Precision-guided procedures that target the exact source of your pain. Our board-certified specialists use fluoroscopic and ultrasound guidance to deliver treatments that are accurate, safe, and effective.
Interventional pain procedures are minimally invasive techniques that directly address the anatomical source of pain. Unlike systemic medications, these targeted treatments deliver relief precisely where it is needed — reducing side effects and improving outcomes. All procedures at Epione Pain Center are performed by fellowship-trained specialists using fluoroscopic or ultrasound imaging guidance.
An epidural steroid injection (ESI) delivers a corticosteroid medication directly into the epidural space — the area surrounding the spinal cord and nerve roots. By reducing inflammation at the source, ESIs can provide significant relief from pain that radiates from the spine into the arms or legs.
The procedure takes 15 to 30 minutes and is performed under fluoroscopic (live X-ray) guidance to ensure the medication is placed precisely in the epidural space. A local anesthetic is used to minimize discomfort. Most patients require a series of up to three injections spaced several weeks apart for optimal benefit. Relief typically begins within a few days and can last for several months, allowing you to engage more fully in physiotherapy and rehabilitation.
Recovery: Most patients return to normal activities within 24 hours. Avoid strenuous activity for 1–2 days following the injection.
Clinical evidence: Transforaminal ESIs achieve 70–80% short-term relief in lumbar radiculopathy. A study published in the Journal of Bone & Joint Surgery (Riew et al.) found that transforaminal ESIs reduced the need for surgery in 71% of patients who were initially surgical candidates. NICE guidelines recommend ESIs as a bridge to rehabilitation for acute and subacute radiculopathy. Relief typically lasts 2–6 weeks, with up to 3–4 injections per year considered safe.
The facet joints are small paired joints running along the back of the spine that provide stability and guide movement. When these joints become inflamed due to arthritis, injury, or degeneration, they can generate significant axial back pain and stiffness.
Facet joint injections serve a dual purpose. A small amount of local anesthetic and corticosteroid is injected directly into the joint under fluoroscopic guidance. If the injection provides meaningful pain relief, this confirms the facet joint as the pain generator — valuable diagnostic information. The corticosteroid then reduces inflammation for sustained therapeutic benefit. Recovery is rapid, with most patients resuming regular activities the same day.
Clinical evidence: Facet arthropathy accounts for an estimated 15–45% of chronic low back pain and 36–67% of chronic neck pain (Manchikanti et al., Pain Physician). Diagnostic medial branch blocks using dual comparative blocks reduce false-positive rates to approximately 10%, making them the gold standard for confirming facet-mediated pain. Short-term therapeutic relief of 1–3 months is reported in 40–60% of patients; the primary value of facet injections is guiding the decision toward radiofrequency ablation for longer-lasting relief.
A nerve block involves injecting a local anesthetic — sometimes combined with a corticosteroid — around a specific nerve or group of nerves to interrupt pain signals being transmitted to the brain. Nerve blocks can be used both to diagnose where pain is coming from and to treat it directly.
Most nerve blocks are performed as outpatient procedures lasting 15 to 30 minutes. The technique, imaging guidance used, and expected duration of relief vary by the specific nerve being targeted. Your specialist will discuss what is most appropriate for your condition at your consultation.
Clinical evidence: Greater occipital nerve blocks show an 85% initial response rate for cervicogenic headache and occipital neuralgia, with benefit lasting 1–3 months (Dilli et al., Headache meta-analysis). Stellate ganglion blocks achieve 40–70% short-term response in CRPS of the upper extremity. Intercostal nerve blocks significantly reduce opioid consumption after thoracic surgery.
Medial branch nerves are small sensory nerves that carry pain signals from the facet joints to the brain. A medial branch block is a diagnostic injection that temporarily numbs these specific nerves to determine whether the facet joints are the true source of your back or neck pain.
Accurate diagnosis is the foundation of effective pain treatment. Because chronic axial back and neck pain can arise from multiple structures, it is essential to confirm the pain source before committing to more definitive therapy. If a medial branch block provides substantial, temporary relief, it confirms the facet joints as the pain generator and identifies you as a strong candidate for radiofrequency ablation (RFA) — a longer-lasting treatment.
The procedure is performed under fluoroscopic guidance and typically takes under 30 minutes. Two separate diagnostic blocks are usually required to confirm the diagnosis before proceeding to RFA. This systematic approach ensures the best possible outcomes from more advanced treatment.
Clinical evidence: The International Spine Intervention Society (ISIS/SIS) recommends dual comparative medial branch blocks as the reference standard for diagnosing facet-mediated pain. Single blocks carry a false-positive rate of 27–63%, while dual blocks reduce this to approximately 10%. When patients are selected through this rigorous process, the subsequent success rate of radiofrequency ablation rises to 60–80%. The procedure itself is very safe, with serious adverse events reported in fewer than 1 in 10,000 cases.
Next step: If you experience significant relief from medial branch blocks, you are likely a strong candidate for radiofrequency ablation — a longer-lasting treatment that can provide 6–18 months of pain relief.
Radiofrequency ablation is one of the most effective long-lasting treatments for chronic facet joint and sacroiliac joint pain. A specialized probe delivers precisely controlled heat energy to the medial branch nerves responsible for transmitting pain signals from the affected joints, creating a small lesion that interrupts those signals.
