What should I expect from this procedure?
Stellate ganglion injection is an injection of local anesthetic into the Sympathetic Nervous System. The nerves are located in the neck, on either side of the voice box. The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the upper extremity and may improve mobility.

How quickly can I expect pain relief?
You may experience warmth and redness of the painful arm during and after the injection. You may experience hoarseness of the voice, redness of the eye, drooping of the eyelid and pupil constriction for four to eight hours after the injection. Pain relief may be noted immediately.

How should I prepare for the procedure?
You should eat no solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your regular medications with a small amount of water. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. The Advanced Pain Institute will direct you when to stop taking these medications.

What happens during and after the procedure?
A local skin anesthetic is given near the base of the neck on the affected side. A needle is inserted by the anesthesiologist near the transverse process of the cervical spine (usually at the cervical-6 level). A sterile tubing is attached to the needle and anesthetic medication is slowly injected through the tubing.

Will my insurance cover the procedure?
Most insurance companies currently cover facet joint injections. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you have continued pain, fever or leg weakness, call the Advanced Pain Institute. Please do not perform vigorous activity for one week. When you are feeling better, slowly increase your activity level.

What post procedure instructions are recommended?
You should rest for a few hours following the procedure, and use assistance if needed. You may resume light activity soon after the procedure, and resume your regular diet. Do not drive or operate machinery for at least 12 hours following the procedure.

What should I expect from this procedure?
The epidural space surrounding nerve roots in the thoracic (chest) cavity and the spine may become irritated by a damaged disc or trauma. An injection in this area may help heal the area by reducing inflammation. An injection can help to significantly reduce pain in the mid back and around the rib cage.

How quickly can I expect pain relief?
You should feel relief immediately due to the anesthesia. After the local anesthetic wears off, you may feel some discomfort return, which should resolve after the steroid medication starts to work.

What happens during and after the procedure?
An IV is started so that relaxation medication can be given. The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the back using x-ray guidance. The skin on the back is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

Will my insurance cover the procedure?
Most insurance companies currently cover thoracic epidural. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you have continued pain, fever or leg weakness, call the Advanced Pain Institute. Please do not perform vigorous activity for one week. When you are feeling better, slowly increase your activity level.

What post procedure instructions are recommended?
You should rest for a few hours following the procedure, and use assistance if needed. You may resume light activity soon after the procedure, and resume your regular diet. Do not drive or operate machinery for at least 12 hours following the procedure.

During the Procedure – What to Expect
RF Rhizotomy is an advanced injection procedure.

It's important that you remain awake during the procedure to provide important feedback to the radiologist.

The doctor will perform the procedure using a thin needle electrode placed adjacent to the degenerative facet joint.

The doctor will check the needle placement using a fluoroscope (X-ray camera), which is connected to a TV monitor. X-rays will be taken at this time.

To verify the needle position, the nerve may be stimulated using low voltage electricity. The stimulation will cause the affected muscles to rhythmically contract; we will then use numbing medication (anesthetic) to put the nerve to sleep and then apply heat to the nerve via the electrode for approximately 60 seconds.

This heat is designed to create a lesion, causing the nerve to become cauterized or burnt, which in turn breaks the communication link to the brain.

This procedure is then repeated at other levels including those above and below where the pain is originating.

After the Procedure – What to Expect
Due to the sedation, a nurse will review some guidelines that you will be asked to follow post procedure (pertaining to driving, drinking alcoholic beverages, etc.).

Due to the anesthetic, you may experience numbness and/or relief from symptoms for 2-8 hours after the procedure.

Once the local anesthetic effects have worn off, your usual symptoms may return and may become more severe for up to 5-7 days after the procedure.

You should keep a record of symptoms following the procedure and report to the referring physician at your follow-up appointment.

Patients must understand that approximately 10-12% of those people who have undergone RF procedures experience elevated pain.

What is epidural steroid injection?
Epidural steroid injection is a medical procedure that involves the administration of a dose of pain-killing medication into a small space in your back or neck. Epidural steroid treatment usually involves a series of up to three injections, repeated at regular (weekly) intervals. This treatment has brought relief to many patients who suffer from pain caused by local inflammation, such as bulging discs, arthritis or ligament strain.

How quickly can I expect pain relief?
Relief is not instantaneous, but most patients report that initial benefit is felt 2 to 5 days after the first injection and maximum relief is reached 1 or 2 weeks after the last injection.

How should I prepare for the procedure?
The epidural steroid injection is a safe medical procedure but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything 6 hours prior to the procedure. An exception is always made for routine scheduled medication, which you can take with a sip of water.

We require that a responsible adult driver accompany you to and from the Advanced Pain Institute. Physicians at the Advanced Pain Institute may offer a small dose of relaxing medication prior to the injection, which could impair your driving ability.

Plan on spending about 90 minutes at the Advanced Pain Institute. This includes time for patient registration, preparation, performance of the procedure and observation.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand or arm. We will initiate continuous monitoring of your heart, breathing and blood pressure. You will then be asked to either sit or lie on your side on the treatment bed. Sometimes, X-ray guidance aids in appropriate placement of the medication. Once the equipment has been positioned, you may be offered a sedative medication to help you relax.

After cleaning a small patch of your skin, a local anesthetic is injected into the skin to decrease any pain associated with the procedure. The steroid medication is then administered through a small needle. The procedure itself is very brief, usually less than five minutes.

Occasionally, patients describe a recurrence of their normal back pain during administration of the medication. This is viewed as a reassuring sign that the medication is going to the right place, and the sensation usually disappears quickly.

