A cervical epidural steroid injection (CESI) delivers a corticosteroid and local anesthetic into the epidural space surrounding the spinal cord and nerve roots in the neck. The steroid reduces inflammation around compressed or irritated nerves, while the anesthetic offers immediate temporary relief. Relief typically begins within 3–7 days and can last weeks to months.

Cervical facet joints are small joints on either side of each neck vertebra that guide movement and are a leading cause of chronic neck pain, especially after whiplash. A medial branch block (MBB) numbs the tiny nerves supplying these joints using local anesthetic under x-ray guidance — both diagnosing and temporarily treating the pain. If a block provides significant relief, radiofrequency ablation is then offered for lasting results.

Cervical radiofrequency ablation (RFA) uses precisely controlled radiofrequency energy to heat and temporarily disable the medial branch nerves that transmit pain signals from the cervical facet joints. Because these nerves have no motor function, ablating them causes no weakness or loss of function — only sustained pain relief lasting typically 9–24 months, after which nerves regenerate and the procedure can be repeated.

An occipital nerve block involves injecting local anesthetic and corticosteroid around the greater and/or lesser occipital nerves at the base of the skull. These nerves run from the upper cervical spine to the scalp and are a source of occipital neuralgia, cervicogenic headaches, and some migraines. The block interrupts the pain cycle and reduces nerve inflammation, often providing relief lasting weeks to months.

OnabotulinumtoxinA (Botox) is the only FDA-approved preventive treatment for chronic migraine — defined as 15 or more headache days per month, each lasting 4 or more hours. Injected into specific head and neck muscle groups every 12 weeks, Botox blocks the release of pain neurotransmitters from nerve endings, reducing migraine frequency by an average of 8–9 headache days per month in clinical trials.

The Intracept procedure targets the basivertebral nerve (BVN) — a small nerve inside each vertebral body that carries pain signals from the vertebral endplates, which are the top and bottom surfaces of each vertebra. Endplate inflammation (Modic changes on MRI) is a significant and often underappreciated cause of chronic low back pain. Intracept uses radiofrequency energy to ablate the BVN, eliminating this pain pathway. Clinical trials show lasting, significant improvement in pain and function.

A thoracic epidural steroid injection (TESI) delivers corticosteroid and local anesthetic into the thoracic epidural space — the region surrounding the spinal cord and nerve roots in the mid-back (T1–T12). It is used to treat pain from disc herniations, nerve compression, and post-herpetic neuralgia in the thoracic region, including chest-wall and rib pain from intercostal nerve irritation.

The thoracic facet joints are a significant but often overlooked source of mid-back pain. These small joints stabilize the thoracic spine and can become arthritic or inflamed, causing axial mid-back pain that may radiate around the rib cage. A thoracic medial branch block (MBB) numbs the nerves supplying these joints to diagnose and treat the pain — and if successful, opens the door to radiofrequency ablation for longer-lasting relief.

Thoracic radiofrequency ablation (RFA) uses radiofrequency energy to ablate the medial branch nerves supplying the thoracic facet joints. After two successful diagnostic blocks confirm the facet joints as the pain source, RFA provides lasting relief — typically 12–18 months — by interrupting the pain signal pathway. The procedure has no effect on strength or sensation in the trunk or legs.

Kyphoplasty is a minimally invasive procedure that treats painful vertebral compression fractures (VCFs) — most commonly caused by osteoporosis. A small balloon is first inflated inside the fractured vertebra to restore height and create a cavity, which is then filled with bone cement (polymethylmethacrylate). This stabilizes the fracture, dramatically reduces pain, and can correct spinal deformity. Studies show 90%+ of patients experience significant pain relief within days.

Lumbar discography (provocative discography) is a specialized diagnostic procedure, not a treatment. A small amount of contrast dye is injected into each disc being evaluated. A “positive” response occurs when injection of a specific disc exactly reproduces your familiar, concordant pain — confirming that disc is a pain generator. A control disc with no pain response is used for comparison. Discography is typically performed before intradiscal treatments or spinal surgery to identify the exact disc(s) responsible for pain.

A lumbar epidural steroid injection (LESI) delivers corticosteroid and local anesthetic into the lumbar epidural space — the area surrounding the spinal cord and nerve roots in the lower back. This bathes inflamed nerve roots in anti-inflammatory medication, reducing swelling and pain. LESIs are one of the most commonly performed and evidence-supported procedures in pain medicine, with most patients experiencing significant relief that allows them to participate in rehabilitation and avoid surgery.

Lumbar facet joint injections deliver corticosteroid and local anesthetic directly into the small facet joints of the lumbar spine. These joints guide movement and can become arthritic, inflamed, or injured, producing axial low back pain that may refer into the buttocks or thighs. Facet joint pain accounts for up to 40% of chronic low back pain and is highly treatable with targeted injections.

Lumbar medial branch blocks (MBBs) are the gold-standard diagnostic procedure for facet-mediated low back pain. Local anesthetic is precisely placed at the medial branch nerves — the tiny nerves that carry pain signals from the lumbar facet joints. When the block provides significant relief (≥50–80%), it confirms the facet joints as the pain source and qualifies the patient for radiofrequency ablation — a procedure that can provide over a year of relief.

Lumbar radiofrequency ablation (RFA) is one of the most effective and durable treatments available for facet-mediated low back pain. After two diagnostic medial branch blocks confirm the facet joints as the pain source, radiofrequency energy is used to create a precise thermal lesion on the medial branch nerves, interrupting pain signals for 12–24+ months. Because the procedure targets only sensory nerves with no motor function, there is no effect on strength or movement.

