Our Services
Interventional Pain Procedures
Precision-guided procedures that target the exact source of your pain. Our board-certified specialists use fluoroscopic and ultrasound guidance to deliver treatments that are accurate, safe, and effective.
Interventional pain procedures are minimally invasive techniques that directly address the anatomical source of pain. Unlike systemic medications, these targeted treatments deliver relief precisely where it is needed — reducing side effects and improving outcomes. All procedures at Epione Pain Center are performed by fellowship-trained specialists using fluoroscopic or ultrasound imaging guidance.
Epidural Steroid Injections
Spinal Pain • Radiculopathy • Disc Herniation
An epidural steroid injection (ESI) delivers a corticosteroid medication directly into the epidural space — the area surrounding the spinal cord and nerve roots. By reducing inflammation at the source, ESIs can provide significant relief from pain that radiates from the spine into the arms or legs.
What it treats
- Radiculopathy (pinched nerve) causing arm or leg pain
- Herniated or bulging discs pressing on spinal nerves
- Spinal stenosis (narrowing of the spinal canal)
- Degenerative disc disease with nerve involvement
What to expect
The procedure takes 15 to 30 minutes and is performed under fluoroscopic (live X-ray) guidance to ensure the medication is placed precisely in the epidural space. A local anesthetic is used to minimize discomfort. Most patients require a series of up to three injections spaced several weeks apart for optimal benefit. Relief typically begins within a few days and can last for several months, allowing you to engage more fully in physiotherapy and rehabilitation.
Recovery: Most patients return to normal activities within 24 hours. Avoid strenuous activity for 1-2 days following the injection.
Clinical evidence: Epidural steroid injections are one of the most extensively studied treatments in pain medicine. For sciatica and herniated discs, clinical trials show that about 70-80% of patients get meaningful short-term relief, and up to 71% of people who were told they needed surgery were able to avoid it after targeted injections. ESIs also reduce nerve inflammation in spinal stenosis, creating a window for rehabilitation to work. They are recommended by international clinical guidelines as a bridge treatment to help patients participate in physiotherapy and recovery. Relief typically lasts 2-6 weeks, with up to 3-4 injections per year considered safe.
Facet Joint Injections
Facet Syndrome • Spinal Arthritis • Axial Back Pain
The facet joints are small paired joints running along the back of the spine that provide stability and guide movement. When these joints become inflamed due to arthritis, injury, or degeneration, they can generate significant axial back pain and stiffness.
What it treats
- Facet joint syndrome — chronic axial neck or back pain
- Spinal arthritis and facet joint degeneration
- Stiffness and restricted range of motion from facet inflammation
Diagnostic and therapeutic value
Facet joint injections serve a dual purpose. A small amount of local anesthetic and corticosteroid is injected directly into the joint under fluoroscopic guidance. If the injection provides meaningful pain relief, this confirms the facet joint as the pain generator — valuable diagnostic information. The corticosteroid then reduces inflammation for sustained therapeutic benefit. Recovery is rapid, with most patients resuming regular activities the same day.
Clinical evidence: Facet joints are a very common source of chronic pain — responsible for an estimated 15-45% of chronic lower back pain and up to two-thirds of chronic neck pain. Multiple large studies confirm that facet injections both identify the pain source accurately and provide 1-3 months of therapeutic relief in 40-60% of patients. Their greatest value is diagnostic: confirming the facet joint as the true pain generator before proceeding to radiofrequency ablation for longer-lasting relief.
Nerve Blocks
Headaches • Neuropathic Pain • Sympathetic Pain
A nerve block involves injecting a local anesthetic — sometimes combined with a corticosteroid — around a specific nerve or group of nerves to interrupt pain signals being transmitted to the brain. Nerve blocks can be used both to diagnose where pain is coming from and to treat it directly.
Types of nerve blocks we offer
- Occipital nerve block: For chronic migraines, occipital neuralgia, and cervicogenic headaches
- Stellate ganglion block: For complex regional pain syndrome (CRPS) and sympathetically mediated head and neck pain
- Intercostal nerve block: For post-herpetic neuralgia, rib fracture pain, and thoracic wall pain
- Sympathetic nerve block (lumbar or celiac): For visceral pain, CRPS of the lower extremities, and vascular pain
- Selective nerve root block: For precise diagnosis of radicular pain at a specific spinal level
What to expect
Most nerve blocks are performed as outpatient procedures lasting 15 to 30 minutes. The technique, imaging guidance used, and expected duration of relief vary by the specific nerve being targeted. Your specialist will discuss what is most appropriate for your condition at your consultation.
Clinical evidence: Nerve blocks have strong evidence across many pain conditions. Occipital nerve blocks achieve an 85% initial response rate for chronic migraines and occipital neuralgia, with benefit lasting 1-3 months. Stellate ganglion blocks help 40-70% of CRPS patients in the short term. Intercostal nerve blocks significantly reduce chest wall pain and opioid use after thoracic surgery. Celiac plexus blocks are well-established for abdominal cancer pain.