What happens after the procedure?
After the epidural steroid medication has been injected, we will continue to monitor you for about 20 minutes. If there are no signs of problems, you will be ready to leave. You may go to the reception area and schedule your follow-up injections. We will provide your physician with a written record of the procedure and will keep him/her informed of your progress during the entire course of treatment. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, seven days a week. During normal business hours and after hours (doctor will be paged), you can reach either the nurse or physician by calling (626) 445-2371.

Will my insurance cover the procedure?
The epidural steroid injection is a well-established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible. The same copayments you make at your family physician’s office will often apply at the Pain Management Center.

What is a hypogastric plexus block?
The hypogastric plexus is a collection of nerves that is located in front of the fifth lumbar and first sacral vertebral bodies. This means that the plexus is located near the lower part of your abdomen in the upper front of your pelvis. A hypogastric plexus block involves the administration of a dose of pain killing medication near the region of this nerve collection. The hypogastric block usually involves a series of several injections, repeated at weekly intervals. This treatment has brought relief to many patients who suffer from pain located in the pelvic structures, to include pain located in the region of the bladder, lower intestines, as well as the uterus, ovaries and vagina in women, and the prostate and testicles in men.

How quickly can I expect pain relief? Most patients can expect pain relief within the first 15 to 20 minutes of the injection of local anesthetic. This pain relief may only last several hours; however, if the physician has also used steroid medication, you may also receive some pain relief that will begin roughly 36 hours after the injection. Duration of pain relief is somewhat variable, as it differs from patient to patient.

How should I prepare for the procedure?
The hypogastric plexus block is a safe medical procedure but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for 6 hours prior to the procedure.

We require that you be accompanied to and from the Center by a responsible adult driver. Most likely you will be offered a small dose of intravenous medication during the procedure which will act to not only decrease anxiety, but provide you some pain relief from the minor discomfort of the procedure itself. This intravenous medication will also impair your driving ability.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.

You will then be positioned on your stomach. The physicians will use X-ray guidance to aid in appropriate placement of the medication. After clearing a small patch of your skin, a local anesthetic is injected into the skin to decrease any pain associated with the procedure. The medication will then be administered through a needle near your hip bones on both sides. The procedure itself usually lasts 10 to 15 minutes. Occasionally, patients describe a very transient recurrence of their pelvic pain during administration of their medication. This is viewed as a reassuring sign that the medication is going to the right place, and the sensation usually disappears very quickly.

What happens after the procedure?
After the hypogastric plexus block is performed, we will continue to monitor you in the recovery room for 30 to 40 minutes. If there are no signs of any problems, you will be ready to leave. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week.

Will my insurance cover the procedure?
The hypogastric plexus block is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

What should I expect from this procedure?
Expect the block to provide you with several hours of pain relief. After this time the pain will likely return. If the physicians have used steroid medication in addition to the local anesthetic, this may provide you with further pain relief after 36 to 48 hours. Sometimes, this block is performed for diagnostic reasons. This means that your physicians have chosen to do this block in order to determine a possible cause for your pain. In this instance, you may or may not experience any pain relief.

What possible side effects might I see?
The most common side effect from this procedure is a sore back in the region where the blocks were performed. There is a very small chance of the needle puncturing a blood vessel. This potentially could lead to blood clot formation in your pelvis; however, this is extremely rare and your physician will take extra precautions to attempt to avoid this complication. There is also a very rare chance of injury to either the kidney or urethras. The urethras are the structure that connects your kidneys to your bladder. These risks are, again, extremely small and are even less likely when the procedure is performed under x-ray guidance.

What should I do if any problems develop after I leave?
If you have any questions after the procedure, the medical staff of the Pain Management Center is on call 24 hours a day, 7 days a week.

Post procedure instructions
These will be provided for you, in further detail, by the recovery room nurse prior to your discharge from the Ambulatory Surgery Center. These instructions should include: no driving or operating heavy machinery for 24 hours after the procedure. This is recommended due to the fact that you have received intravenous medication during a procedure which may impair your ability to perform these tasks.

What is an occipital nerve block?
Occipital nerve block is a medical procedure that involves administration of a dose of medication into an area in the back of your head. It is most frequently used to diagnose and treat a type of tension headache most likely due to occipital neuralgia or an irritation of a nerve in the back of one’s head. This treatment has brought relief to many patients who suffer from pain caused by occipital tension headaches.

How quickly can I expect pain relief?
Pain relief is usually felt fairly quickly after the injection of medication. If your doctor uses a local anesthetic followed by a steroid type of medication, you can expect to feel some initial pain relief that may then dissipate when the local anesthetic has worn off (several hours later). You can expect to feel some additional pain relief roughly 48 hours later when the steroid medication begins to take effect.

How should I prepare for the procedure?
The occipital nerve block is a safe medical procedure but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for 6 hours prior to the procedure.

We require that you be accompanied to and from API by a responsible adult driver. Most likely you will be offered a small dose of intravenous medication during the procedure which will act to not only decrease anxiety, but provide you some pain relief from the minor discomfort of the procedure itself. This intravenous medication will also impair your driving ability.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.

You will then be asked to sit on the side of the bed. After cleaning a small patch of your skin, a local anesthetic will be injected into the skin to decrease any pain associated with performance of the procedure. The medication is then administered through a small needle in the occipital region of your head and neck. The procedure itself is very brief, and usually lasts less than 10 minutes. Occasionally, patients describe a transient worsening of their headache after the medication is administered. This is viewed by the physicians as a reassuring sign that the medication is going into the right area, and this sensation should disappear very quickly.

