Treat your pain and live a better life…

best-pain-doctor-nycWelcome to my blog about pain. Unfortunately, many people suffer from chronic pain. As a board certified physician in physical medicine and rehabilitation, my specialty is treating these people with both acute and chronic pain.

A majority of my practice is working with patients that are experiencing back and neck pain.

My goal with this blog is to help patients who are experiencing any type of back or neck pain to understand what is causing their pain and discuss options that are available to end their pain. I hope to be able to provide readers with a portal that they can can use to educate themselves and facilitate treatment.

My specialty is my Interventional Spine Skills including cervical and lumbar epidural steroid injections, facet injections, medial branch blocks, Radiofrequency ablation, sympathetic ganglion blocks, spinal cord stimulator trials, sacroiliac joint injection, piriformis muscle block and musculoskeletal joint injection. I also perform many other procedures to alleviate acute and chronic pain.

I hope you enjoy reading my blog as much as I enjoy writing it and observing people from all over the world reading it.

– Matthew Grimm, M.D.

Category Archives: Epidural Injection

What is a Spinal Epidural, and do I Need one?

what-is-spinal-epidural-injection-01What exactly is a spinal epidural? And what are the signs that you might need one?

The back is one of the most commonly reported sites for pain. Anatomically, just about every functional tasks put a strain on the lower back. Even if good body mechanics and posture are used, we all have pain in our backs every once in a while.

For some people, though, lower back pain becomes a chronic problem. At this point, they may be desperate for help. One potential solution could be through a spinal epidural shot.

What a Spinal Epidural is

A spinal epidural, or epidural spinal injection, is a procedure in which a small amount of medication- typically steroids- is injected into the spinal region. The primary reason for needing a spinal epidural shot is chronic pain. In order to best understand why a spinal epidural would be needed or how it works, we have to better understand how exactly the spine itself works.

How the Spine is Designed

The spine is a collection of 33 bones. These bones are not technically connected but are held together through a series of cartilaginous discs. The exact structure of each vertebra is designed to allow some rotation, bending, and twisting. However, there are also safety mechanisms in place to keep the body from bending and twisting too much. if the body were to not have these mechanisms, the spinal column itself would be put under great pressure, causing even more nerve pain. Occasionally, for one reason or another, inflammation in the spinal region can occur. This may be due to the cartilage in the intervertebral discs being worn down over time, autoimmune disorders, or traumatic accidents- such as a car crash. This inflammation causes redness, swelling, and pain in the affected region.

As mentioned earlier, the spine is under constant stress due to gravity. This makes it difficult for the spine to heal. Because of a slower healing rate and constant pressure being applied, this pain can last for an extended period of time.

How a Spinal Epidural Helps

how-epidural-helps-treat-pain-02When this swelling and pain occurs in the lower back and doesn’t go away, some kind of outside assistance has to be applied to relieve pain. One possible option is an epidural spinal injection. When steroids or some other pain-relieving medication is injected into the spinal region that is affected, it is able to reduce swelling and relieve pain. This targeted approach is very effective for dealing with localized pain.

For some people, an epidural spinal injection will provide relief for years. For others, this may only provide a short-term solution, with a more invasive procedure being required.

Do I need an epidural spinal injection?

So, how can you tell if an epidural spinal injection would help you? The first step, identifying the location of your pain. Obviously, a spinal epidural can only help in the spinal region. Next, we need to identify the cause of your pain. Simpler treatments, such as exercise, massage, or icing may help less severe conditions.

Do you have back pain? The best way to find out if a spinal epidural would help you is to talk to a doctor. Schedule an appointment with Dr. Grimm so you can discuss whether or not a spinal epidural will work for you.

646-862-5555

What is a Lumbar Epidural?

Lumbar-Region-epidural-injection-01The lumbar region of the spine can be one of the most aggravating places to experience chronic pain. People try many different treatments to find relief to pain in their lower back. One common treatment that many people find effective for them is the use of a lumbar epidural. How does a lumbar epidural work? In order to best understand how a lumbar epidural works, we first have to look at the anatomy and physiology of the lumbar spine.

What is the Lumbar Region?

