Procedure and Treatment Information
Our medical procedures and treatments aim to provide relief from your specific persistent pain or assist with your diagnosis.
At Sydney Pain Specialists, we perform a range of procedures and offer various treatments. Below is an overview of our key procedures and treatments.
Botox or Dysport (Botulinum Toxin type A) is well known for its use in cosmetics, but it is also used to treat movement disorders and pain. When used for pain management, Botox is designed to stop painful muscle spasms for a period of up to four months.
Bursas are pockets of fluid located around the joints where muscles and tendons glide over the bones. Bursa can become inflamed (bursitis), leading to swelling and pain. Common causes of bursitis are repetitive movements, excessive pressure, or injury. A bursa injection involves the injection of local anaesthetic and steroid into the bursa to reduce the pain.
Coccygeal Nerve Injection
A coccygeal nerve injection involves the injection of local anaesthetic and steroid onto the coccygeal nerve (located over the tailbone) to treat coccygeal pain. This procedure is performed in conjunction with manipulation of the coccyx (tailbone) under sedation.
Coeliac Plexus Block
The coeliac plexus is a bundle of nerves within the abdomen, sometimes referred to as the “solar plexus”. A coeliac plexus block is performed to treat or diagnose pain arising from the upper abdomen, pancreas, or liver.
The epidural space is located between the vertebral column and the dura mater (the outer layer of the spinal canal). It contains spinal nerve roots, which can become irritated and cause pain in the upper and lower limbs. An epidural injection or block is an injection of local anaesthetic and long-lasting steroid into the epidural space. Occasionally, a strong pain killing medication, such as morphine, may also be injected.
Etanercept is a prescription medication that is taken by injection. It is used to treat various inflammatory conditions, such as rheumatoid arthritis. In pain medicine, it may be used to treat sciatica and low back pain caused by spinal nerve root inflammation. It works by neutralising an inflammatory protein (TNF-alpha) released from inflamed discs. By working on the immune system, it helps to reduce inflammation and pain and prevent the spine from getting worse.
Greater Trochanter Block
Trochanter bursitis causes pain around the hip and buttock that radiates down the outside part of the leg. A greater trochanter block involves the injection of local anaesthetic and steroid into the greater trochanter (hip socket). The steroid reduces inflammation, irritation and swelling.
Iliotibial Band Injection
Inflammation of the iliotibial band produces pain when the knee joint is moved, which may be felt on the lower thigh or outside of the knee. An iliotibial band injection involves the injection of local anaesthetic and corticosteroid into the inflamed area to reduce the pain.
Ilioinguinal Nerve Block
The ilioinguinal nerve travels down from the lumbar spine, around the pelvis, and into the groin and pubic areas. This nerve can be damaged by surgery or scar tissue following hernia repair. An ilioinguinal nerve block involves the injection of local anaesthetic and steroid into the ilioinguinal nerve for pain relief or diagnostic purpose.
Intercostal Nerve Block
Intercostal nerve blocks are used to treat unresolved post-thoracotomy pain or pain from herpes zoster (shingles), or to diagnose abdominal pain versus abdominal wall pain.
Local anaesthetic and steroid are injected onto a branch of the intercostal nerve, which is located to the side of the ribs. The steroid (Kenacort) reduces inflammation, irritation and swelling around the intercostal nerve.
Interscalene Nerve Block
An interscalene nerve block involves the injection of local anaesthetic and steroid into the brachial plexus – a group of nerves located in the side of the neck. The steroid reduces inflammation, irritation and swelling around the brachial plexus.
Ketamine is a medication often used in the treatment of neuropathic pain and conditions such as complex regional pain syndrome (CRPS). Ketamine is administered intravenously via a computer operated infusion pump in a hospital-based setting. The aim of a ketamine infusion is to reduce the level of pain and, at the same time, increase sensitivity to analgesia, thus reducing the amount of medications needed for pain management.
A lumbar sympathectomy is an injection procedure performed to block the sympathetic nerves and increase the blood supply to the skin in the leg. This can reduce pain and assist with healing. Phenol is commonly injected and can produce pain relief that may last up to 9 months.
Medial Branch Block
Facet joints are small joints between the vertebrae. If injured, these joints can become the source of persistent neck upper limb, lower limb, or back pain. A medial branch block involves the injection of local anaesthetic, with or without corticosteroid, onto the nerves that supply the facet joints. This procedure may provide pain relief for up to six months.
Occipital Nerve Block
The occipital nerves run from the top of the spinal column up to the back of the scalp. An occipital nerve block involves an injection of local anaesthetic and steroid onto the area of the occipital nerves. This is performed to treat headaches arising from occipital neuralgia, whiplash, injury or tension.
Pamidronate is a medication known as a bisphosphonate. It is used to treat a number of problems affecting bones, such as osteoporosis, Paget’s disease and bones affected by cancer. It may also be used to treat complex regional pain syndrome. Pamidronate is administered intravenously via a computer operated infusion pump in a hospital-based setting.
Percutaneous Electrical Nerve Stimulation (PENS)
PENS therapy is used to treat chronic nerve pain, such as hypersensitivity, neuropathic headache and chronic post-surgical pain. A PENS machine delivers low voltage electrical current to the peripheral nerves via probes placed just under the skin. This desensitises the nerves and therefore provides pain relief.