What happens after the procedure?
After the occipital nerve block is performed, we will continue to monitor you in the recovery room for 30 to 40 minutes. If there are no signs of any problems, you will be ready to leave. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either a nurse or physician by calling (626) 445-2371.

Will my insurance cover the procedure?
The occipital nerve block is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments, depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

What should I expect from this procedure? Occasionally, patients will describe a transient worsening of their headache as the injection is made. This is viewed by the physicians as a reassuring sign that the medication is going to the right place, and the sensation usually disappears very quickly. This should then be followed by a pain free interval of several hours. After the local anesthetic has worn off, your headache may return for up to 1-1/2 days. After this time, the steroid medication that was also injected for your occipital nerve block should begin to work and provide you with further pain relief.

What possible side effects might I see?
As stated above, after the local anesthetic that was injected as part of your occipital nerve block wears off, your headache may return for roughly 24 to 36 hours. After this time, you should receive some pain relief from the medication that was also injected during the time of your occipital nerve block. You may also experience some slight soreness at the site of the injection. This is very normal, and should go away within a couple of days.

What should I do if any problems develop after I leave the hospital?
If you have any questions after the procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either the nurse or physician by calling (626) 445-2371.

Post procedure instructions
These will be provided for you, in further detail, by the recovery room nurse, prior to your discharge from the Ambulatory Surgery Center. These instructions should include: no driving or operating heavy machinery for 24 hours after the procedure. This is recommended due to the fact that you have received intravenous medication during a procedure which may impair your ability to perform these tasks.

What is an implanted epidural portal?
An epidural portal (or port) is an implanted device which allows access to the epidural space in your spine. It is used for the delivery of medications for pain management. A port is a small, stainless steel disc (about the size of a half dollar) with a raised “septum” in the center. Because the section is raised, it is easily felt through the surface of the skin. The port is usually implanted under the skin on the chest. Attached to the base of the port is a narrow flexible tube, called a catheter. The catheter runs beneath the skin from the epidural space in the space around to the front of the chest where it is attached to the port. Since the entire device is placed under the skin, the risk of infection is greatly reduced. The septum is made of a remarkable, self-sealing rubber material. Over years of use, the septum may be punctured many hundreds of times and reseals itself instantly after use. This procedure is done only after a trial of epidural medications has been proven to be useful in managing your pain.

How quickly can I expect pain relief?
Once the epidural port is placed, an infusion of medications (local anesthetics and/or narcotics) is initiated. These medications should bring about pain relief within minutes. It may, however, take a few days to adjust the dose for the optimal pain relief.

How should I prepare for the procedure?
The implanted epidural portal placement is a safe medical procedure; but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for 6 hours prior to the procedure.

Following placement of the epidural portal you will be required to stay overnight for observation.

We require that you be accompanied to and from the Advanced Pain Institute by a responsible adult driver.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.

Your back will be cleaned and the insertion point of the epidural port will be anesthetized with local anesthesia. The epidural needle is placed through a small incision in your back and the catheter is threaded through the needle under the guidance of X-ray. A second small incision is made on the upper part of your chest wall and a pocket is created in the tissues beneath the skin. The small circular epidural port is inserted into this pocket and connected to the catheter which is tunneled underneath the skin from you back. The two incisions, on the chest wall and on your back, are closed with stitches and both are dressed with a sterile dressing. The port is then accessed with an access needle and connected to an external infusion pump containing the epidural medications. The epidural port will be functioning before you leave the surgical suite to provide you pain relief.

A majority of this procedure is performed under a local anesthesia, thereby providing minimal discomfort at the time of the surgery, and also providing pain relief for 6 to 12 hours afterwards. You will also receive sedation to provide optimal comfort during the procedure.

What happens after the procedure?
Once the port is placed, it will be accessed with a special needle and connected to an external infusion pump containing the epidural medications. We will assess that the port is functioning correctly by observing for signs of pain relief from the medications, as well as development of numbness from the local anesthetic. You will be monitored for 20 to 40 minutes by a recovery room nurse and a pain management physician. If there are no signs of problems, you will be ready to leave the recovery area and be transferred to your room in the Advanced Pain Institute for overnight observation. You will be monitored for proper functioning of the newly placed epidural port, as well as for any complications related to the procedure and the anesthesia. If there are no further difficulties, you will be released the following day.

A home nursing agency will be required to provide care for your epidural port. The medication cassette will need to be changed daily. The dressing, needle, and the infusion tubing will need to be changed every three days by a home visiting nurse. The visiting nurse will also monitor for any possible signs of infection.

Your port will be dosed with medications on either an intermittent or continuous basis based on the determination of the pain management physician.

Will my insurance cover the procedure?
The implanted epidural portal is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

What should I expect from this procedure?
You will require a short period of recovery from this minor surgical procedure. You may notice soreness in the chest wall where the epidural port is placed and some soreness in the back where the catheter is inserted; the pain is usually quite minimal. There will be some bruising which may last up to a week, but will resolve. Your home nursing agency will assist in monitoring the two sites for any evidence of infection. Signs to monitor are redness and/or increased pain or swelling of the two incision sites. The stitches will be removed at the Advanced Pain Institute in approximately one week, provided that the incisions are well healed.

What possible side effects might I see?
The epidural portal placement is a safe minor surgical procedure but, as with any procedure, it has risks as well as benefits. The major risks of an in dwelling foreign device are infection and/or local bleeding. Usage of such a device over the long term requires vigilance to maintain clean technique and decrease the likelihood of infection.

