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: Lumbar injections

Lumbar Radiculopathy

BestPainDoctorNYC2What Is Lumbar Radiculopathy?

Lumbar radiculopathy is the medical term for what is commonly known as sciatica. Sciatica or lumbar radiculopathy results from mechanical irritation of one of the nerve roots in the lumbar spine and most typically presents as low back pain radiating into the buttock and/or into the leg.

Causes of lumbar radiculopathyBest-Pain-Doctor-NYC-4

Radiculopathy or irritation of a lumbar nerve root is usually caused by a herniated lumbar disc (also called a prolapsed or ruptured disc). The intervertebral discs are composed of an inner semi-fluid material enclosed in a cartilaginous outer ring. Normally, they act as cushions or shock-absorbers for compressive or rotational forces on the spine.

Increased compressive forces on the lumbar intervertebral discs occur with bending and lifting. Many years of cumulative stress can lead to small tears in the outer cartilaginous ring (called annulus). Eventually, these tears can progress to bulging of the disc or a complete rupture of the annulus (ruptured or herniated disc). A prominent disc bulge or a herniation of the disc can impinge on one of the nerves exiting the lumbar spinal cord and cause radiculopathy (sciatica).

Best-Pain-Doctor-NYC-5Signs and symptoms of lumbar radiculopathy

Mechanical irritation of a lumbar nerve root can cause numbness and/or weakness of leg on the affected side. For example, irritation of the fifth lumbar nerve root typically presents with numbness or pain in the lateral (outside) lower leg and/or weakness of the ankle (which causes the foot to drag during swing phase of that leg).

TreatmentBest-Pain-Doctor-NYC-6

Initial conservative treatment of lumbar radiculopathy consists of oral nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) and bedrest. Physical therapy is prescribed for strengthening exercise of the abdomen and lumbar spinal muscles. For intense pain, oral narcotics are often required. Lumbar epidural steroid injections which have a powerful anti-inflammatory effect on the irritated nerve root can be beneficial.

Surgery is reserved for unrelenting symptoms and significant neurologic impairment (e.g., leg weakness). A decompressive discectomy removes any disc material impinging on the lumbar nerve root. Alternatively, the minimally invasive intralaminar microendoscopic lumbar discectomy can be performed.

For the management of pain due to lumbar radiculopathy, contact Dr. Matthew Grimm, best pain doctor in NYC.

Best-Pain-Doctor-NYC-1

Facet Joint Injections, Cervical and Lumbar

 

BestPainDoctorNYC1Facet joint injections are safe and effective non-surgical treatments used to relieve pain and inflammation in the facet joints of the spine.  The bones of the spine (vertebrae) are connected to each other at the facet joints, which are located at the top and bottom of each vertebra. These joints allow the spine a range of motions. However, conditions like spinal stenosis, sciatica, herniated disc, and arthritis can cause damage to these joints, leading to chronic pain and inflammation. These may also be accompanied by limitation in spine movements, especially in the neck (cervical) and lower back (lumbar) areas. Aside from these areas, pain may be referred to other parts of the body such as the shoulders, upper back, buttocks, hips, groins, or down to the knee. A Chronic Pain Specialist may recommend facet joint injections to manage these symptoms and allow proper healing.

How Facet Joint Injections WorkBestPainDoctorNYC2

Facet joint injections aim to reduce the inflammation of the joints in the spine. Cervical facet injections reduce neck pain, as well as pain that spreads to the back of the head, shoulder or upper back. Lumbar facet injections, on the other hand, reduce the low back pain, as well as pain that spreads to the buttocks, hips, groins and knees.

Facet joint injections are administered into the lining of the spinal joints where a soft membrane called synovium can become inflamed, causing pain and muscle spasm. The painful area is targeted and a combination of a local anesthetic and an anti-inflammatory drug (steroid) is injected to bathe the affected joint. The treatment has a localized effect, thus avoiding the widespread effects of oral medications. The result is a significant reduction of inflammation and pain over time, which allows one’s muscles to relax and consequently improves one’s mobility for a period of weeks or months. It also facilitates healing and improves a patient’s ability to resume normal activities as well as exercise.

BestPainDoctorNYC3General Procedure

Facet joint injections are usually performed as an outpatient procedure 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 asked to lie face down on the examination table.  The injection site is first sterilized and then numbed using a local anesthetic. Using an imaging device to guide the placement of the needle, the doctor targets the affected facet joint and carefully injects the medication.

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 a year if needed.

BestPainDoctorNYC4Contact Us

Facet joint injection is a minimally invasive, safe, and effective means of treating neck and back pains that are unresponsive to other forms of treatment. If you want more information about treating chronic neck and back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if facet joint injections are a treatment option for you.Hives Treament Top Allergist NYC4

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.