Common Procedures

Interventional Pain Management is a medical subspecialty that uses cutting-edge technology and invasive procedures to treat pain and other functionally limiting conditions. See more info at






Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back. Both facet joint injections and medial branch blocks are used to diagnose and treat pain stemming from facet joints. While treating pain, typically steroids or steroids mixed with anesthetics are used.

The mechanism of pain control is different for facet joint injections and medial branch blocks.









Dysfunction in the sacroiliac joint, also called the SI joint, can sometimes cause lower back and/or leg pain. Leg pain from sacroiliac joint dysfunction can be particularly difficult to differentiate from radiating leg pain caused by a lumbar disc herniation (sciatica) as they can feel quite similar. For decades, the sacroiliac joint was suspected as a common cause of low back and/or leg pain, although difficulty in accurate diagnostic testing left many in the medical profession skeptical. Today it is estimated that the sacroiliac joint is responsible for 15% to 30% of lower back pain cases. The sacroiliac joint connects the hip bones (iliac crests) to the sacrum, the triangular bone between the lumbar spine and the tailbone (coccyx). The primary function of the sacroiliac joints is to absorb shock between the upper body and the pelvis and legs.


Other muscles that support sacroiliac joint function include the gluteus maximus and the piriformis muscle.







Botulinum toxin injections are used to reduce the excess muscle activity caused by dystonia. Botulinum toxin is produced naturally by a bacterium called Clostridium botulinum which is also associated with causing botulism, a rare form of food poisoning. However, although botulinum toxin is exceptionally toxic, when it is purified and used in tiny, controlled doses, it can be used safely and effectively to relax excessive muscle contraction.

The injection enables the botulinum toxin to be targeted directly into the muscles affected by dystonia. The toxin has an effect on the nerves at their junction with the muscles. It acts as a blocker preventing release of the chemical messenger acetylcholine which is responsible for making the muscle contract. As a result, the signals that would normally be telling the muscle to contract are halted and the muscle spasms are reduced or eliminated.

Because each muscle affected by dystonia has to be injected separately, and also because there is a limit to the total quantity of toxin that can be injected into the body at one time, botulinum toxin is more suitable for treating dystonia which are focal to one or two areas of the body rather than generalized dystonia. However, sometimes the toxin is used to treat a specific part of the body in generalized dystonia as part of a wider treatment regime.

Botulinum toxin injections are administered by trained medical professionals (usually a doctor, physiotherapist or dystonia nurse) and most commonly delivered at a local hospital. Some people find the injection hurts a little but others are not concerned about it at all. Depending on the location of the muscle spasm, doctors will either select the muscles by observing the abnormal postures or movements and feeling for the muscle spasm or will use an EMG (electromyography) machine which measures muscle activity.  

The number of injections will vary depending on the severity of your dystonia. Talk to your doctor about the number of injections you will need.

After the injection, the treatment takes effect gradually over 4–7 days, sometimes longer. Where it is a suitable treatment, botulinum toxin provides significant relief for the majority of people but it is not perfect – usually mitigating symptoms rather than completely eliminating them. The positive effects of botulinum toxin injections can last up to 16 weeks, sometimes longer; although many people find that the injections need repeating before this and usually attend a clinic around every 12 weeks.

Botox for Migraine










Joint injections are used to deliver steroids directly into a joint, such as a knee, ankle, hip or wrist. Sometimes fluid is removed from the joint before the steroid is injected.

Steroid joint injections can help with pain and swelling by treating the underlying joint inflammation – improvement is often with a several days.

Joint injections are performed in an office or hospital setting, often with a cold spray or other local anesthesia. After the skin surface is thoroughly cleaned, a needle in injected directly into a joint. At this point steroids can be injected into the joint. The steroid treats the inflammation inside the joint, leading to decreased swelling and pain.

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb, and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may also be more easily aspirated or injected with aid of ultrasound.


A trigger point injection can help soothe muscle pain, especially in your arms, legs, lower back and neck. It also can be used to treat fibromyalgia, tension headaches and myofascial pain.

Trigger points are painful “knots” in your muscles. They form when a muscle can’t relax. Sometimes you can feel these knots when you rub your muscle.

Injecting small amounts of anesthetic and steroid into the trigger point can help alleviate the pain. You will sit or lie down for the procedure. Your doctor will press on your muscle to locate the area where you have pain. Then, he or she will insert a small needle into the area and inject a mixture of anesthetic and steroid.

You can have several trigger points injected during one visit to your doctor’s office. The procedure only takes a few minutes.

The risk of complication from a trigger point injection is very low. Complications such as bleeding and infection at the injection site are uncommon. However, you may have temporary soreness or numbness at the injection site.

Trigger point injection may be right for you if your muscle pain has not improved with other treatment, including pain medication and physical therapy.



