The Pain Management Department at Pomona Valley Hospital Medical Center is a specialty outpatient department providing interventional pain management procedures to patients with chronic pain.

Our mission is the relief of chronic pain through intervention. Within that mission we aspire to achieve the goals of providing care based on the patient’s needs, to relieve the physical symptoms associated with chronic pain while maintaining the patient’s level of function, to assist the patient in regaining quality of life, as pain is intimately linked to overall quality of life, and to manage side effects associated with analgesia.

Pain is a major health problem in this country and is the most common symptom that prompts people to seek medical care. It is the second leading cause of medically related work absenteeism, resulting in more than 50 million lost workdays each year. Back pain alone produces chronic disability in approximately one percent of the U.S. population, and another one percent are temporarily disabled by it.

The Pain Management Program is an outpatient program dedicated to the treatment of actual chronic pain through procedural intervention. The nurses are trained in pain management procedures and provide education to patients and family both pre and post procedure.

The Pain Management Department currently allows physicians to perform the most current pain management procedures in an environment especially tailored to their patients.

The procedures performed in this department include epidural analgesia, trigger point injections, nerve blocks, joint injections, botox injections, and pump trials.

Procedures:

Epidural Analgesia: Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Trigger Point Injections: Trigger point injection (TPI) is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched (called a jump sign). The trigger point can trap or irritate surrounding nerves and cause referred pain, pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time.

Nerve blocks: Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain. Occasionally, an imaging study (e.g. MRI) may not clearly show which nerve is causing the pain and an SNRB injection is performed to assist in isolating the source of pain. In addition to its diagnostic function, this type of injection for pain management can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).

The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Flouroscopy (live x-ray) is used to ensure the medication is delivered to the correct location. Following the injection, the steroid also helps reduce inflammation around the nerve root.

Facet injection: The facet joints are paired joints in the back that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.

In cases where the facet joint itself is the pain generator, a facet block injection can be performed to alleviate the pain. Similar to SNRB’s, facet block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.

In a facet block procedure, a physician uses fluoroscopy (live x-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.

Botox: Botulinum toxin injection therapy (also known as "BOTOX® therapy") is used to treat dystonia – a neuromuscular disorder that produces involuntary muscle contractions, or spasm – that affects muscles that control movement in the eyes, neck, face, voice box, or the smooth muscle in the bladder. It is also used to treat Migraine headaches. The goal of the therapy is to reduce muscle spasm and pain.

Pump Trail: After your doctor confirms that you are a candidate for an intrathecal drug delivery system, he or she may decide to perform a screening test (also known as a "trial"). Participation in the trial allows your doctor to evaluate how well the therapy may work for you. The objective of the trial is to determine your response to medication delivered into the intrathecal space.