RFA typically provides pain relief lasting 6 to 18 months. Because nerves can regenerate over time, the procedure may be repeated if pain returns. Many patients find that with each subsequent treatment, the duration of relief extends further. Studies using strict diagnostic selection criteria (dual comparative medial branch blocks with ≥80% relief) report that approximately 60–80% of patients achieve ≥50% pain reduction with RFA. A landmark RCT published in the New England Journal of Medicine (Lord et al.) found median time to return of 50% pain was 263 days for cervical RFA versus 8 days for sham.
The procedure takes 30 to 60 minutes and is performed under fluoroscopic guidance as an outpatient procedure. Local anesthetic minimizes discomfort during the procedure. Some patients experience temporary soreness at the treatment site for a few days; significant pain relief typically develops within 1 to 3 weeks.
Eligibility: Successful medial branch blocks are required before proceeding to RFA. This ensures the best possible outcome from the procedure.
Trigger points are hyperirritable knots within muscle tissue that cause local pain and can refer pain to distant sites. Myofascial pain syndrome — characterized by widespread trigger point activity — can be a significant source of chronic pain that is often overlooked.
A small amount of local anesthetic is injected directly into the trigger point using a fine needle, causing the muscle to relax and releasing the tension responsible for pain. The procedure is performed in-office and takes only minutes. Patients often experience immediate improvement in muscle tightness, with full pain relief developing over the following days. A series of injections may be recommended for persistent myofascial pain.
Clinical evidence: A systematic review of 23 RCTs (Cummings & White, Journal of Electromyography and Kinesiology) found that the mechanical needle disruption itself is the primary therapeutic agent — the nature of the injected substance does not significantly alter outcomes. Success rates of 50–70% are reported for appropriately selected patients with myofascial pain syndrome. Best results are achieved when combined with stretching, physiotherapy, and correction of postural or ergonomic perpetuating factors.
Joint injections deliver therapeutic agents directly into a painful joint to reduce inflammation, relieve pain, and improve mobility. This approach is far more targeted than oral medications and avoids systemic side effects.
Injections are guided by ultrasound where appropriate to ensure precise intra-articular placement and maximize therapeutic benefit.
The procedure takes 10 to 20 minutes and is performed in our clinic. After the area is cleaned and numbed with local anesthetic, the injection is delivered directly into the joint under imaging guidance. Most patients notice improvement within a few days. Corticosteroid injections typically provide 1–3 months of relief; hyaluronic acid may last 3–6 months. You can resume normal activities the same day, though we recommend avoiding high-impact exercise for 48 hours.
Clinical evidence: Intra-articular corticosteroid injections for knee osteoarthritis provide clinically meaningful short-term pain relief in approximately 70% of patients (Jüni et al., Cochrane Database). A 2015 meta-analysis in JAMA confirmed moderate benefit at 1–2 weeks, declining over 3 months. Viscosupplementation with hyaluronic acid shows modest but sustained benefit at 6 months in patients with mild-to-moderate knee OA (Bannuru et al., Annals of Internal Medicine). Ultrasound-guided placement improves accuracy to over 95% compared to 70–80% for landmark-guided injections.
Recovery: Most patients return to normal activities the same day. Temporary soreness at the injection site is common and typically resolves within 24–48 hours. We recommend limiting repetitive corticosteroid injections to 3–4 per joint per year.
The sacroiliac (SI) joints connect the sacrum (base of the spine) to the iliac bones of the pelvis. SI joint dysfunction is a frequently underdiagnosed cause of low back and buttock pain, often confused with discogenic or lumbar facet pain.
Like facet joint injections, SI joint injections serve both to confirm the SI joint as the pain source and to provide therapeutic relief. The injection is performed under fluoroscopic guidance to ensure accurate placement within the joint space. Confirming SI joint involvement through a diagnostic injection is also an important step before considering longer-term interventions such as radiofrequency ablation of the lateral branch nerves.
The procedure takes 15 to 30 minutes. After numbing the skin with local anesthetic, a needle is advanced under fluoroscopic guidance into the SI joint space. A small amount of contrast dye confirms correct placement before a mixture of local anesthetic and corticosteroid is injected. Most patients can go home within 30 minutes and return to normal activities the next day.
Clinical evidence: SI joint dysfunction accounts for an estimated 15–30% of chronic low back pain cases (Sembrano & Polly, Spine Journal). A diagnostic SI joint injection with at least 75% pain relief is the reference standard for confirming SI joint origin. Therapeutic injections provide 1–3 months of relief in approximately 60% of patients (Hansen et al., Pain Physician systematic review). For longer-lasting results, cooled radiofrequency ablation of the lateral branch nerves supplying the SI joint achieves ≥50% pain reduction in 47% of patients at 6 months versus 12% for sham (Patel et al., RCT).
Fluoroscopy-guided: All SI joint injections at Epione are performed under live X-ray guidance to confirm accurate needle placement and maximize safety and efficacy.
Our specialists will review your history, imaging, and symptoms to recommend the most appropriate interventional procedures for your specific condition.
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