Pain Management

Cervical Radiofrequency Ablation (C-RFA)

Cervical pain is pain that arises in the neck and upper back region. This type of pain can be caused by many factors and can be quite common. In fact, previous studies have estimated that nearly two-thirds of the population will suffer from some form of neck or upper back pain during their life. Some of the more commonly reported causes of neck or upper back pain include pinched nerve, muscle strain, herniated/slipped intervertebral disc, or direct trauma or injury.

Radiofrequency neurotomy of the facet joints in the cervical spine is one of the minimally invasive treatments available for cervical pain that do not require surgery and is one of the most commonly performed treatments for cervical facet joint pain management.

Existing evidence has provided some support for the role of cervical facet radiofrequency neurotomy in providing relief from moderate to severe neuropathic cervical facet joint pain. Studies have also examined the long-term benefits of this treatment. Findings from these studies indicate that most patients can expect to be free from neuropathic pain for up to 15 months following the procedure. Further, approximately 50% of the patients in these studies were reported to be free from symptoms for up to two years following the procedure.

Epidural Steroid Injection

Treatment usually involves a series of injections, repeated at regular intervals. Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain, neck pain, arm and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain.

The goal of an epidural injection is prolonged pain relief. While epidural injections can sometimes provide relief on their own, they are commonly used in conjunction with a comprehensive rehabilitation program to provide additional pain relief.

Nerve Blocks

For patients with cervical pain, we offer facet medial nerve blocks and nerve root blocks.

Blocks are injections of medication onto or near nerves. The medications that are injected include local anesthetics, steroids, and opioids. In some cases of severe pain it is even necessary to destroy a nerve with injections of phenol, pure ethanol, or by using needles that freeze or heat the nerves. Injections into joints are also referred to as blocks. Although not technically correct, such shorthand is commonly used.

** Information provided by www.spineuniverse.com

Stellate Ganglion/Sympathetic Blocks

During a sympathetic nerve block, a numbing medicine is injected into the area around the sympathetic nerves in the lower back or neck to reduce or eliminate pain by ‘turning off” the nerve impulses. The goal of the nerve block is to return the sympathetic system back to it’s normal state of regulation. Additional blocks can be given if the initial block is successful and can continue as long as the pain continues to diminish.

Botox® for Pain Management

Botox® injections allow therapy to be targeted to specific problem muscles, not possible with existing medications. Botox can be used to reduce the muscle tension involved with chronic headaches, neck aches and back pain. It can also be used to reduce spasticity or excessive muscular contractions to relieve pain; assist in posturing and walking; and allow better range of motion.

Thoracic Medial Branch Nerve Blocks

During this procedure, anesthetic is injected near the small medial nerves associated with a specific facet joint. Typically, a patient can have multiple levels treated during one procedure. This procedure can also serve as a diagnostic tool to identify the source of a patient’s pain by the amount of relief achieved from the treatment.

If the patient has the appropriate duration of pain relief after the medial branch nerve block, then he or she may be a candidate for a subsequent procedure – called a Medial Branch Radiofrequency Neurotomy (or ablation) – for longer term pain relief.

Intercostal Nerve Blocks

Blocks are injections of medication onto or near nerves. The medications that are injected include local anesthetics, steroids, and opioids. In some cases of severe pain it is even necessary to destroy a nerve with injections of phenol, pure ethanol, or by using needles that freeze or heat the nerves. Injections into joints are also referred to as blocks.

** Information provided by www.spineuniverse.com

Epidural Steroid Injection

Treatment usually involves a series of injections, repeated at regular intervals. Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain, neck pain, arm and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain.

The goal of an epidural injection is prolonged pain relief. While epidural injections can sometimes provide relief on their own, they are commonly used in conjunction with a comprehensive rehabilitation program to provide additional pain relief.

Radiofrequency Rhizotomy

Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed alongside the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

** Information provided by www.spineuniverse.com

Kyphoplasty

Kyphoplasty is a minimally invasive surgery that is used to treat spinal compression fractures that occur primarily in osteoporosis weakened vertebrae. While compression fractures are most common in the thoracic spine, or the middle of the back, they can also occur in the lumbar region, or lower back. Kyphoplasty can be used to reduce pain caused by the fracture, to stabilize the vertebra and to restore vertebral height.

