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Back Pain Treatment in Bluffton, SC

Charles J Nivens MD PA Spine Medicine

When you come to Dr. Nivens, you will receive complete neck and back pain relief that you won’t find anywhere else. We treat acute or chronic pain in the spine, neck, back, arms or legs. We guarantee a quick and speedy diagnosis to any problem you may have; as well as careful, accurate treatment.  

Types of Procedures

Transforaminal and Interlaminar epidural steroid injections and radiofrequency nerve ablation are non-operative procedures. Therapeutic injections may be considered an adjunct to medication and physical therapy. Injection therapy may help control pain from degenerative disc disease, injury, osteoarthritis and other disorders of the spine/joints. Dr. Nivens strives to relieve and control acute and chronic pain.

Spinal injections will help resolve painful inflammation caused by various spinal disorders. 

Facet Joint Block
Joint inflammation between the spinal bones can cause back pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint.  

Medial Branch Nerve Block
A medial block uses similar medication injected outside the joint space near the nerve that transmits pain from that joint.

Charles J Nivens MD PA Spine Medicine

Transforaminal (TF) Epidural Steroid Injection (ESI)
Pain and discomfort from cervical or lumbar radiculopathy/radiculitis (nerve root pain) may be relieved by a TF ESI. Radiculitis is irritation and inflammation of a nerve root that serves a particular body part (arm, leg). Transforaminal Injection means putting the needle just inside the foramen. The MD is not putting the needle into a nerve or blocking the nerve, he is putting medicine around the nerve.

Interlaminar Epidural Steroid Injections
The epidural space is the space surrounding the membrane that covers the spinal cord and nerve roots. Disorders such as spinal stenosis and herniated disc can cause nerve irritation, inflammation and pain. An epidural injection places anti-inflammatory medication such as steroids into the epidural space. Epidural injections are performed in the cervical, thoracic and lumbar spine.

Charles J Nivens MD PA Spine Medicine

Sacroiliac Joint Injection

The sacroiliac joint is the largest joint of the spine. It is located where the tailbone joins the pelvis. Inflammation of the sacroiliac joint can cause low back and buttock pain. An injection of an anesthetic and steroid may help relieve joint pain.

Radiofrequency Nerve Ablation

Facet joints are one source of back pain. Radiofrequency nerve ablation uses radio waves to produce heat directed at a specific facet joint or SI joint nerve. The heat denatures the sensory nerve and relieves pain. The sensory nerve will regrow, but is commonly not painful.

Fluoroscopic guidance is used to correctly position each needle. The ablation process takes about two minutes. The entire procedure takes about 30 mins-1 hour. 

Musculoskeletal Joint Injections

Pain of various joints (hips,knees, shoulders, elbows etc.) can be due to inflammation of the joint. Steroid injections into the joint space can reduce the pain by reducing the inflammation.

Dorsal Spinal Cord Stimulator

A rechargeable IPG (Implantable pulse generator) is implanted into the patient. The system consists of a generator, leads, a patient programmer, and a charging system. The generator looks and acts much like a pacemaker. By creating tiny electrical pulses, it blocks pain signals before they arrive at the brain, replacing them with a tingling or massaging sensation called paresthesia.

To begin the procedure the patient is given medication to prevent pain, help them relax and make them drowsy. The patient is then positioned on the table on their stomach. Once you are comfortable the leads are implanted. Next, the leads will be attached to the generator. Finally, the generator will be implanted in an area of your body that the patient and physician have decided is acceptable and practical. The entire procedure takes about an hour. 

Patient Restrictions on Spinal Injections for Safety Reasons

  • Allergy to the Drugs to Be Injected
  • Anemia
  • Asthma (Uncontrolled)
  • Bleeding Problems
  • Infection (Currently On Antibiotics)
  • Pregnancy/Breast Feeding (Injections May Be Performed Without the Use of Fluoroscopy – Especially In the First or Second Trimester)
  • Severe Spinal Abnormality

Pre-Test Instructions

  • Stop Blood Thinning Medication (Aggrenox, Plavix, Coumadin) 5 Days Prior.
  • Do Not Take Any Aspirin Products 3 Days Prior.
  • It Is Best To Have Someone Provide Transportation Home.

What to Expect During the Procedure

  • The Procedure Is Performed In A Sterile Setting Similar To An Operating Room.
  • Before Proceeding, The Fluoroscopy C-Arm Is Positioned Over The Patient. Fluoroscopic Guidance Is Used During The Procedure To Guide The Needle Into The Proper Position.
  • The Injection Site Is Cleaned And Draped. Skin Numbing Medication Is Injected Into And Around The Procedure Site.
  • After The Needle Is Placed, An Anesthetic And Steroid Are Injected.
  • The Patient Is Brought To The Recovery Area Where The Medical Staff Continues To Monitor Vital Signs.
  • The Area Around The Injection Site Will Feel Numb.
  • Patients Are Usually Discharged Home When Stable With Written Instructions.
  • Steroids Have Side Effects, Like All Drugs. The Common Ones Are Flushing, Increased Energy, Increased Appetite And Elevated Blood Sugars In Some Diabetics. All Of The Side Effects Are Not Common, But The Side Effects Listed Here Are The Most Common Ones Noted. If You Have Any Questions After The Procedure, Call Dr. Nivens' Office. 

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