The epidural portal accesses the epidural space. The medications delivered there may cause numbness and/or weakness and/or sedation depending on which medication is used and what dose is administered. These side effects are normally reversible. You may have some local tenderness at the portal insertion points once the numbing medicine has worn off.

What should I do if any problems develop after I leave the hospital?
If you have any questions after the procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either the nurse or physician by calling (626) 445-2371.

Post procedure instructions
Prior to leaving the hospital, the incision areas will be dressed with a clear, dry sterile dressing. You will be able to see through the dressing and can watch for any signs of infection. The visiting nurses will change the access needle and tubing for the infusion pump every three days. They will also monitor to make sure the wounds are healing appropriately.

What is a brachial plexus block?
A brachial plexus block is a medical procedure that involves the administration of a dose of local anesthetic into an area either in your neck, above your collarbone or into your upper arm (near the armpit). This block may be performed as a single injection or a very small catheter may be inserted into one of these areas in order to provide continuous or repeated administration of medication. This treatment has brought relief to many patients who suffer from chronic pain of their arm and shoulder.

How quickly can I expect pain relief?
Relief is fairly quick (within 10 to 15 minutes) after the injection of medication.

How should I prepare for the procedure?
The brachial plexus block is a safe medical procedure but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for 6 hours prior to the procedure.

It is required that you be accompanied to and from the Advanced Pain Institute by a responsible adult driver. Most likely you will be offered a small dose of intravenous medication during the procedure which will act to not only decrease anxiety, but provide you some relief from the minor discomfort of the procedure itself. This intravenous medication that you receive will impair your driving ability; therefore, it is imperative that you be accompanied by a responsible adult driver.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.

After cleaning a small patch of your skin in the region of your neck, your collar bone or your upper arm, the local anesthetic is injected into the skin to decrease any pain associated with the performance of this procedure. After exact placement of the needle is confirmed, your physician will administer the medication through a small needle. If you and your physician had decided pre-operatively to place a catheter for more continuous administration of medication after the procedure, this will then be placed in the proper position. The procedure itself usually lasts 20 minutes. Occasionally, patients describe a recurrence of their normal arm or shoulder pain during the administration of the medication. This is viewed as a reassuring sign that the medication is going to the right place and the sensation should disappear very quickly.

What happens afterwards?
After the brachial plexus block is performed, we will continue to monitor you in the recovery room for 30 to 40 minutes. If there are no signs of any problems, you will be discharged. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either the nurse or physician by calling (626) 445-2371.

Will my insurance cover the procedure?
The brachial plexus block is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

What should I expect from this procedure?
A dose of local anesthetic will be administered through a small needle into an area either located in your neck, above your collar bone, or in the upper part of your arm. Your physician then may place a small catheter into one of these locations. This would have been discussed with you prior to the procedure and would enable administering a more continuous delivery of medicine. In some instances, despite the medicine being administered to the appropriate location, the patient is not experiencing any pain relief. Although this is unfortunate, it may give your doctor some valuable information.

What possible side effects might I see?
Occasionally patients will describe recurrence of their normal arm or shoulder pain during administration of the medication. This is viewed as a reassuring sign that the medication is going to the right place and the sensation usually disappears very quickly. Other possible risks of this procedure include bleeding, infection, or the injection of medication into a blood vessel which potentially can cause seizures. These risks are extremely rare, and your physicians will be continually monitoring your vital signs in order to guard against these complications.

What should I do if any problems develop after I leave the hospital?
If you have any questions after the procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either the nurse or physician by calling (626) 445-2371.

Post procedural instructions
These will be provided for you, in further detail, by the recovery room nurse prior to your discharge from the Advanced Pain Institute. These instructions should include: no driving or operating heavy machinery for 24 hours after the procedure. This is recommended secondary to the fact that you have received intravenous medication during a procedure which may impair your ability to perform these tasks.

In addition, some patients notice weakness in the arm or shoulder that has been “blocked.” It is important, therefore, for you not to attempt to lift heavy objects with this arm for 12 to 24 hours after the procedure.

What is a gasserian ganglion block?
A gasserian ganglion block is a medical procedure administering of a dose of local anesthetics directly to a bundle of nerves that supplies sensation to your face and scalp. This nerve block may bring relief to patients who suffer from trigeminal neuralgia and other syndromes of facial pain, as well as patients who suffer from pain caused by cancer. In some instances, in patients who suffer from facial pain from cancer, a small dose of medication to kill the nerve going to the gasserian ganglion can be used. This is not an option for patients who do not have cancer.

How quickly can I expect pain relief?
Relief is instantaneous, if the pain that you are experiencing is related only to the nerves which go to the gasserian ganglion. Total duration of pain relief will be 6 to 12 hours. If a nerve killing medication is used, maximum relief starts in 1 to 2 days, and may last up to 3 to 6 months.

How should I prepare for the procedure?
The gasserian ganglion block is a safe medical procedure but as with any procedure it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for 6 hours prior to the procedure. An exception is always made for routine scheduled medication, which you can take with a sip of water.

We ask that you be accompanied to and from the Advanced Pain Institute by a responsible adult driver. Physicians, or a nurse at the Advanced Pain Institute may offer a small dose of relaxing medication prior to the procedure, which could impair your driving ability.

Plan on spending approximately 90 minutes at the Advanced Pain Institute. This includes time for registration, preparation, performance of the procedure and observation period.

