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Knowledge Center

Chronic Pain

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Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Pain

Chronic pain is a complex condition driven by a number of biological, behavioural, psychological, and social factors. At NeuPath, we aim to acknowledge the multifaceted experience of living with Chronic pain by developing patient centered tailored treatment plans. A common first visit will include a thorough assessment which includes reviewing your pain history, previous treatments, and current medications. The initial appointment is extremely helpful in developing a customized treatment plan.

I’ve been treating Chronic Pain for many years and some of the most common interventions that I recommend are:

  • Address pain tolerance and coping mechanisms, explore maladaptive behavioural patterns
  • Discuss the difference between hurt vs harm
  • Focus treatment on anatomic areas of pain, using different modalities: medications and injections where appropriate
  • Work to ensure improvement and/or stability in symptom management and functional goals

We understand that chronic pain is a complex medical problem that can have a significant effect on your physical, emotional and spiritual well- being. The main goal of a successful pain management is reduced pain but, most importantly, a return to better function and quality of life.

Cervical Radiofrequency Ablation (RFA)

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After your Cervical RFA procedure, you will be monitored for approximately 30 minutes. The clinic will give you appropriate directions to follow for care following the procedure.

We caution against driving after an RFA procedure.

Post-procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation and can last 2–4 weeks. The full benefits of pain relief take usually 6-12 weeks.

Nerves will regenerate after the RFA procedure. However the time it takes for them to regenerate varies from 8–24 months. Your typical pain may or may not return after this nerve regeneration.

If your pain does return another RFA can be done.

Do I have Cervical Facet Joint Pain?

If you have pain for greater than 2 months in the head, neck, shoulder, or upper back area you may have facet joint pain.

Tests such as X-rays or MRIs do not always show if the facet is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the medial branch nerve.

A Cervical RFA disrupts the function of the cervical medial branch nerve temporarily. The medial branch nerve is then no longer able to transmit pain signals from the affected facet joint to the brain.

RFA Procedure

A thin needle is inserted near the facet joint under fluoroscopy (a type of X-ray). Fluoroscopy is used to position the needle accurately and safely. The nerve will be stimulated by the Physician to assess if the needle is in the proper position. This can cause some of your symptoms to be reproduced and/or your arm or hand to twitch.

The area will be numbed with an anesthetic medication with the correct needle position. The Physician will use radiofrequency energy to disrupt the medial branch nerve signal.

What is a Cervical RFA?

This outpatient procedure is used to help with treating headaches, neck, shoulder, and upper back pain.

What are Cervical Facet Joints?

Facet joints are found on either side of the spine. Each of these joints is about the size of a thumbnail. There are 7 vertebrae in the cervical spine that are connected by facet joints.

Facet joints connect vertebrae to one another along with guiding the spine when moving.

Medial branch nerves are located near facet joints. They communicate pain from facet joints to the brain. Therefore the nerves tell the brain when the facet joint has been irritated.

Injury to a facet joint typically involves damage to cartilage inside the joint and the connecting ligaments surrounding the joint.

Pain from an injured cervical joint may range from mild muscle tension to more severe pain. This pain can radiate into different areas, often the shoulder blade area, depending on which facet joint is irritated.

Sacroiliac Joint Lateral Nerve Block

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After your SI Joint Intra-articular Injection, you will be monitored for approximately 15-30 minutes. The clinic will give you appropriate directions to follow for care following the procedure.

Post-procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation. You may also notice some numbness and tingling in the leg and foot for a maximum of 4-6 hours.

There should be pain relief immediately lasting 4-6 hours. The corticosteroid takes about 1-week post-injection for it to take optimal effects. Pain relief lasts anywhere from a few weeks to several months, depending on the ultimate cause of your SI joint pain.

Do I have SI Joint Pain?

If you have pain for greater than 2 months in the lower back to buttock and/or leg. Tests such as X-rays or MRIs do not always show if the SI joint is the reason for your pain. The best way to test if you have this pain is to block the pain signals from the lateral nerve.

A SI joint lateral Block disrupts the function of the SI joint lateral branch nerve temporarily. The lateral nerve is then no longer able to transmit pain signals from the affected facet joint to the brain.

SI Joint Lateral Block Procedure

A thin needle is inserted directly into the SI joint under fluoroscopy (a type of X-ray). Fluoroscopy is used to position the needle accurately and safely. A small amount of dye is used by the Physician to assess if the needle is in the proper position.

This injected dye can cause some discomfort. The area will be numbed with an anesthetic medication with the correct needle position.

What is a SI Joint Nerve Block?

This outpatient procedure is used to help with diagnosing pain from the low back to the buttock, and sometimes into the leg.

What are SI Joints?

The SI joint is what attaches the spine to the hip. It is made up of the Sacrum (part of the spine) and the Ilium (part of the hip).

