The sources and causes of chronic pain are many, including disease, traumatic injury, headaches, musculo-skeletal irregularities and post-surgical discomfort. TPI offers a wide range of treatment options, tailored precisely to each patient's needs. Procedures available at TPI include the following.

Expanded Procedure Descriptions

• Medication and Physical Therapy
• Therapeutic nerve block – Literally blocking the pain at its source in the nerve, this procedure involves injecting a local anesthetic or neurological agent. Various types of nerve blocks can be useful in treating pain caused by both benign and malignant disease.
• Epidural Steroid Injection (ESI) (view animations Cervical | Lumbar) – A frequently used, non-invasive option in the management of acute and chronic lower back pain. The procedure delivers steroids to the affected area.
• Radio frequency discal nucleoplasty – A needle inserted into the disc guides a probe to the area of pain. The probe generates an energy field that helps to vaporize some of the nucleus, thus reducing the pressure on surrounding nerve roots.
• Discogram (view animation) – An outpatient procudure, this is a diagnostic tool that determines which particular disc is causing the pain. Uses an imaging technique that projects a picture onto a monitor so that a radiopaque dye can be injected into the suspect intervertebral disc.

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• Spinal column stimulator (view animation) – For patients with neuropathic pain. Involves sending electric signals into the target area, producing a tingling that eases the pain.
• Spinal Pumps (view animation) – Involves surgically implanting a pump under the skin to deliver opioids directly into the spinal fluid.
• Intra-discal electrothermal therapy (IDET) (view animation) – A needle is inserted into the offending disc, then slowly heated to 90 degrees centigrade. The heat softens the wall of the disc, sealing any cracks and eliminating the source of pain.
• Laser discectomy (LASE) – For patients who suffer from a herniated disc. Involves surgically removing the offending portions of the disc.
• Botox injections – Used for treating muscle spasms, and has been proven useful in treating myofascial pain. Botulinum Toxin is a natural substance that is injected into the muscle to decrease spasticity. Relief can last from three to six months.
• Radio frequency thermocoagulation (or lesioning) – Fluoroscopically guided radio frequency lesioning (RFL) is used to treat facet joint disease and its associated pain. In the procedure, probes are placed near the offending nerve, then heated for 60-90 seconds. Relief from pain can be sustained for up to 12 months, but the procedure will have to be repeated once the nerve regenerates.

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