Located just above the tailbone and below the ribs, the lumbar section is made up of five separate vertebrae. These individual bones are able to act as a unit thanks to the cartilaginous discs located between them. These discs serve as cushions, absorbing the pressure that is caused by any movement. Even the simple act of walking put some pressure on the lumbar spine and vertebral discs. Typically, these disks hold up very well under the pressure. However, there are certain occasions in which these cushions do not do their job as well as they should. when this happens, we typically see pain and swelling around a specific section of the lumbar region of the back.

Problems With the Lumbar Region

lumbar-epidural-info-relief-top-nyc-pain-doctor-02Many people feel at least some pain in their lower back every now and then. This makes sense, as we have already discussed how much the lumbar region is used. Real problems can begin to develop, though, when excessive strain is put on this region of the body. This can be something as simple as performing a heavyweight exercise with poor form, packing up a box and moving it by lifting it and twisting at the same time, or just having bad sitting posture for too long. As time goes by, these discs wear out. This leads to friction between the lumbar vertebrae, causing pain and swelling. Because the back is constantly being used, we typically do not give our back enough rest to heal properly from such an injury. This means that over time, this injury will only get worse and worse.

In other cases, lumbar pain is caused to buy an autoimmune disorder. In these cases, the body attacks itself as it would a virus. This can cause the same swelling, pain, and general inflammation that we see. Regardless of the exact cause of the swelling and pain, this inflammation makes it difficult to engage in simple, routine daily tasks.

How Epidurals can Help

pain-relief-lumbar-region-description-faq-info-03An epidural is a procedure in which we inject a small amount of localized pain reliever or steroids into a specifically targeted spot in the back. Before we perform a lumbar epidural, we first have to identify the exact location that you are feeling pain. Once the target is found, we can inject a small needle into the epidural area, or the space between the vertebrae just before the spinal cord. This injection can help to reduce swelling and pain in the region affected. for some people, a single lumbar epidural treatment is enough to relieve the pain and reduce the swelling for years. For other people, more regular treatments are needed to keep the pain and swelling away.

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Do you think a lumbar epidural would help you? Schedule an appointment with Dr. Grimm so that we can discuss how we can help manage your pain.

Matthew Grimm, MD
646-862-5555

Lumbar Epidural

Lumbar Epidural Injeciton Doctor NYC p01Lumbar epidural injections are commonly given to patients suffering from chronic low back pain caused by nerve irritation and inflammation. This type of severe pain may be related to various conditions like fractures, ruptured intervertebral discs, arthritis, and spinal stenosis. These conditions may cause pinching, compression and irritation of spinal nerves and lead to symptoms like low back pain, which can radiate to the buttocks and legs. One may also experience muscle stiffness, tingling or numbing and weakness in the legs. When these symptoms do not respond to conservative treatments, a lumbar epidural may be a suitable option. In addition, patients who experience cancer-related pain may also benefit from this form of treatment.

How a Lumbar Epidural Works

The goal of lumbar epidural injection is to reduce chronic pain and inflammation in the lumbar area, buttocks, and legs. This treatment consists of short outpatient procedures that are done either in the hospital or in a doctor’s clinic.

An anti-inflammatory medication consisting of local anesthetics and steroids is injected into the spinal area of the lower back below the waist, to bathe the affected nerves and discs. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure

Lumbar Epidural Injeciton Doctor NYC p02A lumbar epidural is a procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. After thorough evaluation, the patient is briefed about the procedure and prepared beforehand so that he is relaxed. He may be given an oral medication to relax.

The patient is positioned sitting up or lying on the stomach. The skin at the lumbar area is cleansed thoroughly with sterile scrub. A small amount of local anesthesia is administered on the skin and underlying tissues to numb the area before treatment.

Lumbar Epidural Injeciton Doctor NYC p03When ready, the physician directs a special needle with x-ray guidance into the lumbar epidural space, which surrounds the outer covering of the spinal cord. Proper positioning of the needle is ensured with the use of a small amount of contrast medium or dye injected before the medication is given.

Finally, a small mixture of local anesthetic and anti-inflammatory (steroid) drug is injected into the epidural space. The patient may experience temporary discomfort, numbing, and weakness of the back and legs for a few hours, which is an expected result.

The patient is monitored for about an hour before they are discharged. They will be asked to evaluate their improvement in the succeeding week and report for follow-up. Repeat injections may be performed up to three times, if needed, every two weeks.

Contact Us

A lumbar epidural injection is a minimally invasive, safe, and effective means of treating low back pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your back pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if lumbar epidural injections are a treatment option for you.

