiple modalities including, but not limited to, injections and medication management. Each patient is different and therefore each type of pain is different. This is why at Cleaver Medical Group, we believe in a well-balanced and safe approach to effectively help treat and alleviate each patient’s pain. Our pain management services are offered at our Cumming, Dahlonega, and Dawsonville locations.
EPIDURAL INJECTIONS
Patients will find the comfort using an epidural steroid injection, which include a reduction in pain radicular pain. Patients seem to have a quick, better and positive response when the epidural steroid injections are coupled with an organized therapeutic exercise program.
NEUROMODULATION INCLUDING SPINAL CORD STIMULATORS & PUMP REFILLS
Neuromodulation including spinal cord stimulators & pump refills treatments that involve stimulation or administration of medications directly to the body’s nervous system for therapeutic purposes. Neuromodulation can be utilized to treat movement disorders, and epilepsy, as well as pain conditions.
OCCIPITAL/SUPRAORBITAL NERVE INJECTIONS
The supraorbital nerve runs through the bones of the face at the eyebrow, provide sensation to the temple and the acme of the head. The nerve exits the head just higher than the eyes. Supraorbital Nerve Injections obstruct for Migraine and Headache.
SYMPATHETIC NERVE BLOCK
A Sympathetic nerve block usually involves a sequence of injections to relieve pain caused by complex regional pain syndromes, usually after injury to a joint. This nerve block can be used to treat pain relating the nerves of the sympathetic nervous system. If you have pain in the higher part of your body then you may get pain relief from blocking the ganglion in your neck area.
CELIAC/SPLANCHNIC NERVE BLOCKS
The celiac plexus obstruct and the splanchnic nerve block can be used for abdominal soreness that may be caused by exasperation, firmness or setup of the nerve bundles inside various abdominal organs, as well as owing to tumor invasion, fibrosis, or chronic tenderness resultant from chronic pancreatitis disease, along with others.
DIAGNOSTIC NERVE BLOCKS
Nerve blocks are used for pain treatment and administration. A Diagnostic Nerve Block involves deadening a specific nerve or group of nerves that may be concerned in taking a patient’s pain. If a particular pain-carrying nerve is insensitive and a patient notes significant improvement in pain symptoms, the location of the pain generator is likely confirmed.
SACROILIAC JOINT INJECTION
A sacroiliac joint inoculation moreover called a sacroiliac joint block—is largely used either to make a diagnosis or take care of low back pain and/or sciatica symptoms related with sacroiliac joint dysfunction. The sacroiliac joints stretch out subsequently to the spine and unite the sacrum with the hip on both sides.
TRIGGER POINT INJECTIONS
Trigger point injection (TPI) might be an alternative for treating soreness in various patients. TPI is a practice used to treat throbbing areas of muscle that have trigger points, or knots of muscle to facilitate when muscles do not unwind. Numerous times, such knots can be felt below the skin.
MEDIAL BRANCH BLOCKS
Medial branch blocks can be used independently to provide long-term pain relief. They can also be used to precisely identify the facet joints as the cause of pain, and are the preliminary procedure prior to radiofrequency neurotomy of the medial branch nerves. Medial branch blocks have been performed safely for many years with excellent outcomes.
RADIOFREQUENCY ABLATIONS
In Radiofrequency (rhizotomy) ablations procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain. The terms radiofrequency ablation and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy.
CRYOABLATION
According to the Clavien-Dindo classification, five grade II complications and four grade complications occurred. The technical success rate was 94%. Two tumors required a second session of cryoablation because of recurrence or residual tumor.
DISCOGRAM
The indications for getting a discogram prior to a lumbar fusion surgery are extremely variable amongst spine surgeons. Ordering the procedure depends on access to a skilled discographer. A discogram is basically a very subjective test, and if there are no experienced discographers available, then the spine surgeon may forego the test since a poorly done discogram does not yield any useful information.
The Clever medical group health care is providing to be an effective method for controlling chronic pain. A Sympathetic nerve block usually involves a sequence of injections to relieve pain caused by complex regional pain syndromes, usually after injury to a joint. This therapy targets the sympathetic nervous system and series of nerves that extend out from your spine to your body to help control several involuntary body functions, or body functions that you have no control over. These include blood flow, digestion, and sweating.
