Pain Specialists Australia

⭐️Hot Off the Press⭐️

Corticosteroid Injections for Chronic Pain: What You Need to Know.

Are you considering nerve blocks with corticosteroids for managing chronic pain?

Here’s a quick guide to help you understand when it’s recommended and when it’s not. This is based on an article just published.

Benzon HT, Elmofty D, Shankar H, Rana M, Chadwick AL, Shah S, et al. Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society. Reg Anesth Pain Med. 2024 Jul 16:rapm-2024-105593. doi: 10.1136/rapm-2024-105593. Epub ahead of print. PMID: 39019502.️

When Corticosteroids Are Recommended:

• Cluster Headache
• Post-Herniorrhaphy Pain
• Morton’s Neuroma

When Corticosteroids Might Be Useful:

• Transversus Abdominis Plane Block
• Suprascapular Nerve Blocks
• Vaginal Trigger Points

When Corticosteroids Are Not Recommended:

• Sympathetic Nerve Blocks
• Medication Overuse Headache
• Migraine
• Carpal Tunnel Syndrome
• Pudendal Neuralgia
• Trigger Point Injections

Areas with No Data:

• Supraorbital Nerve Blocks
• Continuous Interscalene Block
• Lower Extremity Peripheral Nerve Blocks

For personalised advice and treatment options, contact our clinic today. We’re here to help you find the most effective pain management solutions.

Stay informed and make the best choice for your chronic pain management. Follow us for more tips and updates on pain management treatments!

Pain Specialists Australia wished you a very well informed week ahead.

https://ow.ly/m77a50SLFQH

🌟 Exciting News! 🌟

Our very own Pain Specialist, Dr. Bradley Lewinsohn, will join Dr. Sally Cockburn on the Victorian Saturday Mornings with Matt Preston - ABC Radio Show! 🎙️

They’ll delve into chronic pain topics, discussing pain medications like opioids and advanced therapies such as nerve stimulators for neuropathic pain.

📅 Tune in tomorrow, July 27th, from 10:30 to 11:00 AM on 774 ABC Radio. Don’t miss it! 📻

https://ow.ly/iVcU50SKHfN

https://ow.ly/h5XR50SKHfO

📢 In celebration of National Pain Week 2024, we’re excited to share some of our latest YouTube videos

Defining Chronic Pain: What you need to know 🌟

Knowledge is power and power is control. Watch now and take the first step towards control of your pain 🙌

🎥 https://ow.ly/I0Mc50SGw7s

📢 In celebration of National Pain Week 2024, we’re excited to share one of our latest YouTube videos

Decoding Chronic Pain: Exploring It's Far Reaching Consequences. 🌟

Knowledge is power and power is control. Watch now and take the first step towards control of your pain 🙌

🎥 https://youtu.be/LR_tl1DWmAc

📢 In celebration of National Pain Week 2024, we’re excited to share one of our latest YouTube videos

Can Chronic Pain Can Be Fatal? Understanding the risks 🌟

Knowledge is power and power is control. Watch now and take the first step towards control of your pain 🙌

🎥 https://ow.ly/1MaJ50SGw67

📢 In celebration of National Pain Week 2024, we’re excited to share one of our latest YouTube videos on Decoding Chronic Pain: Nociception vs. Pain. 🌟

Knowledge is power and power is control. Watch now and take the first step towards control of your pain 🙌

🎥 https://ow.ly/czST50SGw3q

📢 In celebration of National Pain Week 2024, we’re excited to share one of our latest YouTube videos on treating Shoulder Pain using Radiofrequency Ablation for relief. 🌟

Discover how this innovative treatment can help you find lasting relief from chronic shoulder pain. Watch now and take the first step towards a pain-free life! 🙌

🎥 https://ow.ly/Toqo50SGw0y

While we will celebrate National Pain Week starting July 22, 2024, at Pain Specialists Australia, every week is Pain Week for us. We have dedicated our practice to treating chronic pain all year round.

As one of Australia's leading pain clinics, we have made pain our world, which allows us to be leaders in reducing pain and the suffering it causes.

We have dedicated our practice to treating chronic pain all year round. As one of Australia's leading pain clinics, we have made pain our world, which allows us to be leaders in reducing pain and the suffering it causes.

National Pain Week is Australia’s annual awareness event for chronic pain. Chronic Pain Australia aims to draw attention to the experiences of those living with chronic pain and reduce the social and other barriers associated with managing this condition.