Radiofrequency Ablation of the Medial Branch Nerves

Radiofrequency Ablation of the Medial Branch Nerves 01

Radiofrequency Ablation of the Medial Branch Nerves

is a safe and effective way to relieve chronic lumbar (lower back) pain using radio waves to create heat. These radiofrequency waves are electromagnetic waves that travel at the speed of light and Radiofrequency Ablation of the Medial Branch Nerves 03blocks nerve tissue from transmitting pain signals to the brain. The medial branch nerves are sensory nerves that carry pain signals from injured facet joints to the brain. Facet joints are parts of the spinal bones (vertebrae) that allow one to do a wide range of motions. Injury or degenerative changes in these joints, particularly in the lower back, can cause inflammation and severe pain, which may not respond to conservative medical therapy. (click picture to enlarge)

How Radiofrequency Ablation Works

Radiofrequency ablation provides long-term pain relief that exceeds the effects of a nerve block or other types of injections. Various types of chronic pain conditions respond well to radiofrequency ablation including pain from previous spinal surgery, whiplash injury, complex regional pain syndrome and spondylitis (arthritis of the spine).

The procedure involves the placement of insulated needles with a tiny electrode next to the medial nerve branch. A small radiofrequency current is directed to the medial branch nerve of the facet joint for 60-90 seconds, which generates heat (60-80 degrees Celsius) that destroys the nerve tissue. The result is blockage of pain signals to the brain.

Radiofrequency Ablation of the Medial Branch Nerves 05Radiofrequency ablation is a relatively safe and common technique that can provide dramatic and long-lasting pain relief without systemic side effects. Patients benefit from this procedure because pain is reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

Radio Frequency Ablation for Back Pain: General Procedure

Radiofrequency ablation is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient needs to be relaxed but alert during the procedure to help the doctor correctly place the electrode used during nerve ablation. The procedure will take 20-45 minutes, with the patient lying on their stomach (prone). After the skin is properly sterilized, local anesthesia is injected to numb the area.

Radiofrequency Ablation of the Medial Branch Nerves 02Using x-ray guidance, insulated needles are directed next to the targeted medial nerves. The doctor will use X-rays to guide twin, insulated needles with an electrode are placed next to the nerve. During the procedure, the doctor asks the patient if he feels a tingling sensation or a muscle twitching. These signs will help ensure the electrode isRadiofrequency Ablation of the Medial Branch Nerves 04 properly positioned. Once the needle and electrode are placed correctly, the nerve is heated with radio waves until pain signals to the brain are blocked.

Post Operative Recovery after Radiofrequency Ablation Procedure for Back Pain:

After the procedure, the patient is monitored in a recovery area and discharged when stable. The patient may feel some local pain for several days after the procedure, which may be relieved by oral medications. Some swelling or bruising may occur where the needle was inserted and this may be reduced by applying a cold pack. It may take weeks for the full effects of radiofrequency ablation to be felt, but the pain relief may last for six months or even longer. Some nerves grow back, and radiofrequency ablation may need to be repeated.

Contact Us

Radiofrequency Ablation of the Medial Branch Nerves is a minimally invasive, safe, and effective means of treating low back pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your back pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if radiofrequency ablation is a treatment option for you.

Cervical Epidural

Cervical Spine Epidural Injection 01Cervical epidural injections are commonly given to patients who suffer from nerve root inflammation and irritation in the neck, causing them to experience neck pain and arm pain. These symptoms may be caused by a neck injury or normal wear and tear, which leads to damage of the discs found between the cervical or neck bones. These changes affect the nearby nerve roots that give sensation to the neck, shoulders, and arms, thereby causing severe pain that is often unrelieved by medications or conservative management.

How a Cervical Epidural Works

The aim of treatment with a cervical epidural is to reduce inflammation from the damaged intervertebral discs, which is causing irritation to the spinal nerves. An anti-inflammatory medication consisting of local anesthetics and steroids is therefore injected into the upper spine or neck, to bathe the affected nerves and discs, targeting the painful areas in the neck and arms. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Cervical Spine Epidural Injection 02Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure

A cervical epidural is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

Cervical Spine Epidural Injection 03The patient sits on a chair in a position that allows the physician to visualize the cervical vertebrae (neck bones) using x-ray guidance. The skin at the back of the patient’s neck is cleansed thoroughly with sterile scrub. A small amount of local anesthesia is administered on the skin and underlying tissues to numb the area before treatment.