A transforaminal epidural steroid injection (TFESI) — also called a selective nerve root block (SNRB) — delivers medication directly to a specific nerve root as it exits the spine through the foramen (a small opening between vertebrae). Unlike interlaminar ESIs that spread medication broadly, TFESIs target the exact nerve root causing symptoms, providing both highly precise diagnostic information and concentrated anti-inflammatory treatment at the exact pain source.

The sacroiliac (SI) joints connect the sacrum (base of the spine) to the iliac bones of the pelvis, transmitting forces between the upper body and legs. SI joint dysfunction is a surprisingly common and frequently missed cause of chronic low back and buttock pain, responsible for 15–25% of chronic low back pain cases. An SI joint injection delivers corticosteroid and local anesthetic precisely into the joint under fluoroscopic or CT guidance.

Sacroiliac joint radiofrequency ablation (RFA) uses radiofrequency energy to interrupt the lateral branch nerves that supply the SI joint. Because the SI joint has a complex, multi-nerve supply (from L4 to S3 lateral branches), specialized cooled-RF or multi-tined electrodes are used to ensure adequate coverage. Following successful diagnostic SI joint injections, RFA provides relief typically lasting 9–18 months and can be repeated as needed.

A caudal epidural injection accesses the epidural space through the sacral hiatus — a naturally occurring opening at the base of the sacrum (tailbone). This approach is particularly useful for patients with prior lumbar spine surgery where scar tissue makes standard epidural entry difficult, or for those with significant lumbar stenosis or multilevel disease. A larger volume of medication bathes the lower lumbar and sacral nerve roots.

Peripheral nerve and joint injections use ultrasound or fluoroscopic guidance to deliver medication precisely into painful joints, bursae, or around peripheral nerves throughout the body. Ultrasound guidance dramatically improves accuracy over landmark-based injections — increasing successful intra-articular placement from ~65% (blind) to over 95% (ultrasound-guided) for joints like the hip and shoulder. Medications used include corticosteroids, hyaluronic acid (viscosupplementation), and platelet-rich plasma (PRP).

Genicular nerve blocks and radiofrequency ablation (RFA) target the sensory nerves supplying the knee joint — specifically the superior medial, superior lateral, and inferior medial genicular nerves — without affecting knee strength or stability. This approach is particularly valuable for patients with knee osteoarthritis who are not yet ready for or do not want knee replacement surgery. RFA of the genicular nerves can provide 6–12+ months of meaningful knee pain relief.

Carpal tunnel injections deliver corticosteroid directly into the carpal tunnel — the narrow passageway in the wrist through which the median nerve travels. The corticosteroid reduces swelling of the tendons and synovial tissue within the tunnel, relieving pressure on the median nerve. Performed with ultrasound guidance, the injection is highly accurate and significantly more effective than blind injection, often providing 3–12 months of relief and helping many patients avoid surgery.

Sympathetic nerve blocks target the sympathetic ganglia — clusters of nerve cells that regulate blood flow, sweating, and pain processing in the limbs. In conditions like Complex Regional Pain Syndrome (CRPS) and certain cases of peripheral vascular disease, the sympathetic nervous system becomes dysregulated and drives severe, burning pain. A stellate ganglion block treats upper extremity symptoms; a lumbar sympathetic block treats lower extremity symptoms. These blocks can interrupt the pain cycle and provide both diagnostic and therapeutic benefit.

Groin and pelvic peripheral nerve blocks target specific nerves responsible for chronic pelvic, groin, and genital pain that is often challenging to treat with conventional therapies. These include the ilioinguinal nerve (inner groin/scrotum/labia), iliohypogastric nerve (lower abdominal wall), genitofemoral nerve (genitals/upper inner thigh), and pudendal nerve (perineum/genitals/anus). Ultrasound-guided delivery ensures precise, accurate placement with minimal discomfort.

Trigger points are hyperirritable spots within taut bands of skeletal muscle that cause localized pain and refer pain to distant sites in predictable patterns. They are a primary cause of myofascial pain syndrome and commonly coexist with other pain conditions. Trigger point injections (TPIs) deliver local anesthetic (with or without corticosteroid) directly into these tender muscle knots, disrupting the pain cycle and promoting muscle relaxation. For refractory trigger points, botulinum toxin (Botox) provides longer-lasting relief.

The ganglion impar (also called the ganglion of Walther) is a single sympathetic ganglion located at the junction of the sacrum and coccyx (tailbone). It receives pain signals from the perineum, distal rectum, anus, vagina, and distal urethra. A ganglion impar block delivers local anesthetic and/or corticosteroid to this ganglion, interrupting sympathetically-mediated perineal and tailbone pain. It is a highly effective, underutilized treatment for a challenging and often overlooked group of pain conditions.

Spinal cord stimulation (SCS) is an advanced neuromodulation therapy that uses mild electrical impulses delivered via thin electrodes in the epidural space to modify pain signal processing at the spinal cord level. Unlike treatments that target the source of pain, SCS changes how the nervous system perceives pain — essentially disrupting the transmission of pain signals before they reach the brain. Modern SCS systems use high-frequency, burst, and closed-loop programming that eliminates the “tingling” sensation of older systems, providing natural pain relief.

Spasticity is a condition of involuntary muscle stiffness, spasms, and overactivity caused by damage to the brain or spinal cord’s motor control pathways. It affects millions of people with stroke, multiple sclerosis, cerebral palsy, spinal cord injury, and traumatic brain injury. OnabotulinumtoxinA (Botox) injected into specific spastic muscles temporarily reduces their overactivity by blocking the nerve-muscle junction, improving movement, reducing pain, and making rehabilitation more effective — without causing weakness in non-targeted muscles.