At Pain Specialists Australia, we understand the daily challenges faced by those with chronic pain. Our mission is to provide compassionate, effective care to help you live a more comfortable and fulfilling life.

Join us this National Pain Week to raise awareness and support the chronic pain community. Together, we can make a difference.

To raise awareness for National Pain Week, Pain Specialists Australia will be publishing a short educational video each day next week. Videos will include;
- The First Consultation with a Pain Specialist – Why it Matters.
- Defining Chronic Pain: What you need to know.
- The Effects of Chronic Pain: Exploring its far-reaching Consequences.
- Decoding Your Chronic Pain: Nociception Vs. Pain
- Chronic Shoulder Pain – Radiofrequency Ablation of the Articular Branch Nerves
- Can Chronic Pain Be Fatal? Understanding the Risks
- Decoding Your Chronic Pain: The Power Of Curiosity & Actively Understanding Pain
- And more.

We wish you a great weekend ahead.

Don’t Manage Pain Alone
https://ow.ly/ApEJ50SF5qk

Bridging the Gap: A New Tool for Documenting Phantom Limb Sensations.

We recently came across a published article discussing a new tool designed to address the lack of standardised methods for documenting phantom sensations and phantom limb pain. This innovative tool not only visualises these sensations as perceived by patients but also quantifies their visible and invisible body image.

Bressler M, Merk J, Heinzel J, Butz MV, Daigeler A, Kolbenschlag J, Prahm C. Visualizing the Unseen: Illustrating and Documenting Phantom Limb Sensations and Phantom Limb Pain With C.A.L.A. Front Rehabil Sci. 2022 Feb 9;3:806114. doi: 10.3389/fresc.2022.806114. PMID: 36189032; PMCID: PMC9397903.

Key Features of the New Tool

The first version of this tool provides essential functions to assist both patients and healthcare professionals:

- Self-Identification: Adapting a 3D avatar for patients to identify with.
- Phantom Limb Modelling: Creating a visual model of the phantom limb.
- Position Adjustment: Adjusting the position of the phantom limb for accuracy.
- Pain and Cramp Documentation: Drawing pain and cramps directly onto the avatar.
- Intensity Quantification: Measuring the intensity of pain and cramps.

Evaluation and Feedback

The tool was evaluated with 33 healthcare professionals, including occupational therapists and physiotherapists. They were presented with two cases to model the appearance and position of the phantom limb and document pain and cramps. Usability was assessed using the System Usability Scale (SUS), which achieved a high score of 81%, indicating strong usability.

Patient Testing

Additionally, the tool was tested on 22 patients with limb amputations. For each patient, body image and phantom sensations were modelled to assess the tool's functional scope. The accuracy of the body image was evaluated through a self-developed questionnaire and semi-structured interviews. Pain sensation was measured using the SF-McGill Pain Questionnaire.

Insights and Improvements

While the functions provided by the tool were considered useful by most participants, semi-structured interviews highlighted the need for an improved pain documentation component. Observations revealed some operational difficulties, which will be addressed in future versions.

Conclusion

This tool allows for an accurate visualisation of phantom limbs and sensations, serving as both a descriptive and quantitative documentation tool. It helps bridge the gap between the therapist's understanding and the patient's perception of phantom limb pain and sensations. Based on the collected feedback, future versions with extended functionality are anticipated to better serve the needs of patients and healthcare professionals alike.

Stay tuned for more updates on this innovative tool and continuous efforts to enhance the documentation and understanding of phantom limb sensations.

https://ow.ly/XEuT50SARuZ

Red Flags for Spinal Fracture May Not Be Accurate
A recent Cochrane Review has found that many of the traditional red flags clinicians use to screen for spinal fractures in patients with back pain may not be as diagnostically accurate as previously thought.

(Remember Cochrane reviews are quite stringent & don't always translate to the real world so consider this review with caution).

Understanding Spinal Fractures and Back Pain
Fractures are an uncommon cause of new back pain visits, accounting for only 1% to 4.5% of cases (Cochrane Database Syst Rev 2023;8[8]). Diagnosing a spinal fracture is crucial as the treatment differs significantly from that of common back pain.

The Importance of Accurate Diagnosis
“When you assess pain, you have to look for cues & direct from where the cause of the pain is coming,” said Dr. Lynn R. Webster, a pain management physician in Salt Lake City, in an interview with Pain Medicine News.

Findings from the Cochrane Review
Researchers analyzed 14 studies to evaluate the diagnostic accuracy of various red flags used to screen for vertebral fractures. These studies included primary, secondary, and tertiary care settings & covered a range of vertebral fracture types, including osteoporotic, vertebral compression, vertebral stress, and unspecified vertebral fractures.