This nerve block can be used to treat pain relating the nerves of the sympathetic nervous system. If you have pain in the higher part of your body then you may get pain relief from blocking the ganglion in your neck area. If you have pain in the lower part of your body then a ganglion near the lower spine may be embattled with a sympathetic nerve block.
The celiac plexus obstruct and the splanchnic nerve block can be used for abdominal soreness that may be caused by exasperation, firmness or setup of the nerve bundles inside various abdominal organs, as well as owing to tumor invasion, fibrosis, or chronic tenderness resultant from chronic pancreatitis disease, along with others. In scrupulous, soreness endorsed to pancreatic cancer responds especially sound to a celiac plexus obstruction.
The celiac plexus in addition to the splanchnic nerves are the names of the sympathetic nerves occupied in the utility of the abdominal organs. They are a solid cluster of nerve cells and underneath tissue, positioned at the back of the stomach, in the area of the celiac artery immediately lower the diaphragm. Nerve signals to the greater part of abdominal organs run all the way through the celiac plexus and the splanchnic nerves. This includes the pancreas, liver, gallbladder, stomach, small intestine, and the parts of the colon.
Neuromodulation including spinal cord stimulators & pump refills treatments that involve stimulation or administration of medications directly to the body’s nervous system for therapeutic purposes. Neuromodulation can be utilized to treat movement disorders, and epilepsy, as well as pain conditions.
Spinal cord stimulation involves electrical stimulation of the spinal cord to disrupt pain signals from the spinal cord to the brain, and to deal a painful sensation with a more pleasant tingling sensation. Spinal cord stimulation therapy and peripheral nerve field stimulation are related types of electrical stimulation that treat chronic pain. Electrical mild pulses are directed to interrupt pain messages to the brain, reducing the feeling of pain. Nerve stimulation also used to treat epilepsy, is now being applied to treat neuropathic neck pain and regions of neuropathic pain.
Epidural injections are a type of interventional procedure performed in office by Pain Management physicians. These injections are usually done for patients experiencing pain in the neck (cervical), mid/upper back (thoracic), and/or low back (lumbar). These types of pains will sometimes move into the extremities as well causing “radicular pain”. Radicular pain is generally caused by, but not limited to, bulging or herniated discs in the spine. These disc disorders can cause residual nerve compression and/or inflammation to the surrounding nerves. Epidurals can help alleviate the pain caused from these disc disorders by aiding in the relief of surrounding disc inflammation and irritation. Depending on where the patient is experiencing pain is where the injection will be performed. These procedures are also done under fluoroscopic guidance (real time x-ray), which allows the physician to see exactly where the needle is being placed in the spine. This type of imaging modality helps to increase the accuracy and overall pain relief experienced by the patient. For a video that demonstrates a cervical epidural injection, please refer to spine-health’s website and demonstration.
The supraorbital nerve runs through the bones of the face at the eyebrow, provide sensation to the temple and the acme of the head. The nerve exits the head just higher than the eyes. Supraorbital Nerve Injections obstruct for Migraine and Headache. In sustain of patients who occurrence severe headache pain that is contained in the forehead, at or above the eyebrow, and for whom other therapies, together with drugs, have not worked, a supraorbital nerve (SON) block may give reprieve. The headache specialists at the Diamond Headache Clinic have years of knowledge in performing this process. To become skilled at if a supraorbital nerve block might be suggested as component of your individualized headache treatment plan, talk to your general practitioner. Although all doctors who execute this practice use a limited anesthetic, some mix the anesthetic with a corticosteroid. The anesthetic numbs the skin and it also reduces the nerve impulses passing along pain nerves. Corticosteroids are tough anti-inflammatories that may possibly facilitate to put a stop to headache pain for a longer interlude of time.
A sacroiliac joint inoculation moreover called a sacroiliac joint block—is largely used either to make a diagnosis or take care of low back pain and/or sciatica symptoms related with sacroiliac joint dysfunction. The sacroiliac joints stretch out subsequently to the spine and unite the sacrum with the hip on both sides. There are two sacroiliac joints, one lying on the right another one lying on the left. Joint inflammation and/or dysfunction in this part can origin soreness.
