Breast Biopsy 
Pain Management
Physician’s use image guided spinal injection for outpatient therapy. Spinal injection is used to determine the source of the generation of pain and also to treat pain and inflammation.
At INVISION we have experienced spine interventional radiologists. These physicians have been specially trained to perform therapeutic spine and joint injections. They work with your treating physician to help identified the anatomic cause of your pain and also treat the cause. We use steroids to help reduce inflammation and break the cycle of pain, inflammation, decrease in mobility, and progression of symptoms. The steroids that we use are potent therapeutic anti-inflammatory agents. These steroids are not the same drugs that are abused by athletes.
INVISION radiologists also perform diagnostic services in our pain management suite. We perform arthrograms, discograms, and myelograms, which also assist in surgical planning and diagnosing your pain.
This page contains the following information about pain management:
- Reasons for Undergoing Pain Management
- Risks Involved in Pain Management
- Conditions to Let Our Doctor Know About
- Insurance Coverage
- Procedure Locations
- Scheduling This Procedure
- Preparation Guidelines
- What to Expect During Your Procedure
- Aftercare for Your Procedure
- Getting Your Procedure Results
Reasons for Undergoing Pain Management
Your physician may order pain management at Invision to help localize the origin of your pain and offer conservative treatment that may prevent the need for surgery. It may also be used as a measure to alleviate pain before joint surgery.
Risks Involved in Pain Management
The risks of injection include infection, bleeding, nerve injury, and injury to adjacent structures. These are uncommon. Ask your doctor if you have any concerns.
There is also a theoretical risk of x-ray exposure. However, the doses used at INVISION are low and are not associated with adverse effects.
There is also a slim chance that you will react to the medications we use. In the rare event of an allergy or contrast reaction, our nurses and physicians are trained to handle the situation.
Conditions to Let Our Doctor Know About
In advance of your exam, let your INVISION radiologist or technologist know if any of the following circumstances apply to you:
- Currently pregnant
- Any allergies
- Any chronic medical conditions
- Using aspirin or anticoagulants such as Coumadin or Warfarin
Insurance Coverage
You generally need a referral from a physician for pain management therapy. Your doctor’s office staff will authorize therapy with your insurance company prior to your appointment. Please bring your insurance card with you to the procedure.
Procedure Locations
Pain management is performed as an outpatient only at INVISION at the Centrum.
The RIA/INVISION physicians also provide pain management services at the Medial Center of Aurora, Sky Ridge Hospital, Swedish Medical Center, Porter Adventist Hospital, and Littleton Adventist Hospital.
Scheduling This Procedure
To schedule an appointment, call the facility at which you want to receive the pain management treatment.
| Invision at the Centrum | 720-493-3330 |
| Medical Center of Aurora | 303-695-2705 |
| Sky Ridge Hospital | 720-225-1810 |
| Littleton Adventist Hospital | 303-738-2767 |
Physicians may fax orders for pain management procedures to 303-741-8951.
Preparation Guidelines
Following are the preparation guidelines for pain management treatments. A technologist or nurse will contact you before your procedure as a reminder and to answer your questions. You may also contact the facility where you will have the procedure to have any questions answered.
Therapeutic Pain Management Therapy
- Blood thinning medications such as aspirin and Coumadin or Warfarin could result in bleeding during your procedure. Typically these agents are stopped between 72 and 96 hours prior to procedure. Contact your doctor first to make certain that you may safely stop these medications. If you cannot stop these medications, then a spine injection may not be the best procedure for you.
- Bring any prior imaging studies such as x-rays, MRI, or CT scans with you for your procedure. The spine interventionalist will review these studies to make certain that the procedure is safe and determine the exact site for injection.
- Bring a list of your medications and allergies with you.
- If you are ill or taking antibiotics, please call us and we will gladly reschedule your procedure. A spine injection should not be performed on patients within a week of taking antibiotics.
- Notify us if you have had dental work within the prior week. This would increase the risk of your infection.