The review assessed 29 different questions and physical exam tests thought to aid in diagnosing spinal fractures. Most markers did not result in accurate diagnosis.

However, a few indicators were found to be more predictive and diagnostically accurate:

-Use of Steroids: Steroids can weaken bones, increasing fracture risk.
-Age Over 74: Older age significantly raises fracture risk.
-Recent Trauma: Recent falls or similar traumas are strong indicators.
-Contusion or Abrasion: Presence of bruises or scrapes near the painful area.

Clinical Implications
Dr. Webster emphasized that many traditional indicators can mislead doctors. He noted that focusing on the four most reliable criteria can help avoid unnecessary tests and treatments, improving diagnostic accuracy.

Conclusion
This review highlights the importance of using the most accurate diagnostic criteria for spinal fractures to ensure appropriate treatment. Clinicians should focus on the key indicators of steroid use, age over 74, recent trauma, and visible contusions or abrasions to improve diagnostic accuracy and avoid unnecessary treatments.

https://ow.ly/CG9J50SsoZY

Pain Specialists Australia wishes you a restful weekend and we'll recommence social media posts after short break.

Spreading of complex regional pain syndrome (CRPS): not a random process.

CRPS is a chronic pain condition that typically affects one limb but can sometimes spread to other parts of the body. Understanding how & why CRPS spreads can offer insights into the underlying mechanisms of this condition. This post provides an overview of the patterns & factors associated with the spread of CRPS, based on a study involving 185 patients.

Patterns of CRPS Spread

CRPS usually starts in one limb, but it can spread to additional limbs in various patterns:
- Contralateral Pattern (49%): Spread to the opposite limb.
- Ipsilateral Pattern (30%): Spread to the same side of the body.
- Diagonal Pattern (14%): Spread in a diagonal manner, often triggered by a new trauma.

Several factors influence the likelihood and pattern of CRPS spreading:

- Trauma: In many cases, a new trauma precedes the onset of CRPS in another limb. The percentages for trauma-related spread are 37% for contralateral, 44% for ipsilateral, and 91% for diagonal.
- Age: Patients with multiple affected limbs tend to be younger than those with a single affected limb.
- Severity: Those with multiple affected limbs often exhibit more severe symptoms and movement disorders.

Mechanisms Behind CRPS Spread are still not fully understood, but several hypotheses exist:

- Spinal Cord Changes: Alterations in the spinal cord processes might contribute to the contralateral spread of CRPS.
- Supraspinal Changes: Changes at the brain level, such as in the thalamus, may also play a role. Some studies show that patients with CRPS exhibit altered brain activity that could explain the spread of symptoms.
- Genetic Factors: Younger patients and those with a familial history of CRPS may have a genetic predisposition that makes them more susceptible to multiple affected limbs.

Implications for Patients

Key takeaways for patients include:
- Monitor for New Trauma: Be aware that new injuries, even minor ones, can trigger the spread of CRPS.
- Early Diagnosis and Treatment: Early intervention might help manage symptoms and reduce the risk of spread.
- Genetic Considerations: If you have a family history of CRPS, discuss this with your healthcare provider to better understand your risks.

Conclusion

The spread of CRPS is a complex process influenced by various factors, including trauma, age, and genetic predisposition. Understanding these patterns can aid in better management and treatment strategies for those affected by this debilitating condition. Continued research is essential to fully elucidate the mechanisms behind CRPS spread and to develop more effective interventions.

For more detailed information, you can refer to the study by van Rijn et al. (2011), which explores the non-random spread of CRPS and its underlying mechanisms: https://ow.ly/mxrH50SsoQr

Pain Specialists Australia welcomes you to your week ahead.

We get asked many times over "When should I be seeing a pain specialist?", so we've put together a video of when to consult with a pain specialist. This video is relevant for both patients, their families as well as general practitioners, medical specialists and any other healthcare practitioners.

https://ow.ly/IRzz50Ssnxs

Pain can be both physically and mentally exhausting. If pain persists for more than three months and interferes with daily activities, it's time to see a pain specialist. When pain management and medications are no longer effective, a specialist can provide advanced treatments and tailored care. Additionally, if pain is accompanied by other symptoms such as numbness, weakness, a pain specialist can help diagnose and address underlying conditions.

Remember, if you've got questions, just ask us and tell us about your pain.
https://ow.ly/gVY750Ssnxv

We wish you a great weekend ahead.