When ready, the physician directs a special needle with x-rayCervical Spine Epidural Injection 04 guidance into the epidural space, which surrounds the outer covering of the spinal cord in the neck. Proper positioning of the needle is ensured with the use of a small amount of contrast medium or dye injected before the medication is given.

Finally, a small mixture of local anesthetic and anti-inflammatory (steroid) drug is injected into the epidural space. The patient may experience temporary numbing and weakness of the arms and hands for a few hours, which is an expected result.

Patients are allowed to stay in a recovery area where they will be monitored for about an hour. After discharge, they will be asked to evaluate their improvement in the succeeding week and report for follow-up. Repeat injections may be performed up to three times, if needed, every two weeks.

 

Contact Us
A cervical epidural injection is a minimally invasive, safe, and effective means of treating neck pain that is unresponsive to other forms of treatment. If you want more information about treating chronic pain in the neck and arms, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your neck pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if cervical epidural injections are a treatment option for you.

Low Back Pain AKA Lumbago

…is a common disorder affecting over 80% of the general population at some point in their life.  In addition to causing emotional and physical strain onthe body, it also causes a great amount of financial strain as it is the number one cause of job-related disability.

In this blog I hope to discuss various treatment options as well as explain why I feel that I am best suited to treat your low back pain and how I am the best low back pain specialist!

Causes of Low Back Pain:

First lets discuss one of the most common causes of  low back pain.  It can be acute, subacute or chronic.  Acute low back pain duration is generally less than 4 weeks, subacute is from 4-12 weeks and chronic is low back pain lasting longer than 12 weeks.  Also in addition to the duration of low back pain it can be defined as axial or radicular low back pain.

In this first article we will discuss radicular or radiating lower extremity low back pain. Radicular low back pain is pain that originates in your low back and shoots in an electricity like sensation down your posterior legs, at times all the way to your toes.

Back Anatomy:

Next we will discuss some basic anatomy of your lumbar spine. The Lumbar spine (or lower back region) is made up of five vertebrae (L1-L5) and in between each of these vertebrae lies fibrocartilage discs called intervertebral discs.  These discs act as cushions or “shock absorbers” for the spine, preventing the vertebrae from rubbing together allowing the vertebrae to comfortably protect the spinal cord as well as provide active range of motion for your lower back.

Your bodies motor and sensory functions are controlled by nerves.  These nerves stem from the spinal cord and exit the cord through small holes called foramina which lie within the vertebrae.

Ligaments and musculature of the lower back and abdomen provide stability for the spine and small joints, called facet joints, direct the motion of the spine and is how each vertebrae interact with each other.  Facet joints can be thought of like any other joint in the body, just like your finger joint is made up of a number of small bones each connecting with each other through a joint.

Radiculopathy:

Now that we have the basic anatomy of the Lumbar Spine down, we can discuss one of the most common causes of low back pain which are caused by one of the above mentioned structures. One of the most common causes radiating lower extremity or “radicular” low back pain as due to a disc herniation impinging on your spine or nerve roots as they exit the spine.

Herniated Disc:

What is a herniated disc you may ask?  Well let me explain.  As described above in your spine in between each vertebrae lies a fibrocartilage disc which acts as a shock absorber for the spine.  You can think of the discs structure as a jelly donut, with a soft center encased within a tougher exterior. The cause of a disc herniation can result from general wear and tear on the disc,such as while performing jobs that require constant sitting.  Disc herniations often result from jobs that require any type of lifting or repetitive bending activities.

If you are someone with complaints of general minor back pain or chronic back tiredness it makes you susceptible to a herniation from only a mild activity such as bending over to pick up a pencil or simple gardening!  Disc herniations can also occur from trauma to the body when subjected to any type of accident, be it from a motor vehicle accident or a slip and fall accident.

Lumbar Disc Herniation:

I will now discuss pain symptoms related to lumbar disc herniations.  Pain can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting low back pain that radiates into the lower leg regions innervated by the affected nerve roots or spinal cord segments irritated or impinged by the herniated disc material.

Pain complaints often are described to the thighs, knees, calves or all the way to the toes.  Other pain symptoms include numbness, tingling, muscular weakness and decreased weakness in the same affected areas as the pain complaints.