During the procedure, a small incision will be made over the affected area as the patient lies face down on the procedure table. A narrow tube is threaded through the pedicle into one side of the fractured vertebra by using x-ray guidance.

During balloon kyphoplasty, a balloon tamp will inserted into the fractured vertebra and then inflated to create an open cavity inside the bone and to restore height to the collapsed vertebra. Then, the balloon tamp is deflated and removed from the vertebra, leaving a new cavity in the bone so that a type of bone cement called PMMA can be injected into the cavity until it is full, creating an internal cast within the fractured vertebra.

To preserve uniformity and increase the chances of complete correction, this process can be repeated on the other side of the vertebral body. The surgeon will then close the incision and the patient lies flat on the operating table until the cement hardens, usually about 5 minutes.

In other forms of kyphoplasty, other surgical approaches for creating the cavity may be used, such as a net or ball. Most patients can go home the same day as the procedure.

Coccygeal Nerve Block/Ganglion Impar Block

Useful as both a diagnostic and therapeutic tool, the Ganglion Impar Block treats patients suffering from coccydynia/coccygodynia (pain in the tailbone), pain in the perineum, distal rectum and anus, vulva and distal third of the vagina.

Treatment for nonmalignant pain conditions such as coccygodynia or perirectal pain from tumor involvement can be performed with local anesthetic and steroids.

Neurolytic blockade can be performed, but require an additional diagnostic block to be performed prior to the procedure. For treating rectal pain, the Ganglion Impar block can be a better option over other neurolytic procedures because the Ganglion Impar block generally leaves the bowel and bladder function unaffected.

However, this should be confirmed first with the local anesthetic block.

Lumbar Sympathetic Block

During a sympathetic nerve block, a numbing medicine is injected into the area around the sympathetic nerves in the lower back or neck to reduce or eliminate pain by ‘turning off” the nerve impulses. The goal of the nerve block is to return the sympathetic system back to it’s normal state of regulation. Additional blocks can be given if the initial block is successful and can continue as long as the pain continues to diminish.

Nerve Root Blocks

Blocks are injections of medication onto or near nerves. The medications that are injected include local anesthetics, steroids, and opioids. In some cases of severe pain it is even necessary to destroy a nerve with injections of phenol, pure ethanol, or by using needles that freeze or heat the nerves. Injections into joints are also referred to as blocks. Although not technically correct, such shorthand is commonly used.

** Information provided by www.spineuniverse.com

Epidural Steroid Injection

Treatment usually involves a series of injections, repeated at regular intervals. Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain, neck pain, arm and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain.

The goal of an epidural injection is prolonged pain relief. While epidural injections can sometimes provide relief on their own, they are commonly used in conjunction with a comprehensive rehabilitation program to provide additional pain relief.

Facet Joint Injections

In cases where the facet joint itself is the pain generator, a facet block injection can be performed to alleviate the pain. Similar to selective nerve root blocks, facet block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient. The facet joints are paired joints in the back that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.

In a facet block procedure, a physician uses fluoroscopy (live x-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.

** Information provided by www.spine-health.com

Sacroiliac Joint Injection

During a sacroiliac joint injection, a physician uses fluoroscopy (live x-ray) to guide the needle into the sacroiliac joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific joint capsule that has just been injected.

** Information provided by www.spine-health.com

Transforaminal Injections

During a transforaminal injection, a long acting steroid is injected into the area where the nerve roots exit the spine, or the foramen. A small sleeve of the epidural space extends over the nerve root just outside the spinal canal. These injections are also known as root sleeve blocks, root blocks or transforaminal epidural blocks.

Long acting steroid medication is injected to reduce inflammation and /or swelling of the spinal nerve roots and surrounding tissues. Reduction of inflammation or swelling can work to reduce pain, numbness, tingling or other symptoms caused by nerve irritation. Additionally, transforaminal injections can be used to identify a specific spinal nerve root level or levels that could be the source of pain.

