Definition of Interventional Pain Management and Nerve Block Services

1. Diagnostic and therapeutic nerve block service.
2. Objective assessment of physiological mechanisms and location underlying a patient's pain.
3. Diagnosis of pathways by which pain is transmitted.
4. Review current drug therapy and suggest alternatives or modifications.
5. Review and/or order further investigations (lab, radiographic, electrodiagnostic, MRI scans etc.)
6. Initiate further consultation with clinical sub-specialties if required (eg. physician or therapist).
7. Diagnostic and Therapeutic Surgical Procedures:
   • Facet blocks (intra-articular or medical branch nerve block)
   • Epidural blocks (translaminar or transforaminal)
   • Epidural neuroplasty (translaminar or transforaminal)
   • Myofascial pain (trigger point injection, Botox A or prolotherapy)
   • Herpes Zoster and postherpetic neuralgia
   • Complex Regional Pain Syndromes (RSD and Causalgia)
   • Pain due to trauma or malignancy
   • Radiofrequency neurotomy or pulse radiofrequency modulation
   • Cryoablation
8. Evaluation for implantable technologies
   • SCS (Spinal Cord Stimulator)
   • DIS (Drug Infusion Systems)
   • Epidural Systems
   • Intrathecal/Spinal systems

Why do I need a Pain Block (nerve block)?

A pain or nerve block is a method by which pain can be controlled through the use of a local anaesthetic very similar to a "dental freezing" it is possible to provide a numbing effect to the painful area. The injection may in itself cause some discomfort during the injection and is no different from the expected discomfort after having received "dental freezing". By and large, the pain block is not particularly painful during the first two to six hours after it has taken. After the freezing has worn off, one can experience some discomfort for a period of hours to a few days. In many instances such as chronic pain, the painful site and accompanying nerve pathways are sensitized so that it is not unusual for the injection to cause discomfort for a slightly longer period of time than would normally be anticipated.

There are a number of different local anaesthetics all of which have different lengths of time that they produce their numbing effect. With this knowledge, it is possible to sort out the characteristics of the pain causing structures and to calculate the most reasonable sites or origins of the pain. At the time of the first visit or consultation, information is taken with respect to the history of the problem, findings on the physical examination and the available imaging or X-ray studies that have been performed. After reviewing this information, there are certain factors that are considered important in the decision to perform a nerve block. One of the most important factors in considering the nerve block is that the discomfort is fairly well localized and accessible through an injection.

Although there are certain side effects of the injection itself, these are uncommon and easily treated. Although uncommon or rare, some of these side effects might include infection, bleeding, prolonged nerve block, nerve damage or allergic reaction. Should the injection inadvertently gain access to an artery, it is possible to experience a brief seizure-like disorder which is self limited and relatively well treated. One of the most common side effects is a simple faint which again is self limited.

It is important to monitor the effects of the nerve block and you keeping a simple diary of how the nerve block influences your pain or more accurately through the use of a specific pain diary can do this. Since each individual patient has different ideas as to what their personal pain diary should be, we believe that a standardized diary is more appropriate and have devised a simple way of monitoring your pain in order that we better understand the effects of the pain or nerve block. You will be provided with this diary and instructed either by the physicians or nursing staff as to how this document should be filled out. If there are any questions, please do not hesitate to call the clinic for clarifications.

We would like to emphasize that the pain or nerve block is not necessarily a permanent solution to your painful condition. Although certain medications can be injected along with the local anesthetic blocks, they may not necessarily result in complete resolution of the pain condition. If there are more permanent methods in treating your pain condition, this will be discussed with you by the physician.