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Head and Face

Migraine Treatment

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).

Pain Management Providers



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. 

Medication Management

Medication Management

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:

  • Non-steroidal anti-inflammatories
  • Anti-depressants
  • Acetaminophens
  • Muscle relaxants
  • Anti-convulsants

Do you prescribe Suboxone ?

Our practice does not offer Suboxone.

Do you require a referral or can I just call to make an appointment?

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.

What happens at the first appointment?

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.

My previous provider said she/he will not prescribe any more medication. What do I do now?

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.

  • Do you prescribe opioid pain medications?

    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.

Other than opioid medications, how could my pain be managed?"

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.

Will my pain get worse if I am very active?

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.

Should I wait for my pain to go away before I go back to activities I used to do?

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.

I want to stop opioids, but I don’t know how, and I’m worried about withdrawal."

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.

I’ve been told that there is a difference between physical dependence and addiction to pain medications, but I don’t understand. Can you explain the difference to me?"

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.

Interventional Procedures

Interventional Procedures

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.




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.

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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.

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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.

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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. 

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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About Your Appointment


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.

Patient Forms

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.

Medical Release

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.

Privacy Policy

Please download and read our privacy policy before your appointment.

Referrals, Co-payments and Deductibles

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.

No Show or Late Fee

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.

After Hours Policy

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.

Prescription Refills

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.

Spine Conditions


 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.


Extremity Pain

Carpal Tunnel Syndrome

Carpal tunnel syndrome happens as a result of a compression of a nerve in the wrist, causing pain, numbness and tingling. If you’re struggling with carpal tunnel syndrome, you may have chronic pain in the wrist and difficulty with wrist mobility. Because carpal tunnel syndrome may worsen if left untreated, it’s important to receive an accurate diagnosis and begin developing a treatment plan as soon as possible. 


Complex Regional Pain 

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. 


Cubital Tunnel Syndrome

Cubital tunnel syndrome is a condition that results from a compression of a nerve in the elbow called the ulnar nerve. This syndrome causes chronic irritation of the “funny bone,” and can result in serious elbow pain and loss of mobility.



Epicondylitis is a condition that is caused by inflammation of the tendons connecting the forearm to the elbow. Often referred to as Tennis or Golfer’s Elbow, it results in pain in one of two places: on the outside (Tennis Elbow, or lateral epicondylitis) or the inside (Golfer’s Elbow, or medial epicondylitis). Those who struggle with tennis elbow or golfer’s elbow can experience chronic pain and a decrease in range of motion, which can make it difficult to play sports or perform daily tasks. 


Rotator Cuff Pain

The group of muscles and tendons that stabilize the shoulder socket are referred to as the rotator cuff. Damage to these tendons may result in stiffness, pain, or loss of mobility in the shoulder. Although this injury is most often caused by direct damage or repetitive overhead motion, it may also be the result of shoulder imbalance. Rotator cuff injuries are common, especially in athletes, but they should be treated as soon as possible.


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.


Cervical, Thoracic, Lumbar, Caudal Epidural Steroid Injections

  •  Caudal - This outpatient procedure is an injection of a steroid-anesthetic medication through an opening in the sacrum. The medication can reduce swelling and inflammation of irritated spinal nerves. The injection takes only a few minutes to complete, and can make a massive difference for patients who are struggling with chronic back pain. 
  • Cervical - This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves. 
  • Thoracic - thoracic epidural steroid injection is an outpatient procedure which the physicians at Cleaver medical group often perform to relieve pain in the upper back. Those who struggle with back pain in the thoracic area -- that is, the area between the shoulders -- often find that steroid injections provide them with much-needed relief from their chronic condition.


Lumbar Injections

Lumbar epidural steroid injection procedures to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions, and lumbar (lower back) conditions are no exception.


Transforaminal Epidural Steroid injection

This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. 


Epidural Lysis of Adhesions

An epidural lysis of adhesions procedure (LOA) is a minimally-invasive method of removing scar tissue in the abdomen or pelvis, which is often a source of chronic pain. Scar tissue can develop for a number of reasons, from surgery to infection.


Cervical, Thoracic, Lumbar Medial Branch Block

The facet joints, found on both sides of the back of the spine, can become painfully irritated or inflamed. A medial branch block injection may help diagnose the source of a patient’s pain but numbing up the nerve that lies adjacent to these joints. 


Radiofrequency Neurotomy/ Ablation

This is a minimally invasive procedure that uses heat from radio waves to treat painful facet joints in your lower back. This procedure is also called radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy.


Sacroiliac Joint injection

A sacroiliac injection is aimed at relieving pain caused by arthritis in the sacroiliac joint where the spine and pelvis meet. The steroid medication can reduce swelling and inflammation in the joint. 


Trigger Point Injections

This outpatient procedure is designed to reduce or relieve the pain of trigger points and myofascial or muscle pain. These small, tender knots can form in muscles or in the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). 

Nerve Blocks

Genicular Nerve Block

This is an injection of anesthetic to the genicular nerves. These are the sensory nerves that transmit pain signals from the knee to the brain. Anesthetizing these nerves can disrupt the pain signals caused by degeneration of the knee. A genicular nerve block can provide temporary pain relief. It may help determine if a patient is a candidate for genicular nerve ablation, which can provide long-term relief using a permanent nerve block for knee pain.


Lumbar Sympathetic Block

This procedure is an injection that numbs branches of nerves in your lower back. It helps doctors find and treat a number of problems linked to these nerves. 


Intercostal Nerve Block

A steroid medication and local anesthetic are injected into the Intercostal nerves, located under each rib, and can help reduce inflammation and alleviate pain.


Stellate Ganglion Block

The stellate ganglion is part of the sympathetic nervous system that is located in your neck, on either side of your voice box. A stellate ganglion block is an injection of medication into these nerves that can help relieve pain in the head, neck, upper arm and upper chest. It also can help increase circulation and blood supply to the arm.


Ganglion Impar Block

A ganglion of impar block is safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain. This injection is a type of sympathetic block that can be used in the treatment of sympathetically-mediated pain, pain secondary to malignancy, neuropathic pain, and post-surgical pain. Candidates for this procedure frequently complain of a vague and poorly localized pain in the “seat” region, which is burning in character and frequently accompanied by sensations of urgency with urination and/or defecation.