Piriformis Steroid Injection

A piriformis steroid injection offers pain relief for the piriformis muscle. Located in the buttock area, the piriformis attaches to the side of the sacrum, the bone at the base of your spine just above your tailbone. The main job of this muscle is to rotate the leg outward, but is also helps to hold the hip in joint when it is bearing weight. With the sciatic nerve runs down the back of the leg, passing through the piriformis, any tightness in the muscle can cause sciatica, nerve pain that runs down the back of the leg. The patient may also experience pain in the hip and low back region and even in the groin, genitals and rectum.

Steroid medication is injected to reduce inflammation and /or swelling around the nerves that pass near or through the piriformis muscle. Reduction of inflammation or swelling can work to reduce pain, numbness, tingling or other symptoms caused by nerve irritation.

Radiofrequency Rhizotomy

Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed alongside the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

** Information provided by www.spineuniverse.com

EMGs & EEGs

An electromyogram (EMG) is a nerve conduction study that measures the electrical impulses that move through muscles both while at rest and during contraction. The measurement of the efficacy and efficiency of the electrical signals moving through muscles can help identify diseases that damage muscle tissue or nerves.

Using special sensors or electrodes that are attached to your head, an electroencephalogram (EEG) measures the electrical activity of your brain to help identify conditions such as epilepsy, dementia, narcolepsy or to help diagnose physical issues in the brain, spinal cord or nervous system.

Spinal Cord Stimulators

Spinal cord stimulation has been approved by the Food and Drug Administration as an effective treatment for pain since 1989. It is widely recognized as the standard of care for chronic neuropathic back and limb pain. Recent technological advancements offer neurostimulators that provide such effective pain relief that patients are able to reduce or even eliminate their pain medications.

We provide implantation, programming and management of spinal cord stimulators in the cervical and lumbar areas.

VNG (Video Nystagmogram)

Imbalance and falling are very difficult problems. The human ability to maintain an erect posture and move about without becoming dizzy takes a lot of integration of the nervous system. The inner ear sends messages into the brain stem to tell us where we are in space. These will be tested, for example, by the “Dix-Hallpike” and other similar maneuvers. This is where your head is held in a down position while lying down and also by a stream of air, warm and cool, going into the ears to stimulate the ear drums. The other tests that we do will be more or less to find out whether the brain stem and brain balance mechanisms are working well. These call for you to visually track an object from side to side across a TV screen, looking at bars that go across the screen. You may have some testing done with your balance analysis on the Fall-Track device as well. It is through this information and your cooperation with the testing that your doctor can make a more accurate diagnosis.

Abdominal & Pelvic Procedures

Celiac Plexus Block

Used as both a diagnostic test or a treatment, a celiac plexus block is an injection that treats abdominal pain caused by cancer, chronic pancreatitis or adhesions. A local anesthetic is injected to block the celiac plexus nerves from transmitting pain signals to the brain. Although uncommon, risks for the procedure may include the following: injury to major blood vessels, nerve roots, kidneys or lungs. Ganglion Impar Block.

Superior Hypogastric Plexus Block

A superior hypogastric plexus block can be used to manage pelvic pain that has not responded to oral medication or if the side effects from the oral medication (excessive nausea, constipation, and sedation) have become unacceptable to the patient. This injection can be used to alleviate pain that originates from a large area of the abdomen, including the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon and has been successfully used to alleviate both malignancy-associated anal-rectal pain and nonmalignant penile pain.
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Pudendal Nerve Block

Using x-ray images, the pudendal nerve block can be a very effective diagnostic tool when used in concert with a complete history and physical examination for patients with suspected pudendal neuralgia. Pudendal neuralgia affects sensation and function of the external genitals, the urethra, the anus, and perineum. During the procedure, the nerve is injected with a local anesthetic to assess whether symptoms can be relieved.

Splanchnic Nerve Block

A splanchnic nerve block is an injection of medication that helps relieve upper abdominal pain commonly due to cancer or chronic pancreatitis by blocking the nerves. Located on both sides of your spine, the splanchnic nerves carry pain information to the brain from organs in the abdomen. Once the area is numbed with a local anesthetic, a thin needle is guided into the area using x-ray technology is used to guide a thin needle into the splanchnic nerve area, after which an anesthetic is injected. The procedure itself only takes about 45 minutes, and patients can return home the same day. Risk of complication from this procedure is typically very low, but patients may experience soreness and bruising at the injection site and dizziness and diarrhea from the injected medication. These side effects will subside in a few hours. Serious complications, including infection and bleeding, are uncommon.