Interventional Approaches to Thoracic Facet Joint Blocks and Radiofrequency Denervation

Understanding Thoracic Facet Joint Pain:

Facet joint pain in the thoracic spine can significantly affect quality of life. Patients typically describe this pain as radiating anteriorly in a non-dermatomal distribution from the thoracic spine, often accompanied by thoracic paraspinal muscle spasms.

Diagnostic Blocks:

Accurate diagnosis is essential for effective treatment. Diagnostic blocks in the thoracic region involve:

Needle Placement: The needle is positioned at the superior lateral corner of the transverse process where the medial branch transverses. This approach is particularly effective for medial branches T1-4 and T9-10.

Local Anesthetic Injection: A small amount (0.5 ml) of 0.5% bupivacaine or 2% lidocaine is injected at each level.

Safety Measures: Keeping the needle over bone at all times is crucial to avoid pleural damage. Note the variability at T5-8 levels, where medial branches are often in the intertransverse spaces, making the procedure more challenging.
Radiofrequency (RF) Denervation:

When diagnostic blocks confirm facet joint pain, RF denervation offers a longer-term solution:

Procedure Technique: The active tip of the RF needle is placed at the superior lateral corner of the transverse process in a parallel orientation to the nerve. Sensory stimulation (threshold ≤ 0.5 volts) and motor stimulation ensure accurate needle placement.

Pre-Denervation Preparation: Local anesthetic, with or without steroid, is injected to reduce pain, enhance lesion size, and prevent neuritis. A short course of diclofenac sodium can further improve patient satisfaction and reduce neuritis risk.

Efficacy and Repetition: Most patients experience 6 months to 1 year of pain relief following RF denervation. The procedure can be repeated with similar efficacy when pain returns, with each session providing approximately 10 months of relief.

Professional Recommendations:

For a detailed explanation of thoracic facet joint blocks and RF denervation techniques, consult the "Atlas of Image-Guided Regional Anesthesia and Pain Medicine" by James P. Rathmell and the International Spine Intervention Society's "Practice Guidelines-Spinal Diagnostic and Treatment Procedures."

Stay Informed with ASRA Pain Medicine
Follow us for the latest insights on interventional pain management techniques, ensuring you receive the most advanced care for thoracic facet joint pain.
https://ow.ly/jMlO50SnQeA

Pain Specialists Australia wishes you a wonderful weekend ahead and for those in Melbourne, Australia we hope you find somewhere ward for the upcoming holidays.
https://ow.ly/f5Qh50SnQez

Can You Walk Away Low Back Pain?

This study suggests that you could.

Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Open AccessPublished:June 19, 2024DOI https://ow.ly/GGp150SnQ7P

Walking Program Reduces Recurrence of Low Back Pain (LBP)

Background:
LBP is a prevalent issue affecting millions and a significant economic burden. Recurrence of LBP is common, and finding effective prevention strategies is crucial. Exercise, especially walking, is often recommended, but its effectiveness in preventing LBP recurrence hasn't been fully established—until now.

The WalkBack Trial:
The WalkBack trial, a two-arm randomized controlled study, explored the effectiveness and cost-efficiency of a tailored walking and education program in preventing LBP recurrence. Here's what you need to know:

Participants: Adults 18+ from across Australia who recently recovered from non-specific LBP episodes lasting at least 24 hours.
Intervention: Individualized, progressive walking plans paired with education sessions facilitated by physiotherapists over six months.
Control Group: No treatment.
Duration: Participants were tracked for 12 to 36 months.
Key Findings:

Significant Reduction in LBP Recurrence:
The intervention group had a 28% lower risk of LBP recurrence compared to the control group (hazard ratio 0.72, p=0.0002).
Median days to recurrence: 208 days for the intervention group vs. 112 days for the control group.

Safety:
Similar rates of adverse events between groups.
Slightly higher incidence of lower extremity adverse events in the intervention group.

Conclusion:
This study demonstrates that a personalised walking and education program is an effective, scalable, and safe way to prevent LBP recurrence. It’s an accessible intervention that could revolutionise LBP management.

Pain Specialists Australia suggests that if you’ve recently recovered from LBP or want to prevent its recurrence, consider integrating a personalised walking program into your routine.

Staying Active means Staying Healthy.
https://ow.ly/J6V250SnQ7Q

Radiofrequency Neurotomy: A Promising Solution for Greater Trochanteric Pain Syndrome

Did you know that 10-15% of people over 60 suffer from chronic hip pain? One common cause is Greater Trochanteric Pain Syndrome (GTPS), a condition that includes various disorders and is often hard to diagnose and treat effectively.

