Tallahassee Neurology Specialists, P.L.

Medical Services - Neurology & Pain Management


At Tallahassee Neurology Specialists we treat many conditions such as Chronic Pain, Fibromyalgia, RSD, CRPS, neuropathy, spinal stenosis/degeneration/herniation, chronic migraine, and neurological injuries. Our practice has the distinct advantage of an on-site surgical suite which maximizes a warm, patient focused environment. The following procedures are performed under fluoroscopic guidance to ensure the safest, most effective outcome possible. We also offer patients the choice of undergoing their procedures with Moderate Conscious Sedation.

Procedures

Botox Injection:
Botox is in a class of medications called neurotoxins. Botox is injected at the site of the pain and works by blocking the nerve signals that cause the tightening of muscles. Botox injections are typically used in the treatment of:
◾Myofascial pain
◾Migraine headaches
◾Muscle pain due to chronic muscle spasm
◾Neck pain in cervical dystonia
◾Nerve disorders resulting in blepharospasm

There have been very few reported side effects resulting from Botox injections. The most common include discoloration, redness, or discomfort at the injection site. Although Botox injections are not a cure for these conditions, the symptoms can decrease within a few days and the effects can last for several months.

Caudal Epidural:
This procedure is designed for people experiencing chronic lower back and extremity pain. It involves injecting a steroid combined with an anesthetic into the epidural space. The steroid works to reduce inflammation and irritation and the anesthetic interrupts the pain-spasm cycle.
◾Caudal Epidurals are commonly used for:
◾Herniated/Bulging Discs
◾Degenerative Lumbar Spinal Stenosis
◾Sciatica/Lubar Radiculitis

The medication takes about 2-3 days to take effect and can last for several months.

Celiac Plexus Block:

This procedure is performed on patients who are suffering from severe abdominal pain caused by a number of conditions including cancer or chronic pancreatitis. The celiac plexus are nerves which surround the aorta; this is the main artery into the abdomen.


Cervical Epidural

Cervical epidurals are performed to treat pain in the neck, head, and arms. This is usually done after other approaches such as ice, medications, and physical therapy fail.

A local anesthetic is used to numb the area. This is followed by an injection of a steroid such as Dexamethasone or Betamethosone. After the procedure, rest is advised. Return to normal activities is possible after 24 hours.

After the epidural relief from pain usually lasts from a few weeks up to a few months.

Discogram

This diagnostic procedure is performed to determine if the cause of back pain is due to a degenerated or damaged disc(s), and if so which ones. Treatment is then determined based on the findings.

During this procedure x-ray dye or contrast material combined with antibiotics is injected into various spinal discs based on symptoms, and an examination including an MRI.

It is conducted under local anesthesia so the patient can tell the doctor what you he or she is feeling. When each disc is injected the patient is asked if there is any pain, where it is, and if it’s in the same area as the usual pain.

The patient needs to be driven home and the recommendation is to rest for the rest of that day and normal activity can resume the day after the procedure.

Disc Decompression

Back pain caused by pressure on the nerve root can be treated by disc decompression. It is accomplished by removing the disc nucleus while preserving the disc strength.

The X-Ray guided procedure takes between 30-45 minutes to perform. The patient is given a local anesthesia and the choice of sedation to relax. After 1-3 hours of recovery the patient can go home. People can usually resume daily activities in about a week.

Intercostal Nerve Block

People who suffer with pain in the chest area that is caused by shingles or a surgical incision are often given an intercostal nerve block. The intercostal nerves are situated under each rib. If one of these nerves or the surrounding tissue gets irritated or inflamed they can cause pain.

The intercostal nerve block contains a steroid medication and local anesthetic which reduce the inflammation thus alleviating the pain. These blocks also can help determine the exact source of the pain.

This treatment can be effective up to several months, although there may be intermittent pain for 2 or 3 days after the injection until the steroid takes effect.

Side effects are low but may include bruising, tenderness or soreness at the injection site. Rest is recommended for the first 24 hours after the treatment with resumption of normal activity after that

Lumbar Epidural Steroid Injection

This is a treatment for various forms of lower back and leg pain that are used when other non-surgical approaches have been unsuccessful in reducing pain.

After the exact location of where the nerve roots are being squeezed is determined (by imaging tests or computed tomography), in injection containing a corticosteroid is administered. This serves to reduce the swelling and inflammation which then relieves the pain.

The average time for pain relief is about 2-4 weeks. Some people have gotten enough relief that they were able to delay or no longer need surgery.

These injections may be given more than once; however, most experts recommend a maximum number of injections be 3 in a 12-month period.

Occipital Nerve Block

This procedure is indicated for patients who suffer with pain that occurs primarily at the back of the head, but there is some success with patients who get migraines and cluster headaches.

A steroid or other medication is injected around the greater and lesser occipital nerves that are just above the neck area. This reduces the swelling and inflammation which reduces the pain and other associated symptoms.

The injection takes just a few minutes with the patient either seated or lying down. The patient can usually resume regular activities the next day. The steroid takes effect within 3 to 5 days and can last up to several months.

The amount of injections needed varies from individual to individual. Occipital nerve blocks are not recommended for individuals on blood thinning medications, or those with poorly controlled diabetes or heart disease.

Stellate Ganglion Block

Patients suffering from pain the head, neck, upper arm, or upper chest may be candidates for a stellate ganglion block. The stellate ganglion is a group of nerves on either side of the voice box in the neck.

The stellate ganglion block treats problems with circulation or nerve injuries so can be effective in relieving pain from
◾Causalgia
◾Shingles affecting the head, neck, arm or upper chest
◾Reflex sympathetic dystrophy
◾Phantom limb pain

The block consists of two injections: an anesthetic and then a steroid pain medication. The procedure takes less than 30 minutes. The number of treatments needed varies from person to person. Each subsequent treatment tends to last longer.

Transforaminal Steroid Injection

This treatment is done to reduce inflammation and pain that may be caused by an irritated spinal nerve root. It may also reduce tingling and numbness. A long-acting steroid is injected into the neural foramen and targets the nerve root in question. The neural foramen is an opening at the side of the spine where nerve roots exist.

The procedure is done with local anesthesia and takes about 15 minutes. Afterwards, the patient will be observed for about 30 minutes and then allowed to go home. Most people can go back to work the next day.

The steroid will start working in about 3-5 days and can be effective for several months. Side effects are few – the most common is pain at the injection site.

Ganglion Impar Block

The ganglion impar is a cluster of nerve cells located behind the coccyx (tail bone). The purpose of a ganglion impar block is to alleviate some of the symptoms of chronic pelvic or rectal pain.




A local anesthetic is administered in the specified area. A needle is then place into place using fluoroscopic guidance. A contrast dye is used to ensure placement is correct and then the block is performed. Patients may also opt for intravenous sedation. This procedure takes about 15 minutes to perform.




There are few side effects associated with this treatment. Relief from pain varies; however, it can last from weeks to years.

Greater Trochanteric Bursa Injection

Greater Trochanteric bursitis is a condition in which the sac that lies over the outside of the thing bone becomes inflamed and causes pain and stiffness in the hip area.

If conventional methods including resting the affected area, applying ice and taking anti-inflammatory drugs don’t resolve the situation, a greater trochanteric bursa injection may help. This procedure is done by inserting a needle containing a local anesthetic and steroid medication into the affected area. The steroid takes 2 – 3 days to take effect and lasts for several weeks.




After the procedure, the patient rests for a few minutes and then will be driven home by someone. Normal activities can be resumed the following day.

Intradiscal Electrothermal Therapy (IDET)

This minimally invasive treatment is designed to treat people suffering from c