Back Pain Treatment

Dr. Igor Turok specializes in Back Pain Treatment in Wallingford, CT, and Ridgefield, CT.

Back Pain Treatment

Carpal Tunnel Treatment

Dr. Igor Turok specializes in Carpal Tunnel Treatment in Wallingford, CT, and Ridgefield, CT.

Carpal Tunnel Treatment

Elbow Pain Treatment

Dr. Igor Turok specializes in Elbow Pain Treatment in Wallingford, CT, and Ridgefield, CT.

Elbow Pain Treatment

Fibromyalgia Pain Treatment

Dr. Igor Turok specializes in Fibromyalgia Pain Treatment in Wallingford, CT, and Ridgefield, CT.

Fibromyalgia Pain Treatment

Headache Treatment

Dr. Igor Turok specializes in Headache Treatment in Wallingford, CT, and Ridgefield, CT.

Headache Treatment

Knee Pain Treatment

Dr. Igor Turok specializes in Knee Pain Treatment in Wallingford, CT, and Ridgefield, CT.

Knee Pain Treatment

Neck Pain Treatment

Dr. Igor Turok specializes in Neck Pain Treatment in Wallingford, CT, and Ridgefield, CT.

Neck Pain Treatment

Osteoarthritis Treatment

Dr. Igor Turok specializes in Osteoarthritis Treatment in Wallingford, CT, and Ridgefield, CT.

Osteoarthritis Treatment

Shoulder Pain Treatment

Dr. Igor Turok specializes in Shoulder Pain Treatment in Wallingford, CT and Ridgefield, CT.

Shoulder Pain Treatment

Tingling

Dr. Igor Turok specializes in Tingling Treatment in Wallingford, CT, and Ridgefield, CT.

Tingling

What benefits does Stem Cell Recruitment™ Injections offer?

• Powerful Treatment: Helps to relieve pain associated with joints, soft tissue and spinal injuries.
• Convenient & Painless: 15-minute in office, single injection.
• All Natural & Drug-free: Contains a large concentration of Growth Factors, including bFGF -“Basic fibroblast growth factor”—this is a signaling protein encoded by a gene that assists in cell growth and maturation, and tissue repair.
• Quick & Reduced Recovery Time: Return to everyday, low impact activities.
• Safe, Non-steroidal Alternative to Surgery: Helps recruit your body’s stem cells and healing components to reconstruct and regenerate the injured tissue that is causing pain.

Patients have reported pain relief from the following:

• Spinal injuries: neck pain, mid or lower back pain, sacroiliac joints
• Joint Injuries: knees, hips, shoulders, elbows, wrists, ankles, fingers and toes.-Soft tissue injuries: plantar fasciitis, tennis elbow, rotator cuff syndrome

Trigger Point Injections

Often when a muscle is knotted, blood can not circulate through the tissue to nourish it. Some of the tissue will eventually degenerate and form small nodules called trigger points. Trigger points can occur anywhere in the body and cause serious pain.

By injecting a trigger point with medicine, pain is reduced and movement is increased.

Medication Management for Pain

Here are the most common drug therapies available for pain management:

• Contributory medications that work with other drugs to relieve discomfort: antidepressants, anticonvulsants and muscle relaxers
• Anti-inflammatory drugs that provide pain relief by reducing swelling and inflammation
• Opiates or “pain killers” are most often used to treat acute pain or cancer-related pain, but can also be prescribed for chronic pain
• Many of these medications can be delivered in alternative methods such as topical ointments, transdermal patches, sublingual medications, nasal sprays, and of course oral medications and injections.

Magnesium Infusions

Magnesium infusions can be an effective treatment for migraine headaches.

Multivitamin Infusions

Multivitamin Infusions can be an effective treatment for peripheral neuropathy.

Platelet Rich Plasma (PRP)

PRP therapy is a natural (non-synthetic) solution of concentrated platelets and white blood cells derived from your own blood that will not be reabsorbed or synthesized by the body. The patient’s own platelets are harvested and concentrated to work in conjunction with injectables to provide enhanced results and to promote permanent tissue growth and repair for up to 5 weeks.

