SPINE CARE and
PAIN MANAGEMENT

Board Certified Physicians

Pain Conditions and Terminology

Peripheral Nerve Blocks

Iliohypogastric Nerve Block
A nerve block is a diagnosing tool that helps our doctors to know exactly which nerves are causing our patients to feel pain.  Our doctors use a live x-ray-type machine (flouroscopy) to see the patients’ bone structures.  They are often able to tell, based on the patients’ description, the general area where the pain is being generated.  Our physicians select the nerve that is likely the cause of the pain.  That nerve is temporarily numbed with lidocaine (the same numbing medication dentists use).

If the patient feels relief for a few hours before the lidocaine effects wear off, then the doctor can likely conclude that the pain generating nerve has been correctly identified.  This process is repeated another time, just to assure that the pain relief was not a placebo effect.  After two successful nerve blocks, our physicians educate our patients and move on to a more permanent treatment that will likely produce pain relief for 12-24 months—radio frequency lesioning.

Ilioinguinal Nerve Neurolysis
Neurolysis refers to the breaking down or destruction of nerve tissue—especially as the result of a disease. The ilioinguinal nerve is a branch of the first lumbar nerve that is distributed to the muscles of the anterolateral wall of the abdomen, to the skin of the proximal and medial part of the thigh, and to the base of the penis and the scrotum in the male or the mons veneris and labia majora in the female. Thus Ilioinguinal nerve nuerolysis is the destruction of such nerve via chemical (via phenol) or electromagnetic (radiofrequency) means to alleviate pain in such area.

Ilioinguinal Nerve Phenol Injection
The ilioinguinal nerve is a branch of the first lumbar nerve that is distributed to the muscles of the anterolateral wall of the abdomen, to the skin of the proximal and medial part of the thigh, and to the base of the penis and the scrotum in the male or the mons veneris and labia majora in the female.

Sometimes, after hernia surgery, patients can develop a burning pain in the distribution of this nerve that is constant and does not heal.  This injection is then used to treat the pain.

Ilioinguinal Nerve Radio Frequency
The ilioinguinal nerve is a branch of the first lumbar nerve that is distributed to the muscles of the anterolateral wall of the abdomen, to the skin of the proximal and medial part of the thigh, and to the base of the penis and the scrotum in the male or the mons veneris and labia majora in the female.

After a patient has undergone the proper diagnostic tests (nerve block injections), our doctors educate our patients about radio frequency lesioning—a procedure that typically results in 12-24 months of pain relief.

Using high-frequency radio waves and heat, our physicians pulse the pain generating nerve. Through this process, the pain sensory on the nerve is de-activated. The nerve is still functioning, but there is no more pain. Most insurance companies will cover this treatment at least once a year.

“Many conditions can be treated by simply targeting the painful nerve and treating it with our radio frequency procedures. Thanks to these medical advances, we can offer effective treatments without the risk and recovery time of surgery,’” says Dr. Richard Rosenthal, the medical director of Nexus Paincare.

Ilioinguinal Neuralgia
The ilioinguinal nerve is a branch of the first lumbar nerve that is distributed to the muscles of the anterolateral wall of the abdomen, to the skin of the proximal and medial part of the thigh, and to the base of the penis and the scrotum in the male or the mons veneris and labia majora in the female.

Neuralgia is a painful sensation that extends along the course of one or more nerves.

Meralgia Paresthetica
Meralgia paresthetica refers to the entrapment or pinching of the nerve that supplies feeling to the upper outer part of the thigh. This can be caused by trauma or direct pressure. Patients typically complain of a burning sensation or numbness in the lateral thigh. Oftentimes, this condition simply goes away with time.

Meralgia Paresthetica, was first described in 1878. This condition is considered to be due to either compression or injury to the lateral femoral cutaneous nerve near the anterior superior iliac spine as it passes through or under the ilioinguinal ligament. It is thought that the erect human posture, combined with the course of the lateral femoral cutaneous nerve causes tension, mechanical friction, and irritation of the nerve. These factors contribute to the development of pseudoganglion which is thought to play a role in the pathogenesis of Meralgia Paresthetica.

Lat Fem Cut Nerve Block
This injection helps diagnose and sometimes treat a condition in which a nerve gets pinched in the front of the hip. Patients with thie condition complain of burning pain on the outside of the thigh.

Paresthesias (burning pain) or hypesthesias (numbness and tingling) over the upper outer thigh is the classic presentation of meralgia paresthetica (MP). Often, discomfort can be exacerbated by valsalva maneuvers, or any other activity that increases intra-abdominal pressure. Neurologic symptoms are restricted to sensory changes since the lateral femoral cutaneous nerve does not contain motor fibers. Sensory loss is quite discrete, and it is often possible to clearly demarcate the area of numbness. The patient often rubs the outer thigh when describing the symptoms

For classic MP, conservative therapy may be initiated without the necessity for invasive procedures. The diagnosis can be verified by injecting a small quantity of lidocaine at the point of their intersection or at the point of tenderness. The discomfort should resolve transiently. Nerve conduction studies also help diagnose the condition.

MP is treated with conservative therapy, such as physical therapy, weight reduction to reduce abdominal girth, heat application, and analgesics. Patients should avoid wearing constrictive garments, belts, or braces that impart excessive focal pressure at the inguinal ligament. Patients failing conservative measures are referred to a surgeon for consideration of surgical decompression of the LFCN.

Occipital Neuralgia
Occipital neuralgia is described as a chronic pain in the occipital nerve—located at the back of the head near the base of the skull. This is often the result of an injury. The diagnosis and/or treatment for this condition is an occipital nerve block.

