Neck pain is a very common problem. There are many different causes of neck pain and
sometimes there is no cause at all. Here at Western Rockies Interventional Pain Specialists we
focus on treating neck pain based on a combination of symptoms and diagnostic imaging
results. Dr. Lewis uses diagnostic imaging for reference, however; he bases most of his clinical
decision making on the patient’s description of the pain. We offer a variety of procedures for
the treatment of neck pain which are explained in detail below.
An epidural steroid injection is a simple, high-volume injection of steroid in the epidural space.
This treatment is not aimed to diagnose or treat a specific structure in the spine. It is designed
to reduce inflammation, swelling, and pain around the structures of the spine. An epidural
steroid injection can effectively treat a large region of the spine with just one injection. These
injections can be done in the cervical, thoracic, or lumbar spine.
Radiofrequency Ablation Neurotomy
Medial branch block testing is how we diagnose which nerves to treat with radiofrequency
ablation neurotomy. This treatment is designed to treat the nerves that innervate the facet
joints of the spine. It can be performed on the cervical, thoracic, lumbar spine, and nerves to
the sacroiliac joints. Medial branch block testing is performed by placing a small about of
numbing medication directly on the nerves as they exit the facet joints. A successful diagnosis
is made when the pain is gone after the numbing medication has been applied. Once the
nerves have been successfully identified with medial branch block testing, the same nerves are
then treated with radiofrequency ablation neurotomy. The radiofrequency ablation neurotomy
is done with a small needle that is placed on the nerve. That needle then heats up just enough
to remove the very delicate nerve tissue in the targeted area.
Occiptal Nerve Block
Occipital nerve blocks are performed for the diagnoses and treatment of headaches originating
at the base of the skull. Typically, these headaches are described as pain starting at the base of
the skull and radiating up over the head. The injections target the occipital nerves at the base
of the skull. The nerves are injected with numbing medication and steroid. The numbing
medication provides diagnostic information which indicates whether these nerves are primary
pain generators. The steroid decreases inflammation, swelling, and pain.
Sympathetic blocks are designed to treat a component of the central nervous system, the
sympathetic nervous system. These injections are intended for the treatment of neuropathic
pain that originates from the nervous system rather than from a physical structure. The
injections target the sympathetic nervous system chains located on the front of the spine. The
goal of the injections is to interrupt and reset the neuropathic pain cycle that is causing pain.
Sympathetic blocks are performed on the cervical spine, lumbar spine, and pelvis. Injections
are typically done in a series of a least two injections separated by 10 to 14 days.
Spinal Cord Stimulators
Spinal cord stimulators are implanted to treat a specific area of pain by treating specific pain
fibers within the spinal cord. The stimulator interrupts the pain signals before they reach the
brain and are perceived as pain. This treatment is appropriate for patients with neck pain, back
pain, leg pain, or arm pain that either cannot be identified or cannot be treated directly. Some
examples of conditions typically treated with spinal cord stimulation include, but are not limited
to: phantom limb pain, failed-back surgery syndrome, and complex regional pain syndrome. A
four-day trial with a temporary system precedes all implants. Permanent implantation is only
performed if the four-day trial was successful. The trial placement is done in our office and the
permanent implant is placed at the hospital in the operating room.