Prior to your procedure, a small sample of blood is drawn. The blood is placed in a specialized centrifuge that will separate and concentrate your body’s own natural healing agents. Once the solution is prepared, the Platelet-Rich Plasma (PRP) is then injected into the damaged area. The platelets activate and release growth factors that trigger the patient’s body to begin the healing process.

Many patients find that a single treatment can provide relief from their symptoms and that the relief continues to improve over time. However, some patients may need up to 3 injections administered over several weeks to achieve the most relief.

This therapy is intended to resolve the patient’s symptoms by healing damaged tissue so they could experience long lasting results. Patients should begin to experience improvement within the first few weeks and should see continued improvement throughout the healing process.

PRP therapy can be an effective treatment for:

• Tendinosis / Tendinitis-Rotator Cuff-Muscle or Ligament Tears
• Tennis or Golfer’s Elbow
• Plantar Fasciitis
• Joint Pain Caused by Wear and Tear
• As a complement to injectable procedures (i.e. Botox®/Dermal Fillers)

Pronox

Pronox for Pain & Anxiety Relief During Procedures

Breathe Easier During Your Procedure

At our practice, we are committed to making your treatment experience as comfortable as possible. That’s why we offer Pronox™, a safe and effective pain and anxiety relief system that helps patients feel calmer and more relaxed during procedures.

Pronox combines a fixed blend of oxygen and nitrous oxide (“laughing gas”) that you control yourself through a simple handheld breathing device. The effects work quickly and wear off rapidly, helping many patients feel more comfortable without the lingering grogginess associated with traditional sedation.

What Is Pronox?

Pronox is a patient-controlled inhaled analgesia system that delivers a 50/50 mixture of nitrous oxide and oxygen. It is commonly used during minimally invasive medical procedures to help reduce:

• Procedure-related anxiety
• Mild to moderate discomfort
• Fear or nervousness
• Stress during treatment

Because patients control when they inhale the medication, Pronox offers a personalized level of comfort throughout the procedure.

Benefits of Pronox

Fast Relief
Patients often begin feeling calmer and more relaxed within minutes.

Quick Recovery
The effects wear off rapidly once use is stopped, allowing most patients to return to normal activities shortly after treatment.

Patient-Controlled Comfort
You decide when to inhale, giving you greater control over your experience.

Non-Invasive
No IV sedation or needles are required specifically for Pronox administration.

Helps Reduce Anxiety
Pronox can help patients feel more at ease before and during pain management procedures.

What to Expect During Your Visit

1. Your provider will review your medical history and determine whether Pronox is appropriate for you.
2. You will receive instructions on how to use the handheld breathing system.
3. Before and during your procedure, you may inhale the gas mixture as needed.
4. Most patients remain awake, responsive, and relaxed throughout treatment.
5. Recovery is typically quick after the procedure is complete.

Is Pronox Safe?

Pronox has been widely used in medical and dental settings for many years. It is generally considered safe when administered by trained healthcare professionals.Our team carefully evaluates each patient to ensure Pronox is appropriate based on medical history, medications, and overall health.

Who May Benefit from Pronox?

Pronox may be helpful for patients who:

• Feel anxious about procedures
• Have a low pain tolerance
• Prefer to avoid deeper sedation when possible
• Want fast recovery after treatment
• Experience fear of needles or medical procedures

Frequently Asked Questions

Will I be asleep?

No. Pronox is designed to help you feel relaxed and comfortable while remaining awake and able to communicate with your provider.

How long do the effects last?

The effects usually wear off within minutes after you stop inhaling the medication.

Can I drive afterward?

Many patients are able to drive themselves home after treatment, but your provider will give you specific guidance based on your procedure and medical condition.

Is Pronox the same as anesthesia?

No. Pronox is a form of inhaled analgesia and anxiolysis designed to help reduce discomfort and anxiety during procedures.

Comfortable Care Matters

Your comfort and peace of mind are important to us. If you have questions about Pronox or whether it may be right for your upcoming procedure, please contact our office.

Call us today to learn more or schedule your appointment.