pain management rancho bernardo

Services, Treatments, and Technologies

A variety of approaches and modalities can help you deal with both the physical and emotional parts of pain:

Diagnostic Testing

  • Electromyography (EMG) and Nerve Conduction Studies (NCV)
  • Diagnostic Ultrasounds
  • Flouroscopy
  • VAT


  • Interventional Pain Treatment
  • Spine Injections
  • Joint Injections
  • Supartz Injections
  • Botox Injections
  • PRP
  • Stem Cell
  • CALMARE (Certified)
  • Soboxone (Buprenorphine for Opioid Dependence)


  • Interventional Pain Injections
    • Spine Injections
    • Supartz Injections
    • Botox Injections
    • Epidural Steroid Injections
    • Facet Joint Injections
    • Medial Branch Blocks
    • Radiofrequency Ablation
    • Sacroiliac Joint Injections
    • Joint/Bursa Injections: Shoulders, Knees, Hips, Ankles, etc..
    • Hyaluronic Acid Injections for the Knee Joints
    • Platelet Rich Plasma (PRP) Injections
    • Trigger Point Injections


Interventional Pain Procedures Under X-Ray Guidance

A variety of interventional procedures can be used to treat a range of pain conditions, from chronic low back pain to migraine headaches. Many of these techniques are performed under X-Ray guidance, which helps the physician deliver the therapy—whether it's a steroid injection or heat-based remedy—to the exact source of the pain. Our pain management specialists are skilled in determining the most appropriate interventional procedure for each patient, and administering that procedure to achieve the greatest possible pain relief. Our Pain Management is pleased to provide a range of interventional treatment options, including the following.

Epidural Steroid Injections

An Epidural Steroid Injection is a minimally invasive procedure performed under live X-Ray guidance that is used to treat pain in the neck, shoulders, arms, upper and lower back, buttocks, and legs that results from irritation of spinal nerve roots. A variety of conditions such as herniated disc, degenerative disc disease, and arthritis can cause a stenosis (narrowing) of the openings through which nerves exit the spine, which can be irritating to the nerves. By injecting low doses of long-lasting corticosteroids (potent anti-inflammatory pain medications) targeted directly to the source of the pain (instead of much larger oral or intravenous doses) this inflammation can be decreased, providing pain relief.

Medial Branch Blocks / Facet Joint Injections

Medial Branch Blocks and Facet Joint Injections are minimally invasive procedures performed under live X-Ray guidance that are used to diagnose and treat pain arising from the small joints of the spine (facet joints). Diseases of these joints can produce pain in the neck, upper and lower back, and buttocks. Just like any other joint in the body (such as the knee or elbow) these joints may be acutely injured or produce chronic pain due to conditions such as arthritis. Medial Branch Blocks and Facet Joint Injections deliver low doses of long-lasting corticosteroids and local anesthetics directly to the source of the pain to alleviate discomfort. These office-based procedures take approximately five minutes to perform and may be done either under local anesthesia or comfortable sedation.

Radiofrequency Nerve Ablations

Radiofrequency Nerve Ablation is a minimally invasive procedure performed under live X-Ray guidance to treat back and neck pain by using precisely controlled heat to temporarily and selectively disable nerves responsible for pain. The procedure involves inserting a specialized needle with a heated tip near the problematic nerve, where the heat interrupts the nerve's ability to send pain signals.

Major Joint Injections (Knee, Hip, Shoulder)

Joint injections are minimally invasive procedures performed either under live X-Ray or ultrasound guidance to treat pain resulting from various causes, including osteoarthritis. Medications such as corticosteroids, local anesthetics, or hyaluronan (Hyalgan, etc.) are injected directly into the source of the pain to provide relief from mild to moderate osteoarthritis.

Occipital Nerve Blocks

Occipital Nerve Blocks are safe, office-based procedures used to treat various types of headaches, including migraines. Local anesthetic with or without a small dose of corticosteroid is used in this injection, which is administered to the back of the head near the greater and lesser occipital nerves.

Kyphoplasty (Balloon kyphoplasty)

Balloon kyphoplasty is a minimally invasive procedure for the treatment of painful fractures of the spine (vertebral compression fracture) resulting from trauma in patients with osteoporosis or tumors. In kyphoplasty, a small balloon is threaded through an incision in the back to the site of the injury, where it is inflated to gently push any damaged bone back into place. Cement is then inserted into the site to hold the bone in proper position. This procedure is performed in an operating room under a combination of local anesthesia and sedation.