What is Greater Trochanteric Pain Syndrome (GTPS)?
GTPS is a frequent cause of chronic hip pain that affects the outer side of the hip. It can result from issues like tears in the gluteal tendons, trochanteric bursitis, and other conditions in the peritrochanteric space.

Traditional Treatments Often Fall Short
Conservative treatments for GTPS include:
- Medications (like NSAIDs)
- Physical therapy
- Intra-articular injections

Unfortunately, these methods frequently fail to provide long-term relief for many patients.

A Publication has highlighted Radiofrequency Neurotomy as a promising solution.

Abd-Elsayed A, Martens JM, Fiala KJ, Schatman ME. Radiofrequency Ablation of the Trochanteric Branches of the Femoral Nerve for the Treatment of Greater Trochanteric Syndrome. J Pain Res. 2022 Jan 14;15:115-122. doi: 10.2147/JPR.S343165. PMID: 35058713; PMCID: PMC8765535.

Radiofrequency neurotomy (RFN) has emerged as an effective treatment for chronic hip pain, including GTPS. This minimally invasive procedure involves using heat to disrupt pain signals from nerves.

Case Series Highlights
A recent case series involving eight patients with GTPS treated with RFN targeting the trochanteric branch of the femoral nerve showed promising results:
- Patient Selection: Patients had a confirmed diagnosis of GTPS and underwent RFN after conservative treatments failed.
- Procedure: Under fluoroscopic guidance, needles were precisely placed to target the trochanteric branch of the femoral nerve. Heat was then applied to disrupt pain signals.
- Results: All patients experienced significant pain relief, with an average pain reduction of 71.4%. Relief lasted from several weeks to months, with most patients reporting ongoing improvement in quality of life.

Why Choose Radiofrequency Neurotomy?
- Effective: Provides significant, long-lasting pain relief.
- Safe: Minimally invasive with a low risk of complications.
- Targeted: Directly targets the nerves causing pain, ensuring precise treatment.

Pain Specialists Australia wishes you a great week ahead where you get the treatment you need.
https://ow.ly/c3zC50SnPZY

After all the recent negative press on Spinal Cord Stimulation (SCS), we thought we'd provide some balance leading into your weekend.

The Pain Australia Patient Report on SCS.

Recognising the complexities of pain management, particularly for the 3.4 million Australians living with chronic pain, this report summarises the experiences of 73 consumers who have undergone spinal cord stimulation (SCS) implants. Often considered a last resort treatment, Pain Australia garnered varied feedback among recipients, providing insights that are both encouraging and cautionary.

This report, compiled by the leading pain advocacy body in Australia, underscores the diverse perspectives surrounding SCS. While acknowledging positive outcomes reported by some individuals, it also highlights ongoing debates and concerns raised by recent research regarding its sustained benefits and potential risks.

This report offers insights gleaned from 73 individuals who have undergone spinal cord stimulation (SCS) implants—a treatment often considered a last resort for chronic pain sufferers. While the feedback from these participants is generally positive, it's essential to note that their experiences do not represent a comprehensive cross-section of all recipients. Indeed, divergent opinions exist regarding the efficacy and potential risks associated with spinal cord stimulators, as highlighted in recent research¹

At the conclusion of this report, several recommendations are proposed. These include;
- Calls for enhanced regulatory standards to ensure consistent safety and quality assessment of SCS implants.
- The establishment of a national registry for SCS recipients and
- Further independent research and clinical trials to evaluate the long-term effectiveness and safety of spinal cord stimulation.

The full report can be found here https://ow.ly/BFSY50SjxBH

It is imperative that any treatment decisions, including SCS, be made in consultation with multiple healthcare professionals to best meet the individual needs of patients.

Through this comprehensive examination, our aim is to foster informed discussions and empower individuals with chronic pain to navigate their healthcare options with confidence.

Pain Specialists Australia wishes you a balanced weekend ahead.
https://ow.ly/9i5Z50SjxBG

🌟 Teamwork Makes the Dream Work: Key Strategies for Collaborative Success 🌟

In today's dynamic workplace, teamwork isn't just beneficial—it's essential for achieving goals efficiently and fostering a positive work environment. At Pain Specialists Australia we value the power of collaboration and strive to cultivate a team-oriented culture that drives our success. Here’s how we do it:

Clear Communication
Effective teamwork hinges on clear and open communication. We encourage our team members to express ideas, ask questions, and provide feedback openly and respectfully. This ensures everyone is on the same page and promotes a collaborative atmosphere.