Treatment for Radicular Low Back Pain:

Now lets discuss treatment of radicular low back pain.  If a disc herniation causes extreme weakness, paralysis or bowel or bladder dysfunction it is considered a surgical emergency and treatment should be sought at the nearest emergency department.

If your symptoms are less severe which is the case in 99% of radiating low back pain patients we start with conservative management of the pain with anti-inflammatory medication treatment, muscle relaxer medication treatment and physical therapy with emphasis on core abdominal muscle strengthening, heat, ice, massage and ultrasound with transition into a home exercise program.

If symptoms persist despite conservative management as detailed above the next step is further diagnostic steps to confirm the location of the disc herniations.  To do this generally Magnetic Resonance Imaging or MRI is utilized.

The most common locations of lumbar disc herniations is at L4-L5 or L5-S1 as diagnosed by MRI.  Your pain complaints will be to your posterior legs at times all the way to your toes as described above with associated numbness and tingling in the same areas.

Once diagnosis has been confirmed by MRI and conservative treatment measures have failed with anti-inflammatory medications and physical therapy the next step in treatment in treatment is injections directly to the location of the nerve impingement utilizing epidural steroid injections which are performed by a pain management specialist.  Of which I consider myself to be one of the best in Manhattan.

Epidural Steroid Injection:

An epidural steroid injection is a minimally invasive  procedure that can help relieve radiating low back and leg pain caused by inflamed spinal nerves.  Medicines are delivered to the affected spinal nerve through the epidural space, which is the area between the protective covering of the spinal cord, known as the dura, and the vertebrae.  The medicine used is generally a combination of a long acting corticosteroid and either saline or a anesthetic numbing agent.

Expected Results:

You may ask what results can be expected with lumbar epidural injections.  The relief is dependent on both the severity of the herniation as well as each individual patient as well as the expertise and technique of the physician performing the procedure which it is very important to choose a physician who has been fellowship trained in pain management, which I have been, rather than someone who just took a weekend course in epidural injection treatment.

After Epidural Injection:

Following a first epidural injection you will have a follow up appointment to evaluate your response.  Pending your bodies response to the first injection up to 3 injections spaced 1-3 weeks apart may be needed for maximum efficacy.

How Long Does an Epidural Last?

Duration of pain relief varies from weeks to years.  Most importantly post injection therapy should be instituted for transition into a home exercise program focusing on strengthening abdominal and low back muscles in hopes of preventing future low back pain episodes. Now finally patients need to know the risks of epidural steroid injections.

Risks of Epidural Injection:

If you choose the correct physician there are few risks involved with the procedure.  The correct pain management specialist knows how to screen patients for the appropriate patients for this procedure to ensure that it is not performed on a patient in which it is not beneficial.  The proper physician also knows proper technique to ensure appropriate needle position for steroid placement.

Complications generally involve risks associated with needle insertion which involve bleeding, dural puncture, infection, allergic reaction and nerve damage.  As described above risk can be mitigated with selection of a skilled physician who knows proper technique and proper patient selection.

The Top Doctor for Epidural Injection?

I have performed thousands of epidural steroid injection procedures without a single complication.  So you can be sure you are in skilled hands.  Should a complication ever arise, be rest assured that I have been trained to deal with any and every complication. Contact Us today to schedule an appointment.

Epidural Steroid Injection for Back Pain

10898704-lower-back-painHuman back

Epidural steroid injections are a safe and efficient way to treat common back pain symptoms that can arise from the disks, the exiting nerves or the narrowing of the spinal canals.

ESI-translaminalEpidurals are now recommended to be done earlier vs. later as a treatment option to prevent pain symptoms from becoming chronic conditions.

In order to provide the highest level of care, our procedures are done at an outpatient surgery center. Patients lay comfortably on a surgical table. The area is prepped in a sterile fashion. Fluoroscopic guidance (live x-ray) is used to ensure proper needle position within the epidural space and is confirmed using a contrast material that is visualized on the fluoroscopy.

epidural1The whole procedure takes less than 15 minutes in most circumstances. Patients are asked to relax that day and may perform their normal activities the following day.

The steroid (Depomedrol) will start to work within 24-48LESI AP hours. Patients usually receive immediate relief from the local anesthetic injected.

We recommend patients follow-up after one week of injection in our office and usually recommend continued physical therapy to prevent recurrence of symptoms.