Piriformis Muscle Injection
The piriformis muscle attaches at the sacrum and greater trochanter (hip socket). A piriformis muscle injection involves the injection of local anaesthetic and either steroid or Botox into the piriformis muscle. The Botox stops the piriformis muscle from spasming and may provide pain relief for a period of up to three months.
Prolotherapy & Autologous Blood Injection
Prolotherapy and autologous blood injections are used to treat connective tissue injuries that have not healed with other treatments. These procedures involve either the injection of local anaesthetic mixed with dextrose, and sometimes your own blood, or simply your own blood, into the soft tissue. This sets off the inflammatory response, which increases the blood supply and flow of nutrients to the tissues. This aids in the healing of the tissues and therefore treats the pain.
When a disc is damaged there is ingrowth of nerves and blood vessels into the centre of the disc, resulting in pain on movement. A provocative discography is a diagnostic procedure. It involves the injection of dye and antibiotic into the intervertebral disc(s) that your pain physician suspects is/are causing your back pain.
Psoas Sheath Block
The iliopsoas muscle is frequently responsible for pain that can radiate from the spine to the hip area, occasionally extending to the buttocks. A psoas sheath block involves the injection of local anaesthetic and steroid (or Kenacort) into the psoas sheath. The aim of the injection is to reduce inflammation, irritation and swelling around the iliopsoas muscle.
Radiofrequency neurotomy procedures are performed to treat pain arising from joints such as facet joint pain, sacroiliac joint pain, as well as certain headaches. Conventional radiofrequency neurotomy involves delivering alternating electrical current to the pain generating nerve via needle electrodes. This generates heat which damages the nerve and stops the pain. Pulsed radiofrequency neurotomy is a newer version of this procedure. Short bursts of electrical current are applied to the nerve, meaning less heat is generated. The nerve is stunned, not destroyed, which provides pain relief.
Root Sleeve Injection
The root of a spinal nerve is the point at which it exits the spine. The roots are found at each spinal disc level. A root sleeve injection involves the injection of local anaesthetic and steroid onto the sleeve encasing the spinal nerve root that is suspected of causing pain. This can be used to diagnose the pain or to treat radicular (spinal nerve) pain and symptoms.
Sacroiliac Joint Injection
The sacroiliac joint links the lower spine and the pelvis. Inflammation of this joint may cause pain in the low back, buttocks, abdomen, groin or legs. A sacroiliac joint injection involves the injection of local anaesthetic and steroid into the sacroiliac joint to relieve the pain.
Stellate Ganglion Block
The stellate ganglion is a bundle of nerve fibres located at the side of the neck (near the voice box) that form the sympathetic chain. A stellate ganglion block involves the injection of local anaesthetic into the ganglion to block the sympathetic nerves. This procedure aims to reduce the pain, swelling, and other symptoms caused by conditions affecting the sympathetic nervous system, such as complex regional pain syndrome and postherpetic neuralgia (shingles pain).
Patients with chronic pain that doesn’t respond to other treatments may benefit from a Spinal Cord Stimulator (SCS), Peripheral Nerve Stimulator (PNS) or Occipital Nerve Stimulator (ONS). Before receiving an implant, you must first undergo a trial procedure. This involves surgical insertion of stimulating leads, either along the spinal cord, or a peripheral nerve, or the occipital nerve. Stimulation testing is conducted in the operating theatre. The leads are connected to an external device that is trialled at home for around 7 – 10 days. The trial enables you to evaluate the effectiveness of the therapy, and, should the trial be successful, allows your doctor to assess your device requirements before you receive an implant.
Suprascapular Nerve Block
The suprascapular nerve is located at the back of the shoulder blade (known as the scapula). It may become compressed for a number of reasons, such as wearing heavy bags or direct injury. A suprascapular nerve block involves the injection of local anaesthetic and steroid onto the suprascapular nerve to reduce inflammation and treat shoulder girdle or joint pain, or for diagnostic purposes.
Transcutaneous Electric Nerve Stimulation (TENS)
TENS is the most common and accessible form of hyper stimulation analgesia. It is a non-invasive technique, useful in both acute and chronic pain, and in both pathophysiological and neuropathic (nerve) pain. It can be used for peripheral nerve disorders, phantom limb pain, spinal cord and spinal root trauma, low back pain, period pain, and muscle and joint pain.
Trigger Point Injection
A trigger point is a sensitive or irritable point in the body that can be a source of pain. These may be found in the skin, ligament and tendon tissue and can result in bands of pain known as referred pain. Causes for trigger point pain may include repetitive strain injuries, stress and muscular conditions, herniated discs, pinched nerves or surgical scars. A trigger point injection involves the injection of local anaesthetic and sometimes steroid into the tender areas or trigger points.
Zoledronic Acid Infusion
Zoledronic acid is a medication known as a bisphosphonate. It is used to treat a number of problems affecting bones, such as osteoporosis, Paget’s disease and bones affected by cancer. It may also be used to treat complex regional pain syndrome. Pamidronate is administered intravenously via a computer operated infusion pump in a hospital-based setting.