What happens during the procedure?
First, an intravenous line will be placed, generally in your hand or arm. We will initiate continuous monitoring of your heart, breathing and blood pressure. You will be asked to lie on the treatment table. X-ray guidance will be used to help with placement of the medication. Once the equipment has been positioned, you will be offered sedative medications to help you relax and minimize discomfort.

A patch of skin over your face will be cleaned, using an antiseptic solution, and local anesthetic injected into the skin to decrease any pain associated with the procedure. A needle will be placed adjacent to the gasserian ganglion using X-ray guidance. The procedure takes approximately 10 to 15 minutes to perform once the monitors and X-ray machine are in place. Occasionally, because the gasserian ganglion is adjacent to blood vessels, swelling or facial bruising may occur. Should this happen, we would recommend that you rest in a seated position and use an ice pack.

What happens after the procedure?
After the gasserian ganglion block has been performed, we will continue to monitor you for approximately 30 minutes. If there are no signs of problems, you will be discharged. We will provide your physician with a written record of the procedure and will keep him/her informed of your progress during the entire course of treatment. You will be provided with a set of post procedure instructions to guide you following the procedure. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach the nurse or physician at (626) 445-2371.

Will my insurance cover the procedure?
The gasserian ganglion block is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible. The same copayments you make at your family physician’s office will often apply at the Advanced Pain Institute.

How do I make an appointment?
Your physician should send a referral note to the Advanced Pain Institute. The referral must include your name, address and phone number; a brief description of your condition; the physician’s request for this specific procedure; and the physician’s name, address and phone number. When we have received this information, we will call you to schedule an appointment, often within 24 hours.

What should I expect from this procedure?
This is usually a diagnostic procedure that allows us to pinpoint, more accurately, the location of the origin of your pain syndrome. Sometimes repeated gasserian ganglion blocks can be used to decrease certain types of facial pain syndromes. In general, nerve killing procedures are not performed or recommended except in certain instances of patients with cancer pain. In general, local anesthetic is used to block the nerves that go to your pain. You might have some numbness of your face and gums, and decreased ability to chew. This might last between 6 and 12 hours. When the numbness resolves, your pain might return or you might have pain control that extends beyond the duration of the local anesthetic. It will be important for you to tell your pain management doctor about your pain control, following the block.

What possible side effects might I see?
In general, the most frequent complications include facial swelling and bruising because of the proximity of blood vessels to the gasserian ganglion. This should be treated with ice and elevation, should it occur. In addition, other nerves are adjacent to the gasserian ganglion and can, in very rare circumstances, develop weakness from the local anesthetic medication. In general, this would be noticed in the recovery room. However, if you had difficulty with breathing or swallowing following the procedure, we would want you to inform one of the recovery room nurses or physicians. Sometimes, despite the use of an X-ray machine, we are unable to place the medication in the appropriate space because of technical difficulty. Finally, while most patients experience pain relief, in rare instances, sometimes there is an aggravation of the current pain symptoms. This is likely secondary to the facial swelling or bruising as stated, and is likely to last for several days.

What should I do if any problems develop after I leave the hospital?
Call the Advanced Pain Institute at (626) 445-2371.

Post procedure instructions
Use Tylenol and apply ice to the facial region for several hours following the procedure. Try to keep your head elevated for several hours until you are sure that no significant swelling will occur. Non steroidal medication, such as aspirin and Motrin, is not recommended for the first 24 hours because this may increase swelling. Please call the Advanced Pain Institute to report your total duration of pain relief the following day. If you do not have a follow up appointment, or a specific plan, then you need to discuss this with the pain management physician who has been taking care of you.

Spinal cord stimulation can relieve chronic pain in the back, arms or legs. It works by electrically stimulating the spinal cord. Instead of pain, the patient feels a tingling or buzzing sensation. Substitution of one sensation for another is something we do almost instinctively. For example, if we strike our hand on something, we rub it almost immediately, substituting the rubbing sensation for the pain sensation.

The spinal cord stimulation system consists of several parts:
A battery-powered device called a pulse generator is implanted in the back or abdomen. It generates low-voltage electrical stimulation at the spinal cord through an insulated wire lead. The pulse generator never has to be replaced - just the batteries that power it.

A lead is implanted in the epidural space (the next to the sac that surrounds the spinal cord) near the nerves that correspond to the patient's areas of pain.

An external programmer allows patients to fine-tune therapy within physician prescribed parameters to address changing pain relief needs.

The ideal patient for the spinal cord stimulator is someone with one of the following conditions who has not responded well to more conservative therapies:

Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome

Nerve Damage
Spinal Cord Damage
Phantom Limb Pain
Blood Vessel Disease
Spinal Cord Stimulation involves a two part process:

- Implantation of temporary spinal cord stimulator leads with trial period
- Permanent implantation of a spinal cord stimulator generator if trial is successful

Intravenous Lidocaine Infusion:

What should I expect from this procedure?
The intravenous lidocaine infusion is used to assess the potential benefits of lidocaine and related medications on managing your pain. Depending on the specific cause of your pain, some patients report immediate and continued relief associated with the intravenous administration of lidocaine. Other patients with different reasons for their pain indicate that their pain relief is slow in coming on and may last only as long as the medication is being infused. Yet another group of patients receiving the intravenous lidocaine describe some unpleasant or non-beneficial response from the lidocaine. However, prior to the performance of the procedure, your physicians have no way of identifying which group you may belong to. If you noted significant improvement in your pain or change in the way your pain feels during the course of the infusion, your evaluating physicians request that you pay special attention to how long the beneficial effects of this medication last and report this to us either with a telephone call, after you leave the Advanced Pain Institute, or at the time you are scheduled to see us next for further evaluation and/or treatment.