Shared Goals and Vision
Aligning on common goals and a unified vision is crucial. We regularly discuss and refine our objectives, ensuring that every team member understands their role in achieving these milestones. This clarity motivates our team to work cohesively towards shared outcomes.

Utilising Strengths
Each team member brings unique strengths and skills to the table. We believe in leveraging these strengths by assigning tasks that align with individual expertise and interests. This not only maximises productivity but also fosters a sense of value and contribution among team members.

Support and Encouragement
Supporting one another through challenges and celebrating achievements is fundamental to our team culture. Whether it’s offering assistance on a project or recognising a job well done, we believe in uplifting each other and nurturing a supportive work environment.

Continuous Improvement
We are committed to continuous learning and improvement. Through regular training sessions, workshops, and skill development opportunities, we empower our team to stay updated with industry trends and enhance their professional capabilities.

Team Bonding
Building strong relationships among team members is vital. We organise team-building activities, social events, and informal gatherings to foster camaraderie and strengthen our bonds beyond the workplace.

Celebrating Diversity
Diversity enriches our team by bringing varied perspectives and experiences. We embrace cultural diversity and promote inclusivity, respecting different backgrounds and viewpoints to drive innovation and creativity.

Conclusion
We believe that effective teamwork is the cornerstone of our success. By fostering a collaborative environment where communication is open, goals are shared, strengths are utilised, and support is abundant, we empower our team to achieve remarkable outcomes together.

Join us on our journey of teamwork and excellence at Pain Specialists Australia. Together, we can accomplish great things!
https://painspecialistsaustralia.com.au/team

A Safe Technique for Selective Cervical Nerve Root Block (SCNRB).

We recently came across a publication describing a technique for SCNRB that prioritises safety and efficiency. We'd like to share this article & technique with you.

Ott FW, Pluhm R, Ozturk K, McKinney AM, Rykken JB. Counterpoint: Conventional Fluoroscopy-Guided Selective Cervical Nerve Root Block-A Safe, Effective, and Efficient Modality in the Hands of an Experienced Proceduralist. AJNR Am J Neuroradiol. 2020 Jun;41(6):1112-1119.

Before the SCNRB procedure, it's crucial that the patient undergoes recent imaging studies, e.g. cervical spine MRI or other, with helps identify the precise location of the vertebral artery within the neural foramen, ensuring safe needle placement.

Consent: Detailed verbal and written consent is obtained from the patient, highlighting risks such as bleeding, infection, nerve injury, blood vessel injury, and stroke.

Positioning: The patient is positioned at a 45° angle on a wedge-shaped sponge or supine. Ensures the spine remains in a straight line, allowing accurate replication of the measured angle.

Initial Fluoroscopic Positioning:
- Straight Anterior-Posterior View: Position the image intensifier to obtain a clear anterior-posterior view. Adjust the C-arm to center the spinous processes between the lateral masses.
-Rotating to Foramen Angle: Rotate the C-arm to the previously measured angle of the foramen. For an oblique approach, the C-arm is set at around 45°.

Identifying the Injection Site by Counting Vertebrae: Count down from C2. Use a marker to gently mark the posterior-inferior aspect of the foramen on the skin.

Preparation: Sterile prep & drape. Anesthetise the skin and deeper tissues using 1% lidocaine, applied with a 5 mL syringe & a 25-gauge needle.

Needle Insertion & Advancement; Use a short 25-gauge spinal needle, checking its position with fluoro. Advanced the needle to the edge of the lateral mass & no deeper than a few millimeters beyond this point.

Outlining the Nerve Root with Contrast: Use a low-volume extension tubing & inject a small amount of contrast under live fluoro to outline the nerve root & check for vascular filling.

Final Injection: Once the nerve root is outlined & no vascular filling is detected, inject a mixture of dexamethasone & lidocaine.

Post-Procedure Observation: After the procedure, monitored for 15 minutes for any adverse reactions. Assess pain levels.

Conclusion
This advanced SCNRB technique emphasises safety & precision, ensuring optimal outcomes for our patients. By adhering to meticulous procedural steps & utilizing state-of-the-art imaging guidance, we strive to provide effective pain relief with minimal risks.

Pain Specialists Australia wishes you a safe week ahead.
https://mailchi.mp/painspecialistsaustralia.com.au/dont-manage-pain-alone