The use of a sacroiliac joint injection is double, it’s to identify the cause of a patient’s twinge, and to make available healing pain reprieve. At times, these are alienated and an enduring will go through a with the sole purpose to investigative or therapeutic inoculation, even though frequently the two are combined into one vaccination. The Sacroiliac Joint injection process is generally performed in an operating room or an uncommitted practice room. The complete course of action generally takes only minutes, and the patient goes address the same date.
Nerve blocks are used for pain treatment and administration. A Diagnostic Nerve Block involves deadening a specific nerve or group of nerves that may be concerned in taking a patient’s pain. If a particular pain-carrying nerve is insensitive and a patient notes significant improvement in pain symptoms, the location of the pain generator is likely confirmed. A Diagnostic Nerve Block is used to authenticate the location of the pain initiator and the nerve carrying pain impulses from these painful structures. Once identified, the pain generator can be treated with a variety of interventional treatments including repeated nerve blocks, Radiofrequency Cryotherapy.
We are committed to providing a full pain relief services to our patients with treatments. Diagnostic nerve blocks are used to conclude resource of pain. These blocks normally contain an anesthetic with a known duration of relief.
Trigger point injection (TPI) might be an alternative for treating soreness in various patients. TPI is a practice used to treat throbbing areas of muscle that have trigger points, or knots of muscle to facilitate when muscles do not unwind. Numerous times, such knots can be felt below the skin. Trigger points might exasperate the nerves in the region of them and reason referred pain, or pain that is felt in an additional fraction of the body. In the TPI course of action, a health care specialized inserts a minute needle into the patient’s trigger point. The injection contains a confined anesthetic or saline, and may include a corticosteroid. By means of the injection, the trigger point is completed inactive and the ache is alleviated. Frequently, to the point way of treatment will outcome in continuous relief. Injections are given in a doctor’s workplace and generally acquire in a minute a small amount of minutes. Numerous sites may be injected in one visit. If a patient has an allergy to assured drug, a dry-needle performance (involving no medications) can be used.
In Radiofrequency (rhizotomy) ablations procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain. The terms radiofrequency ablation and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy. Radiofrequency ablation is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
Radiofrequency ablation (RFA), also known as radiofrequency neurotomy or rhizotomy, is one of many pain reducing procedures. It is a non-surgical procedure in which radiofrequency waves are delivered to certain nerves in order to interrupt pain signals to the brain. Sensory nerves, not motor nerves, are targeted. RFA is usually used to treat pain from the facet joints, which can contribute to pain in the neck or lower back, as well as the sacroiliac joints, which can contribute to low back pain. Pain from neck facet joints can radiate to the head, neck, shoulders, shoulder blades and arms.
Medial branch blocks can be used independently to provide long-term pain relief. They can also be used to precisely identify the facet joints as the cause of pain, and are the preliminary procedure prior to radiofrequency neurotomy of the medial branch nerves. The facet joints are the small joints located between each vertebra that provide the spine with both stability and flexibility. Facet syndrome occurs when one or more of these joints become inflamed or irritated.
Medial branch blocks have been performed safely for many years with excellent outcomes. The benefit from this procedure will typically occur several minutes following the procedure. The patient is asked to record pain levels during the first days of the procedure to ensure accurate diagnosis of the facet joints as the pain source. Medial branch blocks in one area are generally limited to three within a six month time frame. In many instances, only one or two injections are required to obtain benefit.
According to the Clavien-Dindo classification, five grade II complications and four grade complications occurred. The technical success rate was 94%. Two tumors required a second session of cryoablation because of recurrence or residual tumor. Twelve months after treatment the overall survival was 96.7%, and the disease-free survival rate was 96.4%, including patients with recurrent genetic tumors. Renal function remained unchanged even in the subgroup of patients with a single kidney.
Midterm follow-up shows that percutaneous renal cryoablation is an effective and safe alternative technique for patients whose condition does not allow surgery and that renal function is preserved. Cryoablation combined with percutaneous thermal protection techniques allows treatment of more complex tumors. The treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) is catheter ablation of the atrioventricular nodal slow pathway. The purpose of this study was to ascertain whether cryoablation (Cryo) with 6-mm-tip catheters is as effective as radiofrequency ablation (RF).
We ask that all new patients and anyone with a change of insurance arrive 30 minutes before your scheduled appointment time. Established patients please arrive 15 minutes before your scheduled appointment time. This will ensure that your check-in process is completed thoroughly and will allow you to maximize your time with the provider.