What possible side effects might I see?
Generally, there are no side effects following the intravenous infusion of lidocaine. Because of the nature of this procedure, the maximum effects of the medicine are seen during the time you are being carefully observed by the physicians and staff of the Advanced Pain Institute. Occasionally, patients do describe some peculiar feelings for hours following an intravenous lidocaine infusion. Such feelings can include general fatigue, persistent dizziness or a headache. All of these symptoms that have been previously reported, however, seem to disappear within the first day following the procedure. While we would like to reassure you that such side effects are not dangerous, if you have concerns regarding any particular side effect, or potential complication to the lidocaine infusion that you received, we would appreciate you contacting the physicians and staff of the Advanced Pain Institute to ask us specific questions.

What should I do if any problems develop after I leave the Advanced Pain Institute?
Call the Advanced Pain Institute at (626) 445-2371.

Nucleoplasty:
In the Nucleoplasty procedure, the physician removes tissue and applies controlled levels of thermal energy (heat) to the disc. Nucleoplasty is usually performed on an outpatient basis. Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. You will be awake enabling you to provide important feedback to the physician. With the guidance of X-ray images, your physician will first advance a needle into the disc. A specialized device, known as a Perc-D™ SpineWand™, will then be introduced through the needle and into the disc.

Nucleoplasty consists of creating a series of channels in your disc and then thermally treating the tissue immediately adjacent to the Perc-D SpineWand. Small amounts of radio wave energy are released into the damaged disc through the Perc-D SpineWand that is about the thickness of a dime. The energy creates a molecular reaction that causes some of the spongy tissue inside the damaged disc to dissolve. As pressure inside the disc is reduced, the herniation in the shell retracts, the irritation to the nearby nerve roots is reduced, and pain is relieved. The procedure should take less than an hour.

Who is a candidate for Nucleoplasty?
Nucleoplasty is a minimally invasive procedure developed for patients with contained herniated discs. To understand how a contained herniated disc works, think of a bicycle tire with a bulge in it. The bulge can certainly make for a rough ride. When a bulge or "herniation" appears in the shell of a disc due to injury or the normal aging process, severe pain can result. This is because the disc is surrounded by sensitive nerve roots in the spine. If the bulge is big enough to rub against these nerve roots, pain can radiate throughout the lower back and upper legs. According to the clinical studies, the results are about equal to those of traditional disc surgeries -- but without the trauma, extensive recovery period, high cost, or most of the potential complications. Based on these studies, approximately four out of five Nucleoplasty patients saw successful results as measured by patient satisfaction scores, reduced pain, absence of narcotics use, and return to work. The procedure is safe, effective, cleared by the Food and Drug Administration, and recognized by the American Medical Association as a qualified method for treating contained herniated discs.

Epidural Neuroplasty:

What should I expect from this procedure?
This procedure is otherwise known as epidural lysis of adhesions or the "RACZ" procedure named after the physician who first performed the procedure.

It has been found that after trauma or surgery of the spine, scar tissue forms around the nerves in the spinal canal. It has also been shown that the presence of scar tissue compounded pain associated with nerve roots by adhering the nerve roots to one position and thus increasing the nerve root to tension or compression. This active insult to nerve roots cause significant intraneural edema, or swelling in the nerve root itself. Pain can also result from the nerve endings found throughout the spinal canal and associated structures.

Epidural Neuroplasty or Epidural Neurolysis is a procedure to help identify significant epidural adhesion and fibrosis, whether from trauma to the spinal structures or from corrective surgery itself. By using 1) anti-inflammatory medication, 2) medications aimed at reducing edema, 3) local anesthetics to block nerves that carry pain information to the brain, and 4) fluid and special medications to break down scarring around the spinal nerves and structures. There is rationale to target the anterior epidural space.

The procedure itself is done as an outpatient, under light sedation and x-ray guidance. There are several variations on the procedure, some involving inpatient admissions and several different medications. Your physician will discuss this with you and how it applies to your particular situation. Several different approaches to the scarring are possible, sometimes utilizing both approaches at the same time. During the lysis of the adhesions, pain can sometimes be felt into the back, buttocks or into the legs. This is due to the pressure of the scarring on the nerves.

With treatment that includes hyaluronidase, up to 80% of patients report some pain relief, with a significant number reporting long-term pain relief.

What possible side effects might I see?
Occasionally postoperative pain can be felt for up to 1 week. With the reduction of pain, your physician will occasionally start physical therapy.

As with any procedure, there are potential complications. The most common complication of Epidural Neuroplasty is unintended subarachnoid injection. Others may include bleeding, infection, bladder dysfunction, and transient motor weakness. There is a small chance of hypersensitivity to hyaluronidase, which can be used during the treatment.

 

Epidural injections are common treatment for neck, back and extremity pain.

The epidural space is an area of the spine that the nerves from the spinal cord pass through. If you have Disc Disease, Spinal Stenosis, Epidural Fibrosis, Post-Laminectomy Syndrome or other specific diagnosis of problems in the epidural space of the back, then you may have Epidural inflammation and pain.

Epidural injections with local anesthetics and light steroid medications can reduce inflammation, restore normal size of epidural nerves and relieve pain.

A caudal epidural is such an injection into the caudal canal, which is the sacral portion of the spinal canal.

What should I expect from this procedure?
The injection is mildly uncomfortable and easily tolerated by almost all patients. Dr. MineHart will numb the area of injection for your comfort.

What happens after the procedure?
Complications are extremely rare but can occur. You may wish to discuss this with Dr. MineHart in more detail.