By International Headache Society criteria, occipital neuralgia is relieved by local anesthetic blockade of the involved occipital nerve; thus, the principle indication for occipital block is diagnosis. Another indication is the treatment of chronic occipital neuralgia, often with a series of therapeutic blocks combined with depot corticosteroids. Due to the preservatives included in the steroid, it is believed that a mild degree of neurolysis may result and contribute to the prolongation of pain relief. One must remember that the potential interneuron connections with the upper spinal cord may allow occipital nerve (C2) pain to be referred to the trigeminal distribution; this is due to the proximity of the C2 root to the trigeminal spinal nucleus. Thus, occipital block may relieve pain outside of the typical C2 distribution but within the trigeminal distribution.

Occipital Nerve Block
This treatment is used to provide patients with relief from chronic migraine headache pain that originates in the back of the head. The occipital nerve is located at the back of the head near the base of the skull.

A nerve block is a diagnosing tool that helps our doctors to know exactly which nerves are causing our patients to feel pain. Our doctors use a live x-ray-type machine (flouroscopy) to see the patients’ bone structures. They are often able to tell, based on the patients’ description, the general area where the pain is being generated. Our physicians select the nerve that is likely the cause of the pain. That nerve is temporarily numbed with lidocaine (the same numbing medication dentists use).

If the patient feels relief for a few hours before the lidocaine effects wear off, then the doctor can likely conclude that the pain generating nerve has been correctly identified. This process is repeated another time, just to assure that the pain relief was not a placebo effect. After two successful nerve blocks, our physicians educate our patients and move on to a more permanent treatment that will likely produce pain relief for 12-24 months—radio frequency lesioning.

Auriculotemporal Neuralgia
Neuralgia is a painful sensation that extends along the course of one or more nerves.

The auriculotemporal nerve is part of the mandibular nerve. It passes through the parotid gland and ends in the skin of the temple/scalp. There are communicating branches of the auriculotemporal nerve that send messages to the facial nerves. Headaches and facial related pain may originate in the auriculotemporal nerve.

Therefore, auriculotemporal neuralgia is pain that originates in the auriculotemporal area—headache, face, or jaw pain.

Auriculotemporal Nerve Block
The auriculotemporal nerve is part of the mandibular nerve. It passes through the parotid gland and ends in the skin of the temple/scalp. There are communicating branches of the auriculotemporal nerve that send messages to the facial nerves. Headaches and facial related pain at the temples may originate in the auriculotemporal nerve.

A nerve block is a diagnosing tool that helps our doctors to know exactly which nerves are causing our patients to feel pain. Our doctors use a live x-ray-type machine (flouroscopy) to see the patients’ bone structures. They are often able to tell, based on the patients’ description, the general area where the pain is being generated. Our physicians select the nerve that is likely the cause of the pain. That nerve is temporarily numbed with lidocaine (the same numbing medication dentists use).

If the patient feels relief for a few hours before the lidocaine effects wear off, then the doctor can likely conclude that the pain generating nerve has been correctly identified. This process is repeated another time, just to assure that the pain relief was not a placebo effect. After two successful nerve blocks, our physicians educate our patients and move on to a more permanent treatment that will likely produce pain relief for 12-24 months—radio frequency lesioning.

Auriculotemporal Radio Frequency
The auriculotemporal nerve is part of the mandibular nerve. It passes through the parotid gland and ends in the skin of the temple/scalp. There are communicating branches of the auriculotemporal nerve that send messages to the facial nerves. Headaches and facial related pain may originate in the auriculotemporal nerve.

After a patient has undergone the proper diagnostic tests (nerve block injections), our doctors educate our patients about radio frequency lesioning—a procedure that typically results in 12-24 months of pain relief.

Using high-frequency pulsed radio waves, our physicians pulse the pain generating nerve. Through this process, the chronic pain sensory nerve fibers on the nerve is de-activated. The nerve is still functioning, but there is no more pain. Most insurance companies will cover this treatment at least once a year.

“Many conditions can be treated by simply targeting the painful nerve and treating it with our radio frequency procedures. Thanks to these medical advances, we can offer effective treatments without the risk and recovery time of surgery,’” says Dr. Richard Rosenthal, the medical director of Nexus Paincare.

Suprascapular Nerve Block
Suprascapular refers to the nerve located above the scapula, or shoulder blade. By turning off this nerve, pain from a rotator cuff tear can be eliminated.

A nerve block is a diagnosing tool that helps our doctors to know exactly which nerves are causing our patients to feel pain. Our doctors use a live x-ray-type machine (flouroscopy) to see the patients’ bone structures. They are often able to tell, based on the patients’ description, the general area where the pain is being generated. Our physicians select the nerve that is likely the cause of the pain. That nerve is temporarily numbed with lidocaine (the same numbing medication dentists use).

If the patient feels relief for a few hours before the lidocaine effects wear off, then the doctor can likely conclude that the pain generating nerve has been correctly identified. This process is repeated another time, just to assure that the pain relief was not a placebo effect. After two successful nerve blocks, our physicians educate our patients and move on to a more permanent treatment that will likely produce pain relief for 12-24 months—radio frequency lesioning.

Tibial Neuralgia
The tibial nerve provides sensation to parts of the foot. It can sometimes get damaged and cause a constant burning pain Neuralgia is a painful sensation that extends along the course of one or more nerves.

Ulnar Neuralgia
The ulnar nerve provides sensation to parts of the foot. It can sometimes get damaged and cause a constant burning pain Neuralgia is a painful sensation that extends along the course of one or more nerves.

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