Please bring a photo ID and current updated insurance card with you to each visit. For your convenience, when you make an appointment over the phone, you will be given the option of creating an online account using our patient portal. Please utilize the patient portal to complete as much information as possible before you arrive. Completing this information on the patient portal will cut down the amount of new patient paperwork that has to be completed.
Please print and complete the New Patient Forms and bring them with you to your appointment. Doing so ahead of your appointment will save you time in our office.
Please print and complete the Medical Release Form and bring it with you to your appointment. Doing so ahead of your appointment will save you time in our office.
Please download and read our privacy policy before your appointment.
If we participate in your insurance plan, we will submit claims for you. All co-pays, cost estimates, deductibles and account balances are due at the time of your visit. If you do not have your co-pay or cost estimate, your appointment will need to be rescheduled. If we do not participate in your insurance plan, payment is expected at the time of service. Any services deemed non-covered and/or applied to your deductible are your responsibility.
Due to the increased cost of health care, it is very important for us to value our time and commitment to all of our patients. Please give us a 24-hour notice if you change your appointment in order to avoid a no-show fee of $50.00. If you “No-Show” a surgery/procedure, we will apply a $250.00 “No-Show” fee to your account. These fees will have to be paid in full before we schedule you for any additional appointments.
If you are having any symptoms suggestive of a life-threatening emergency, please call 911 or go to your nearest emergency room. If you have other non-urgent questions or concerns, please call our office at 770-800-3455 and leave a message. We will return your call the next business day. Non-urgent messages left after 4:00 p.m. on the office voicemail will be returned on the next business day.
Refills will be processed within 24 to 72 business hours of receipt of the request. Refill requests received on Fridays will be processed the following business day.
Below are guidelines regarding medication refills:
For routine refills please leave a voicemail with your name, date of birth, pharmacy name and the pharmacy telephone/fax number.
If you do not follow up regularly in our office, your prescriptions may not be refilled.
No new prescription will be provided over the phone or fax.
The indications for getting a discogram prior to a lumbar fusion surgery are extremely variable amongst spine surgeons. Ordering the procedure depends on access to a skilled discographer. A discogram is basically a very subjective test, and if there are no experienced discographers available, then the spine surgeon may forego the test since a poorly done discogram does not yield any useful information. It should be understood that the discogram is less about the anatomy of the disc (what the disc looks like) and more about its physiology (determining if the disc is painful). It is well known to discographers that a really abnormal looking disc may not be painful and a minimally disrupted disc may be associated with severe pain. It is impossible to definitively diagnose a painful disc without performing a discogram.
The lumbar discogram, if performed properly, is designed to induce pain in a sensitive disc. A spinal fusion procedure that is designed to obliterate an internally disrupted, painful disc (pain generator) would not be the procedure of choice if pressurization of the disc didn’t reproduce the patient’s clinical discomfort. The spine surgeon needs to be absolutely sure that the level or levels being fused are responsible for the patient’s pain.
Coccydynia
Coccydynia is an inflammation of the tip of the tailbone, called the coccyx. If you’re struggling with this condition, you may be experiencing pain and tenderness between the buttocks that can make it difficult to sit or even walk comfortably.
Cervical Neck Pain
Cervicalgia is a term for neck pain and stiffness, which can occur for a wide variety of reasons including poor sleep posture, underlying nerve conditions, and more. If you’re struggling with chronic neck pain and seeking relief, The Physicians can help provide you with an accurate diagnosis that pinpoints the source of your symptoms.
Cervical Radiculopathy
Cervical radiculopathy is an irritation or compression of one or more nerve roots in the cervical spine. Because these nerves travel to the shoulders, arms and hands, an injury in the cervical spine can cause symptoms in these areas. Cervical radiculopathy may result from a variety of problems with the bones and tissues of the cervical spinal column, and can cause serious back pain that interferes with your daily life.
Lumbar Radiculopathy
Lumbar radiculopathy, also known as sciatica, is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.
Degenerative Disc Disease
Degenerative Disc disease is a term used to describe the pain and symptoms from a degenerated disc in the spine. Degeneration of discs occurs naturally with age -- however, this degeneration does not always result in spinal pain. Degenerative disc disease is most commonly found in the cervical spine (neck) or the lumbar spine (lower back). Because degenerative discs become worse over time, it’s important to receive a diagnosis and treatment as soon as possible.