Some patients do well with 1-2 injections but others will require a series of 3-4 injections and if successful may need booster injections every 3-12 months, depending on your diagnosis and pain level.

 

Epidural injections are common treatment for neck, back and extremity pain.

The epidural space is an area of the spine that the nerves from the spinal cord pass through. If you have Disc Disease, Spinal Stenosis, Epidural Fibrosis, Post-Laminectomy Syndrome or other specific diagnosis of problems in the epidural space of the back, then you may have Epidural inflammation and pain.

Epidural injections with local anesthetics and light steroid medications can reduce inflammation, restore normal size of epidural nerves and relieve pain.

A caudal epidural is such an injection into the caudal canal, which is the sacral portion of the spinal canal. In this procedure, a stylet is used to guide the needle to the precise point of injection.

What should I expect from this procedure?
The injection is mildly uncomfortable and easily tolerated by almost all patients. Dr. MineHart will numb the area of injection for your comfort.

What happens after the procedure?
Complications are extremely rare but can occur. You may wish to discuss this with Dr. MineHart in more detail.

Some patients do well with 1-2 injections but others will require a series of 3-4 injections and if successful may need booster injections every 3-12 months, depending on your diagnosis and pain level.

 

Cervical facet joints are small joints located in pairs on the back of your neck. They provide stability and guide motion in your neck. If the joints become painful they may cause pain in your head, neck, shoulders, down between your shoulder blades or in your arms.

Facet joint injections can help relieve pain in several ways. After numbing medicine is injected into the joint, you will experience immediate pain relief that will help confirm or deny the joint as a source of your pain. Additionally, the temporary relief of the numbing medicine may better allow a chiropractor or physical therapist to treat that joint. The time released steroid will also help reduce any inflammation that you may have within your joints.

What should I expect from this procedure?
The injection is mildly uncomfortable and easily tolerated by almost all patients. Dr. MineHart will numb the area of injection for your comfort.

What happens after the procedure?
Complications are extremely rare but can occur. You may wish to discuss this with Dr. MineHart in more detail.

Some patients do well with 1-2 injections but others will require a series of 3-4 injections and if successful may need booster injections every 3-12 months, depending on your diagnosis and pain level.

The injection is mildly uncomfortable and easily tolerated by almost all patients. Dr. MineHart will numb the area of injection for your comfort.

 

What should I expect from this procedure?
The chemical destruction of the nerve, called neurolysis, is a form of treatment that consists of 7-10 weekly injections of phenol mixed with a local anesthetic. This treatment is used in management of chronic pain, treatment of cancer pain and alternative management to treat spasticity in order to improve balance, gait, self-care and global rehabilitation. Chemical neurolysis is a safe and effective treatment option for patients who want to avoid a surgical procedure and any associated complications.

The injections are given into the area of the neuroma (nerve tissue). To ensure precise placement of the injection directly into the neuroma, we utilize diagnostic ultrasound, which allows us to see exactly where the injection is being placed. Nerve tissue has a natural affinity for phenol and it is easily absorbed into the nerve. The injection is mildly uncomfortable and easily tolerated by almost all patients. Dr. MineHart will numb the area of injection for your comfort.

What happens after the procedure?
Avoidance of repetitive activities that aggravate the pain combined with short-term immobilization of the affected area may also provide relief. The use of local heat as well as gentle range of motion exercises should be introduced several days after injection technique.

 

What should I expect from this procedure?
Intra-articular spinal facet injections are diagnostic/therapeutic injections done to determine the presence or absence of mechanical pain, or pain caused by certain movements. This injection is done to diagnose and treat pain. Your physician will inject local anesthetic and steroid medications into the facet joint. Facet joints are located in pairs on the back of your spine, and are part of the individual joints/bones that make up your spinal column. These joints can become painful when inflamed. The injection can reduce inflammation and reduce or eliminate your pain. If the initial procedure helps relieve your pain, your physician may complete a series of injections, which has been shown to reduce pain.

How quickly can I expect pain relief?
You might feel some initial pain relief from the local anesthetic immediately following the procedure. Your pain may return and then be relieved again when the steroid begins to work. Do not be alarmed if your relief is temporary, as it can take from 12 hours to 2 days for the steroid to work and relieve your pain.

How should I prepare for the procedure?
You should eat no solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your regular medications with a small amount of water. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. The Advanced Pain Institute will direct you when to stop taking these medications.

What happens during and after the procedure?
You will be taken to the procedure area and positioned on a special x-ray table. You will be connected to monitoring equipment. Your skin will be sterilized with Betadine or a similar solution and the needle insertion site will be numbed with local anesthesia. Needle(s) will be inserted into the facet joints that your physician has determined appropriate for the location of your pain. Generally a local anesthetic will be injected into the region. Your physician on most occasions also injects some dye with the medications.

Will my insurance cover the procedure?
Most insurance companies currently cover facet joint injections. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5° degrees or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), please call the Advanced Pain Institute immediately (626) 445-2371.

What post procedure instructions are recommended?
You should rest for a few hours following the procedure, and use assistance if needed. You may resume light activity soon after the procedure, and resume your regular diet. Do not drive or operate machinery for at least 12 hours following the procedure.

 

What should I expect from this procedure?
A lumbar facet joint block is an injection of local anesthetic into one or more of the small joints located along the side of each vertebrae in the lower back. Multiple injections may be performed, depending upon how many joints are involved. Facet joint blocks are typically requested for patients who have back pain primarily as a result of arthritic changes in the facet joints or for patients who have lower back pain. A facet joint block may be diagnostic, to determine the source of the pain, or therapeutic, to relieve the pain.

