Dr. Casañas has also been extensively trained and has implemented over the last 15 years an extensive array of more invasive injections that are delivered close to where the culpable nerve travels. When the injection to that nerve is performed close to where it comes out of the spinal cord, it is called an epidural injection and when it is done near where the nerve traverses the body, it is called a paravertebral nerve block. When it is performed close to where the facet is (the main joints of the spinal cord), it is called a facet nerve block. In general, the substance used to numb the nerve is Lidocaine. In addition, one can add an anti-inflammatory such as Triamcinolone resulting in transient or permanent pain relief. An epidural block is a procedure that can be optimally performed if it is radiographically guided, but can be performed without it as well. Most of Dr. Casañas’ pain treatment approaches involve facet nerve blocks, as well as paravertebral nerve blocks, all with good success.
In general, most patients are accepting of this procedure in the office and can be done as an outpatient in a very short time. These more invasive techniques would require the data that can be accrued only from MRI studies.
In general, spinal nerve blocks and facet joint injections are utilized for conditions that arise out of chronic and severe arthritis of the facet joint or a degenerative condition or an acute slipped disc condition of the spinal vertebrae. Since there is limited space for the nerves to come out of the spinal cord and out into the body when they go through the bony structures of the vertebrae, a slight displacement or any kind of reactive or angry bone formation (a spur) as a result of wear and tear or trauma can impinge on the nerve and cause what is typically called radiating pain or radicular pain. In addition, some causes of nerve pain can be attributable to a sickness of the nerves themselves which is more specifically called a peripheral neuritis (such as is found in diabetes and heavy metal toxicity), which typically causes numbness and tingling, as well as pain.