Herniated Disc
A herniated disc is a common injury in which one of the discs in your spine protrudes from its casing, pressing into one of the nerves in the surrounding area. Herniated discs can affect any part of the spine, and they can cause severe pain and other problems in the arms or legs.
Spinal Stenosis
The spinal column contains open spaces that create passageways for the spinal cord and the spinal nerves. Spinal stenosis is a narrowing of (or an intrusion into) these openings. This can cause a compression of the nerves. Spinal stenosis most commonly affects the cervical and lumbar regions of the spine.
Spinal Spondylosis/ Facet Joint Pain
Spinal spondylosis is a term used for the natural wear and tear that occurs in the human spine, which can often result in degeneration that causes pain. Spondylosis is common and can become worse as we get older, especially if it occurs in conjunction with other conditions such as osteoarthritis of the spine.
Facet joint pain describes a deterioration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and are surrounded by a lubricating capsule that enables the vertebrae to bend and twist. If you’re living with facet joint pain, you may experience serious pain and a reduction in your range of motion.
Intercostal Neuralgia
The intercostal nerves are located in the muscles beneath your ribcage. When these nerves are compromised, you may feel sudden pain in the chest, beneath the ribs, or when performing an action like sneezing or coughing. A common cause of this stems from the herpes zoster infection called Shingles.
Sacroiliac Joint Pain
Sacroiliac joint pain, or sacroiliitis, is the term used to describe inflammation of one or both of the sacroiliac joints. The sacroiliac joints are located where the pelvis connects to the lower spine, and are primarily used to absorb shock from the spine. Sacroiliitis most often results in pain in the hips, legs, buttocks and lower back.
Post Laminectomy Syndrome
The term “failed back syndrome” or “post-laminectomy syndrome” is an umbrella term used to describe an unsuccessful operation and does not describe a single syndrome. If you have undergone back surgery and are still experiencing pain, you may be suffering from failed back syndrome (FBS), also known as post-laminectomy syndrome.
Compression Fracture
Compression fractures are tiny cracks in the vertebrae that make up your spine. These usually happen as a result of trauma to your spine; however, they may also present themselves in conjunction with osteoporosis and pathologic fractures. Compression fractures can be extremely painful, and can become worse if left untreated.
Spinal Cord Stimulator
A Spinal Cord Stimulator (SCS) is a medical device used to treat chronic pain, especially when other pain management options, such as medications or surgery, have not provided sufficient relief. It works by delivering low-voltage electrical impulses to the spinal cord through a small implanted device, which helps modify pain signals before they reach the brain, providing relief from pain.
The spinal cord stimulator is particularly effective for neuropathic pain, which is pain caused by nerve damage. It is most commonly used for back pain, leg pain, and pain related to conditions such as failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), ischemic limb pain, and other chronic pain conditions.
Kyphoplasty
Kyphoplasty is a minimally invasive surgical procedure used to treat vertebral compression fractures, which are commonly caused by osteoporosis. The procedure aims to relieve pain, restore vertebral height, and stabilize the spine. Kyphoplasty is typically recommended when the fracture causes significant pain or when conservative treatments like medications or physical therapy are ineffective. It is particularly useful for fractures due to osteoporosis, but it can also be used for fractures caused by tumors or other conditions.
Lumbar Intracept Procedure
The Intracept procedure is a minimally invasive spinal procedure designed to treat chronic low back pain caused by degenerative changes in the spine. Using radiofrequency energy, the procedure selectively targets and ablates (destroys) the basivertebral nerve, which helps reduce pain signals from the vertebra to the brain. It specifically targets pain originating from the vertebrogenic (bone-related) pain in the basivertebral nerve, which is thought to be responsible for pain in the vertebral body of the spine, particularly in the lumbar (lower) spine.
Peripheral Nerve Stimulator
Peripheral nerve stimulation (Sprint System) uses electrical impulses to relieve chronic pain of the effected area. It is believed the electrical pulses can help relieve irritated nerve tissue even after completion of the 60 day treatment period. Evidence demonstrates that even after completion of the treatment period a majority of the patients report continued pain relief.