There are many ligaments that help to strengthen the SI joint.

Lateral nerves extend from the Sacrum and communicate with the SI joint. Therefore the nerves tell the brain when the SI joint has been injured.

Sacroiliac Joint Radiofrequency Ablation (RFA)

,

After your SI Joint RFA procedure, you will be monitored for approximately 30 minutes. The clinic will give you appropriate instructions to follow for care after the procedure.

We caution against driving after an RFA procedure.

Post-procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation and can last 2–4 weeks. The full benefits of pain relief take usually 6–12 weeks.

Nerves will regenerate after the RFA procedure. However the time it takes for them to regenerate varies from 8–24 months. Your typical pain may or may not return after this nerve regeneration. If your pain does return another RFA can be done.

Do I have SI Joint Pain?

If you have pain for greater than 2 months in the lower back, buttock, and/or leg area you may have SI joint pain.

Tests such as X-rays or MRIs do not always show if the SI joint is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the lateral nerve.

A SI joint RFA disrupts the function of the lateral nerve. The lateral nerve is then no longer able to transmit pain signals from the affected SI joint.

RFA Procedure

A thin needle is inserted near the SI joint under fluoroscopy (a type of X-ray). Fluoroscopy is used to position the needle.

The area will be numbed with an anesthetic medication with the correct needle position. The Physician will use radiofrequency energy to disrupt the lateral nerve signal.

What is a SI Joint RFA?

This outpatient procedure is used to help with diagnosing and/or treating pain from the low back to the buttock, and sometimes into the leg.

What are SI Joints?

The SI joint is what attaches the spine to the hip. It is made up of the Sacrum (part of the spine) and the Ilium (part of the hip).

There are many ligaments that help to strengthen the SI joint.

Lateral nerves extend from the Sacrum and communicate with the SI joint. Therefore the nerves tell the brain when the SI joint has been injured.

Sacroiliac Joint Intra-articular Injection

,

After your SI Joint Intra-articular Injection, you will be monitored for approximately 15-30 minutes. The clinic will give you appropriate directions to follow for care following the procedure.

Post-procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation. You may also notice some numbness and tingling in the leg and foot for a maximum of 4-6 hours.

There should be pain relief immediately lasting 4-6 hours. The corticosteroid takes about 1-week post-injection for it to take optimal effects. Pain relief lasts anywhere from a few weeks to several months, depending on the ultimate cause of your SI joint pain.

Do I have SI Joint Pain?

If you have pain for greater than 2 months in the lower back, buttock, and/or leg area you may have SI joint pain.

Tests such as X-rays or MRIs do not always show if the SI joint is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the lateral nerve.

SI Joint Intra-articular Injection

A thin needle is inserted directly into the SI joint under fluoroscopy (a type of X-ray). Fluoroscopy is used to position the needle accurately and safely. A small amount of dye is used by the Physician to assess if the needle is in the proper position. This injected dye can cause some discomfort.

With the correct needle position, the joint is then injected with a combination of a corticosteroid (anti-inflammatory) and an anesthetic into the irritated SI joint.

What is a SI Joint Intra-articular Injection?

This outpatient procedure is used to help with diagnosing and/or treating pain from the low back to the buttock, and sometimes into the leg.

What are SI Joints?

The SI joint is what attaches the spine to the hip. It is made up of the Sacrum (part of the spine) and the Ilium (part of the hip).

There are many ligaments that help to strengthen the SI joint.

Lateral nerves extend from the Sacrum and communicate with the SI joint. Therefore the nerves tell the brain when the SI joint has been injured.

Cervical Medial Branch Block

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After your Cervical Medial Branch Block procedure you will be monitored for approximately 15 – 30 minutes. The clinic will give you appropriate directions to follow as well as complete a pain diary. This pain diary is very important as it will guide the Physician treatment plan for you.

We caution against driving after any neck procedures.

Pain relief will last for approximately 4-6 hours, and then the anesthetic wears off.

Short term pain relief is considered a positive test. The Physician will then determine the next step in your treatment plan.Post procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation.

Do I have Cervical Facet Joint Pain?

If you have pain for greater than 2 months in the head, neck, shoulder or upper back area you may have facet joint pain.

Tests such as X-rays or MRIs do not always show if the facet is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the medial branch nerve.

A Cervical Medial Branch Block disrupts the function of the cervical medial branch nerve temporarily. The medial branch nerve is then no longer able to transmit pain signals from the affected facet joint to the brain.

Medial Branch Block Procedure

A thin needle is inserted near the facet joint under fluoroscopy (a type of x-ray). Fluoroscopy is used to position the needle accurately and safely. A small amount of dye is used by the Physician to assess if the needle is in the proper position. This injected dye can cause some discomfort.

With the correct needle position the area will be numbed with anesthetic medications.

What is a Cervical Medial Branch Block(MBB)?