How quickly can I expect pain relief?
You might feel some initial pain relief from the local anesthetic immediately following the procedure. Your pain may return and then be relieved again when the steroid begins to work. Do not be alarmed if your relief is temporary, as it can take 12 hours to 2 days for the steroid to work and relieve your pain.

How should I prepare for the procedure?
You should eat no solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your regular medications with a small amount of water. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. The Advanced Pain Institute will direct you when to stop taking these medications.

What happens during and after the procedure?
During the procedure, a thin needle will be inserted near your lumbar spine to the affected facet joint. The doctor will use an x-ray with dye or a computerized tomography (CT) scan to help guide the needle. He will place the needle tip inside or just outside the facet joint. When the needle is placed properly, the doctor will inject medicines like steroids for inflammation and anesthesia for immediate pain relief.

You may be taken to a recovery room to rest following the procedure. Once the Advanced Pain Institute staff determines you are ok, you will be released.

Will my insurance cover the procedure?
Most insurance companies currently cover lumbar facet blocks. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5° or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), please call the Advanced Pain Institute immediately (626) 445-2371.

What post procedure instructions are recommended?
You should rest for a few hours following the procedure, and use assistance if needed. You may resume light activity soon after the procedure, and resume your regular diet. Do not drive or operate machinery for at least 12 hours following the procedure.

 

What should I expect from this procedure?
The transforaminal epidural steroid injection is a very selective injection around a specific nerve root. The doctor can determine if this nerve root is causing the problem by injecting medication around a specific nerve root. Commonly used in the neck, this type of epidural injection is used most often for diagnostic purposes.

How quickly can I expect pain relief?
You should feel relief immediately due to the anesthesia. After the local anesthetic wears off, you may feel some discomfort return, which should resolve after the steroid medication starts to work.

How should I prepare for the procedure?
You should eat no solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your regular medications with a small amount of water. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. The Advanced Pain Institute will direct you when to stop taking these medications.

What happens during and after the procedure?
You will be asked to lie on a special x-ray table for the procedure. You will be given light intravenous sedation and local anesthetic in the area over the nerve root opening. A needle will be guided into the opening where the nerve root is being compressed, using x-ray. A dye solution that can be seen on our x-ray monitor is injected so that we can determine the extent to which the nerve is being compressed. Local anesthetic will be injected around the nerve root to relieve your pain. A steroid medication is also injected around the nerve root which acts as an anti-inflammatory medication to decrease the inflammation and swelling of the nerve root.

Will my insurance cover the procedure?
Most insurance companies currently cover lumbar transforaminal. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you have continued pain, fever or leg weakness, call the Advanced Pain Institute. Please do not perform vigorous activity for one week. When you are feeling better, slowly increase your activity level.

What post procedure instructions are recommended?
You should rest for a few hours following the procedure, and use assistance if needed. You may resume light activity soon after the procedure, and resume your regular diet. Do not drive or operate machinery for at least 12 hours following the procedure.

 

What should I expect from this procedure?
Discography confirms or denies the disc(s) as a source of your pain. It is a relatively simple procedure that uses a small needle to inject contrast dye into your disc. MRI and CT scans only demonstrate anatomy and cannot absolutely prove your pain source. In many instances, discs are abnormal on MRI or CT scans but are not a source of pain. Only discography, which is a functional test, can tell if the disc itself is a source of your pain. Discography is usually performed only if you think your pain is significant enough for you to consider more advanced treatment options, directed at the disc itself, such as surgery.

How quickly can I expect pain relief?
You should feel relief immediately due to the anesthesia. After the local anesthetic wears off, you may feel some discomfort return, which should resolve after the steroid medication starts to work.

How should I prepare for the procedure?
You should eat no solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your regular medications with a small amount of water. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. The Advanced Pain Institute will direct you when to stop taking these medications.

What happens during and after the procedure?
You will be given an IV with relaxing medicine. You will be asked to lie on your stomach. Your skin will then be cleansed with an antiseptic solution. The physician will numb a small area of skin. Next, the physician will use x-ray guidance to direct a small needle into the center of your disc. You may feel temporary discomfort as the needle passes through the muscle and other soft tissues near your spine. The physician may repeat this at several adjoining disc levels. After the needles are in their proper locations, a small amount of contrast dye is injected into each disc. If a disc is the source of your usual pain, the injection will temporarily reproduce discomfort in the area of your usual symptoms. If a disc is not the source of your pain, then the injection will not produce any discomfort, or will not reproduce your usual symptoms.

Will my insurance cover the procedure?
Most insurance companies currently cover lumbar discograms. They are covered by Medicare and other government funded insurance plans. However, coverage may vary depending on your specific plan and policy.

What possible side effects might I see?
Possible side effects may include drowsiness, temporary numbness, weakness and soreness.

What should I do if any problems develop after I leave the hospital?
If you have continued pain, fever or leg weakness, call the Advanced Pain Institute. Please do not perform vigorous activity for one week. When you are feeling better, slowly increase your activity level.

What post procedure instructions are recommended?
You should not drive and should limit activities on the day of your procedure. Over the next 2-3 days, your muscles may be sore and your usual pain aggravated. Ice will usually be more helpful than heat during this period. You can take your regular pain medicine as prescribed. You will also be given, if desired, a prescription for stronger pain medication. On the second to third day, you may return to your regular activities. Soreness should improve by the third day and your pain will be reduced. When your pain is improved, resume your regular exercises/activities in moderation.