For patients suffering from chronic pain, it may be hard to navigate through all the information. Your pain may have numerous causes and our priority at EuroPainClinics® is not only to find its source but also to get you rid of it using interventional procedures and bring you relief.
To precisely localize the pain, we will proceed with subsequent diagnostic procedures which will help us find the true cause of your pain. Each procedure lasts approximately 15 minutes. The basic diagnostic procedures are:
- Medial branch blocks
Medial branches are very small nerves that make us feel pain coming from the small joints securing the connection of spinal vertebrae – facet joints. We block these nerves by injecting an anesthetic into their proximity to see whether or not they are the source of the pain. This diagnostic procedure is not painful except for the small sting and it may relieve you from pain for a longer period of time.
- Nerve-root block
By injecting a local anesthetic into the proximity of the spinal nerves to see if the nerve is the source of the pain. The active substance also operates against nerve inflammation and can thus alleviate or even eliminate the pain.
- Provocation discography
This procedure is carried out in case the disc is suspected to be the source of the pain. We insert a guiding needle to its periphery and using a syringe, we inject contrast dye into the disc. This will help us see its structure. It will also trigger pain in the patient’s body, which allows them to confirm or disconfirm that this is the kind of pain they suffer from.
Knowing the source of your pain, we will recommend further procedures. Some diagnostic procedures may relieve from pain for a longer period of time. Very often though, a more permanent solution needs to be sought in the form of therapeutic procedures. The most commonly used are:
- Thermal radio-frequency ablation
Thermal radio-frequency ablation, or RF thermal ablation, is a procedure, which, with the use of local anesthetic, utilizes a needle-shaped electrode to apply electric current of the radio frequency to the damaged tissue. The tip is placed alongside the small nerves of the selected location. This creates a relatively high temperature (80-85°C) on the electrode’s isolated tip and the heat destroys the targeted nerve. This interrupts the transmission of the pain from the afflicted joint to the brain (however, this technique does not improve the condition of the joint itself and should be thus complemented with physiotherapy).
- Pulsed radio-frequency
Pulsed radio-frequency uses a needle-shaped electrode to apply electric current to the damaged tissue. However, this technique is different from thermal radio-frequency ablation. The word “pulsed” means the energy is supplied to the electrode intermittently, which allows for keeping the temperature of the electrode low (42-45°C) as opposed to higher temperatures necessary for ablation. Applying the radio-frequency pulses to the nerves blocks the transmission of painful stimuli, thus blocking the sensation of pain. When we apply the electric field of pulsed radio-frequency directly to the nerve, it only affects the part of the nerve responsible for transmitting pain signals.
- Epidural adhesiolysis with a navigable catheter under x-ray control
A special guiding needle is introduced under C-arm x-ray visualization through a natural opening in the sacrum (sacral hiatus), through the intervertebral foramen (natural hole from which the nerve root exits), or between segments in the epidural space. A soft navigable catheter with a movable tip is then introduced through the needle. This catheter is able to reach the affected area very precisely, for example an inflamed spinal nerve. It is used for drug administration, for removing small adhesions, and for diagnosing the spinal canal.
- Epidural adhesiolysis with pulsed radiofrequency (RF) dorsal root ganglion (DRG)
This technology is used to perform single neuromodulation treatment of nerve tissue through pulsed radiofrequency (PRF) in patients with chronic radicular (root) backache. The navigable radiofrequency catheter, Epi Navigator Flex Cath, is a single-pole insertion needle and guide wire. PRF treatment involves the application of mild heat (about 42°C) and an intermittent current to the source of pain: the dorsal root ganglion, or the point of entry or exist of the nerve root. This results in desensitization of the irritated nerve and interrupts the sensation of pain or decreases the perception of its intensity. The main advantage of the innovative Epi Navigator Catheter is its capacity to be manoeuvred to precise points because of its flexibility. The catheter is introduced into the epidural space through the natural anatomic hole in the sacral region (sacral hiatus). Procedures conducted through the Epi Flex Navigator catheter take place under constant radiological imaging guidance. The device also allows for drug administration to the point of pain via its infusion system.
- Intradiscal treatment of disc with posterior denervation (Disc FX)
Disc FX is an innovative system allowing for a safe and effective approach to a damaged disc without injury to the surrounding structures. This method provides an option for those people who have not benefited from conservative treatment, and are not yet ready for major surgery. It is a minimal-access procedure performed on an out-patient basis. Its big advantage is the fact that the patient may go home the same day. The procedure consists of three phases: during the first phase, the disc is punctured with a special needle that functions as a working channel. This needle is used to remove part of the degenerate inner tissue. Then, using a radio-frequency probe, the disc is sealed to minimize the risk of repeated herniation. In the final step, the pathological nerves in the back part of the disc are destroyed with the use of radio-frequency.
A number of minimally invasive procedures are conducted under the expert supervision of EuroPainClinics®. The majority of procedures are performed endoscopically:
Epiduroscopy is an excellent procedure for patients with persistent or new-onset back pain following spinal surgery (FBSS, failed back surgery syndrome). The source of pain is most commonly due to epidural fibrosis (or excess fibrous connective tissue) in the spinal canal, which irritates the spinal root or causes narrowing of the epidural space. The method is effective in patients for whom conventional therapy does not bring about desired results or for those where the pain is unmanageable. A special needle is inserted into the natural opening of the sacrum (into the sacral hiatus) under local anaesthesia and with the assistance of X-Ray visualization. An endoscope is introduced through the needle, and fibrous tissue is removed using laser or radio equency ablation under constant visual guidance. During the procedures, the patient lies, depending on the affected area, on their stomach or on their back. Prior to the procedure itself, a local anesthetic is administered for desensitization of the skin and tissues in the targeted area. All the procedures are performed under radiological, ultrasonic or ultrasonographic guidance.In the case of a narrow spinal canal, a balloon catheter is inserted which will enable its widening and a clear view of the working space. The length of the procedure ranges om 20 to 60 minutes. The patient is under local anaesthesia throughout the procedure.
- Endoscopic Discectomy
Endoscopic discectomy is most commonly performed as a day surgery (outpatient basis), on patients with chronic back pain as a cause of dislocated intervertebral disc/s. Back pain can range om decreased sensation in the limbs to immobility. These patients equently do not benefit om periradicular therapy (PRT) in the long-term, and their MRI findings remain abnormal a er conventional intervention. Under the control of X-Rays, a needle is introduced into the natural anatomical opening in the spine (most o en laterally through the intervertebral foramen) to create a procedural working space. The endoscope, with its set of instruments, is then introduced. The herniated portion of the disc is then removed under constant X-ray guidance. The remaining disc is treated with laser or radio equency (thermoablation) to reduce the risk of recurrence of herniation and to eliminate pathological neural structures that may cause pain. The procedure duration is between 40 to 90 minutes. The patient is under local or general anaesthesia. In contrast to classic surgery, minimal damage to muscle and bone structures occurs.
- Endoscopic Rhizotomy
Endoscopic rhizotomy (endoscopic denervation of facet joints) is a procedure, where under the X-ray guidance of a C-arm, an endoscope is placed in the area of the medial branch of the spinal nerve. Subsequently, the tissue around the medial branch is visualized through the endoscope. Under this visual guidance, we dissect the tissue with a sterile grasper to let us visualize the nerve structure. In the end, the medial branch is coagulated with a radiofrequency probe under the direct visualization of an endoscope. The procedure is finished by removing the endoscope and closing up the incision with 1-2 sutures.