This outpatient procedure is used to help with diagnosing, neck, shoulder and upper back pain.

What are Cervical Facet Joints?

Facet joints are found on either side of the spine. Each of these joints is about the size of a thumbnail. There are 7 vertebrae in the cervical spine that are connected by facet joints. Facet joints connect vertebrae to one another along with guiding the spine when moving.

Medial branch nerves are located near facet joints. They communicate pain from facet joints to the brain. Therefore the nerves tell the brain when the facet joint has been irritated.

Injury to a facet joint typically involves damage to cartilage inside the joint and the connecting ligaments surrounding the joint.

Pain from an injured cervical joint may range from mild muscle tension to more severe pain. This pain can radiate into different areas, often shoulder blade area, depending on which facet joint is irritated.

Cervical Facet Joint Injection

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How Long Should the Pain Relief Last?

After your Cervical Facet Joint Injection you will be monitored for approximately 15 – 30 minutes. The clinic will give you appropriate directions to follow for care following the procedure.

We caution against driving after any neck procedure.

Post procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation. You may also notice some numbness and tingling into the neck and arm for a maximum of 4-6 hours.

There should be pain relief immediately lasting 4-6 hours. The corticosteroid takes about 1 week post injection for it to take optimal effects. Pain relief lasts anywhere from a few weeks to several months, depending on the ultimate cause of your facet joint pain.

Do I have Cervical Facet Joint Pain?

If you have pain in the head, neck, shoulder or upper back area when turning your head for greater than 2 months you may have facet joint pain.

Tests such as X-rays or MRIs do not always show if the facet is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the medial branch nerves which sends the nerve signals from the facet joints to the brain.

Injection Procedure

A thin needle is inserted into the cervical facet joint under fluoroscopy (a type of x-ray). Fluoroscopy is used to position the needle accurately and safely. A small amount of dye is injected by the Physician in order to assess if the needle is in the proper position. This can cause some of your symptoms to be reproduced.
With the correct needle position, the joint is then injected with a combination of a corticosteroid (anti-inflammatory) and a anesthetic into the irritated facet joint.

What is a Cervical Facet Joint Injection?

This outpatient procedure is used to help with diagnosing and/or treating head, neck, shoulder and upper back pain.

What are Cervical Facet Joints?

Facet joints are found on either side of the spine. Each of these joints is about the size of a thumbnail. There are 7 cervical vertebrae that are connected by facet joints. Facet joints connect vertebrae to one another along with guiding the spine when moving. Injury to a facet joint typically involves damage to cartilage inside the joint and connecting ligaments surrounding the joint.
Pain from an injured cervical facet joint may range from mild muscle tension to more severe pain. This pain can radiate into different areas, often shoulder blade area, depending on which facet joint is irritated.

Chronic Shoulder Pain

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Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Shoulder Pain

At NeuPath, our goal is to provide a comprehensive Chronic Pain assessment and a whole-patient focused treatment plan. I’ve treated Chronic Shoulder Pain for many years at NeuPath and many of my patients benefit from a treatment plan that includes the following interventions depending on the type of disorder:

  • General discussions on maintaining mobility and function
  • Medications focussed on reducing pain, inflammation and spasms
  • Injection-based treatments that utilize local anesthetics,, steroids and viscosupplementation by targeting the rotator cuff and the shoulder joint.

Progress amongst patients will greatly vary but after a few treatments, I hope to see a wider range of motion in the shoulder which can look very different from patient to patient. Again, patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.

Osteoarthritis

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Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Osteoarthritis 

At NeuPath, our goal is to provide a comprehensive Chronic Pain assessment and a whole-patient focused treatment plan. I’ve treated Osteoarthritis for many years at NeuPath and most of my patients benefit from a treatment plan that includes the following interventions:

• Promotion of weight loss treatments to reduce the impact of gravity on weight-bearing function

• Medications, both systemic and topical

• Local injection-based treatment that targets both peri-articular structures, superficial nerves and the intra-articular joint space, using a variety of injectables including local anesthetic, steroids, and hyaluronic acid.

Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.

Chronic Back Pain

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Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Back Pain

Chronic Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. Back pain is extremely common and the difference between regular back pain and chronic back pain is the frequency of occurrence. At NeuPath, our goal is to provide a comprehensive Chronic Back Pain assessment and a whole-patient focused treatment plan.
I’ve treated Chronic Back Pain for many years at NeuPath and many of my patients benefit from a treatment plan that includes the following interventions:

  • Stress the role of exercise, focussing on mobility and core strengthening and correcting maladaptive posture
  • Use of anti-inflammatory, anti-spasmodic and analgesic medications for overall pain control and functional improvement
  • Injection-based treatments with local anesthetics targeting nerves, muscular structures and joints
  • Epidural injections to alleviate sciatica associated with back pain

Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.

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