- Wear comfortable clothing.
Diagnostic Pain Management Service
Following are guidelines for diagnostic pain management procedures. These should be followed in addition to the guidelines listed above.
| Discogram |
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| Myelogram |
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What to Expect During Your Procedure
Your experience will differ, depending on whether you are receiving a therapeutic pain management treatment, an arthrogram, a discogram, or a myelogram.
Therapeutic Pain Management Treatment
The staff will first obtain a medical history and answer any questions. You will then be positioned on the table. The technologist will wash the region that will be treated. You will be awake for the procedure. In some circumstances you may receive conscious sedation if required by the treating physician.
The radiologist will use a fluoroscope to obtain real-time images to assist in precise needle placement. During your injection a small volume of x-ray contrast media may be injected to confirm the location of the needle. After the needle location is confirmed, medication will be injected. You may feel pressure during the injection, but most procedures are relatively painless.
Typically you will be in the treatment suite for 30 minutes.
Arthrogram
The technologist will obtain a history and answer any questions that you have. After positioning, the area over the joint will be washed with sterile soap. Typically you will be awake for the procedure, but if required by the treating physician you may receive conscious sedation.
A fluoroscope will be used to obtain precise location of the needle tip. Then contrast medium will be injected into the joint and images obtained.
After the procedure you may sent to another area in the imaging center for a CT or MRI scan. The entire procedure including preparation takes less than 30 minutes. The procedure, other than the injection of local anesthetic, is relatively painless.
Discogram
The staff will obtain a medical history and answer any questions that you have. A nurse will start an intravenous line to give you antibiotics prior to the procedure. Also, this intravenous line will be used to administer medications to help you relax during the procedure.
A fluoroscope will be used to determine precise needle location. Discogram needles will be placed into each disc. Each disc will be separately pressurized to determine the pain levels. Images will be obtained during the procedure. Pain medications will be administered as required.
After the procedure, you will undergo a CT scan of your spine. Also, you will be observed after the procedure until you are alert. Typically the entire time you will need for this procedure is 3 hours. It is imperative that you have a driver take you home after sedation.
Myelogram
After obtaining a medical history and making certain that all your questions are answered, you will be positioned on the table, generally on your stomach. The area over your spine will be washed with sterile soap.
A fluoroscope will be used to determine precise needle tip location. Under local anesthetic using a thin needle, the sac around the nerves will be entered. Contrast medium will be instilled into this sac and images will be obtained. Then, a CT scan will be taken.
You can expect to be in the imaging center for approximately 1 1/2 hours for the procedure. The procedure itself takes only a few minutes. After local anesthetic is administered generally the procedure is relatively painless. It is imperative that you have a driver take you home. Please limit activity for 24 hours after this procedure.
Aftercare for Your Procedure
After any pain management procedure, please follow these instructions:
- Rest at home for 24 hours
- Refrain from any strenuous activity or impact exercise for 48 hours
- Do not take aspirin products for 48 hours
- Do not apply any direct heat to the injection site for 48 hours, including hot tub, hot bath, or heating pad. A shower is okay. Ice is fine.
Rarely a steroid flare can occur. These symptoms include:
- Facial flushing
- Headache
- Increase in pain
- Difficulty sleeping
- Rapid heart rate
These symptoms are temporary and rarely last longer than 24-48 hours. If you have any concerns, please call us.
If you are given a pain journal, please complete and return it to your referring physician.
Call INVISION at 303-741-1501 or your referring physician if you have any questions or problems.
Additional Aftercare Instructions
If you underwent a myelogram, please limit your activity for 24 hours after the procedure. If you received conscious sedation during the procedure you will be given additional after care instructions by the technologist.
Getting Your Procedure Results
Your doctor will receive a written report from the INVISION spine interventional radiologists. Please follow-up with your referring doctor. Your feedback is important to your treatment plan. If a diagnostic procedure is performed, the INVISION radiologist and spine interventionalist will dictate a report. This report will be faxed to your referring physician.