Medial Branch Blocks
Facet Pain Diagnosis • Pre-RFA Assessment
Medial branch nerves are small sensory nerves that carry pain signals from the facet joints to the brain. A medial branch block is a diagnostic injection that temporarily numbs these specific nerves to determine whether the facet joints are the true source of your back or neck pain.
Why it matters
Accurate diagnosis is the foundation of effective pain treatment. If a medial branch block provides substantial, temporary relief, it confirms the facet joints as the pain generator and identifies you as a strong candidate for radiofrequency ablation (RFA) — a longer-lasting treatment. Two separate diagnostic blocks are usually required to confirm the diagnosis before proceeding to RFA.
Clinical evidence: International pain medicine societies recommend dual medial branch blocks as the gold standard for confirming facet joint pain. Performing two separate blocks reduces the false-positive rate to just 10%. When patients are selected through this rigorous process, the success rate of subsequent radiofrequency ablation rises to 60-80%.
Next step: If you experience significant relief from medial branch blocks, you are likely a strong candidate for radiofrequency ablation — a longer-lasting treatment that can provide 6-18 months of pain relief.
Radiofrequency Nerve Ablation (RFA)
Facet Joint Pain • SI Joint Pain • Long-Lasting Relief
Radiofrequency ablation is one of the most effective long-lasting treatments for chronic facet joint and sacroiliac joint pain. A specialized probe delivers precisely controlled heat energy to the medial branch nerves responsible for transmitting pain signals from the affected joints, creating a small lesion that interrupts those signals.
What it treats
- Chronic facet joint pain of the cervical, thoracic, or lumbar spine
- Sacroiliac (SI) joint pain
- Axial back and neck pain confirmed by medial branch blocks
Duration of relief
RFA typically provides pain relief lasting 6 to 18 months. Because nerves can regenerate over time, the procedure may be repeated if pain returns. When patients are carefully selected through diagnostic medial branch blocks, approximately 60-80% achieve at least 50% pain reduction. For whiplash-related neck pain, a landmark controlled trial found a median of 9 months of relief. The procedure takes 30 to 60 minutes under fluoroscopic guidance.
Eligibility: Successful medial branch blocks are required before proceeding to RFA. This ensures the best possible outcome from the procedure.
Trigger Point Injections
Myofascial Pain • Muscle Knots • Referred Pain
Trigger points are hyperirritable knots within muscle tissue that cause local pain and can refer pain to distant sites. A small amount of local anesthetic is injected directly into the trigger point, causing the muscle to relax.
What it treats
- Myofascial pain syndrome
- Chronic muscle tension and spasm
- Referred pain patterns from active trigger points
- Tension headaches arising from cervical trigger points
Clinical evidence: A systematic review of 23 clinical trials found that the needle itself is the key therapeutic tool — by physically releasing the muscle knot, blood flow is restored and the pain-spasm cycle is broken. Success rates of 50-70% are reported for myofascial pain syndrome. Best results are achieved when injections are combined with stretching and physiotherapy.
Joint Injections
Knee • Hip • Shoulder • Arthritis • Bursitis
Joint injections deliver therapeutic agents directly into a painful joint to reduce inflammation, relieve pain, and improve mobility.
Joints treated
- Knee — for osteoarthritis, bursitis, meniscal pain
- Hip — for osteoarthritis, trochanteric bursitis
- Shoulder — for rotator cuff tendinopathy, glenohumeral arthritis
- Ankle, wrist, and small joints — for inflammatory arthropathies
Treatment agents
- Corticosteroid: Fast-acting anti-inflammatory for acute and chronic joint pain
- Hyaluronic acid (viscosupplementation): Restores lubrication in arthritic knee joints
- Local anesthetic: Used alongside other agents for immediate pain relief
Clinical evidence: For knee and hip osteoarthritis, corticosteroid injections provide meaningful relief in about 70% of patients, lasting 1-3 months. Hyaluronic acid injections show more sustained benefit at 6 months. Ultrasound-guided placement improves needle accuracy to over 95%.
Recovery: Most patients return to normal activities the same day. We recommend limiting repetitive corticosteroid injections to 3-4 per joint per year.
Sacroiliac Joint Injections
SI Joint Dysfunction • Low Back Pain • Pelvic Pain
The sacroiliac (SI) joints connect the sacrum (base of the spine) to the iliac bones of the pelvis. SI joint dysfunction is a frequently underdiagnosed cause of low back and buttock pain, often confused with discogenic or lumbar facet pain.
What it treats
- Sacroiliac joint dysfunction and inflammation
- Low back and buttock pain of SI joint origin
- Pelvic girdle pain, including post-partum pelvic instability
- SI joint pain following lumbar spinal fusion
Clinical evidence: SI joint dysfunction accounts for 15-30% of lower back pain cases. Therapeutic injections provide 1-3 months of relief in about 60% of patients. For longer-lasting results, cooled radiofrequency ablation nearly quadruples the success rate compared to placebo.
Fluoroscopy-guided: All SI joint injections at Epione are performed under live X-ray guidance to confirm accurate needle placement and maximize safety and efficacy.
Ready to Explore Your Treatment Options?
Our specialists will review your history, imaging, and symptoms to recommend the most appropriate interventional procedures for your specific condition.