Sympathetic Block

A lumbar sympathetic block is an injection of local anesthetic into or around sympathetic nerves. These sympathetic nerves are a part of the sympathetic nervous system. The nerves are located on the either side of spine, in the lower back. Normally these nerves control basic functions like regulating blood flow. In certain conditions, these sympathetic nerves can carry pain information from the peripheral tissues back to the spinal cord. A lumbar sympathetic block is performed to block the sympathetic nerves that go to the leg on the same side as the injection. This may in turn reduce pain, swelling, color, sweating and other unusual changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving the legs. Certain patients with neuropathy or peripheral vascular disease may also benefit from lumbar sympathetic blocks.

Peripheral Nerve Blocks

A “nerve block” is a technique of injecting numbing medicine (also called local anesthetic) around a group of nerves. This causes a specific area of the body to be numb. Nerve blocks have become an important therapy in the treatment of certain types of acute and chronic pain, particularly where management with medications is unsuccessful. With nerve blocks, medication consisting of an anesthetic and a steroid is injected directly into a nerve to reduce inflammation and block the transmission of pain signals to the brain. A sympathetic nerve block is one that is performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body, such as opening and narrowing blood vessels.

Transforaminal Injection

A transforaminal injection is an injection of long acting steroid into the opening at the side of the spine where a nerve roots exits. This opening is known as a foramen. There is a small sleeve of the epidural space that extends out over the nerve root for a short distance. This epidural root sleeve is just outside the spinal canal. Sometimes these injections are referred to as root sleeve blocks, root blocks or transforaminal epidural blocks. The long acting steroid that is injected reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling. Also, the transforaminal injections can be used to identify a specific spinal nerve root level or levels that are the source of pain.

Sacroiliac Injection

A sacroiliac injection is an injection of a steroid or other medication into a sacroiliac joint. The sacroiliac joints are located on either side or the sacrum or tailbone. They connect the tailbone to the pelvis. The steroid injected reduces the inflammation and swelling of tissue in and around the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.

Stellate Ganglion Block

A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck. A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face.

Spinal Cord Stimulator Trial

Spinal Cord Stimulation (SCS) is a procedure that uses electrical impulses to block pain of the back, arms and legs from being recognized in the brain. Instead of pain, the patient feels a more pleasant tingling sensation. The goal is to lower the level of pain while improving the quality of daily living. The trial involves an outpatient surgical procedure to temporarily place a stimulator wire in your back to find out if your pain will be improved by the stimulation. Numbing medicine will be used on the area of your back where the lead will be placed. Your physician will use live x-ray during the procedure to aid in placement of the wire. The lead is inserted through a needle into the space above your spinal cord. The lead is attached to a power source. Once the lead is in place, your physician will turn the stimulator ON. You will then be awakened for this part of the procedure. You will provide feedback to the physician which aides in the correct placement of the wire to produce stimulation in the area of your pain. The wire will be covered with a dressing and connected to an external battery pack. The trial may last five to seven days. During this time you will decide if the stimulation provides at least 50%-70% relief of your normal pain. You must also be sure that you are comfortable with the sensations of stimulation. You will not be able to shower or get the dressing wet during the trial. If the trial is successful, a procedure will be scheduled to implant the permanent stimulator, wire and battery.


Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative (nonsurgical) care regimens. The most common use of discography is for surgical planning prior to a lumbar fusion. Lumbar discography is considered for patients who, despite extensive conservative treatment, have disabling lower back pain, groin pain, hip pain, and/or leg pain. When a variety of spinal diagnostic procedures have failed to elucidate the primary pain generator, these individuals may benefit from lumbar discography especially if spine surgery is contemplated.

Muscle and Joint Injections Under Ultrasound Guidance

The injection of medication into a painful muscle or joint is used to relieve discomfort associated with a range of conditions, from neck pain to tennis elbow. Because the needle used for the injection needs to reach the exact source of the pain, these procedures are performed with the assistance of an ultrasound machine (the same imaging technique used to monitor pregnancies). Ultrasound allows the physician to guide the needle under the skin, and deliver the injection—which contains a local anesthetic and a low dose of steroid—directly to the origin of the pain.

EMG (Electromyogram)

Measures muscle response or electrical activity in response to a nerve's stimulation of the muscle. The test is used to help detect neuromuscular abnormalities. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle. The electrical activity picked up by the electrodes is then displayed on an oscilloscope (a monitor that displays electrical activity in the form of waves). An audio-amplifier is used so the activity can be heard.EMG measures the electrical activity of muscle during rest, slight contraction and forceful contraction. Muscle tissue does not normally produce electrical signals during rest. When an electrode is inserted, a brief period of activity can be seen on the oscilloscope, but after that, no signal should be present.


The Vestibular Autorotation Test (VAT) is a computerized test of head and eye movements to evaluate both the high frequency horizontal and vertical vestibulo-ocular reflex (VOR). The VOR system stabilizes fixation of the eyes during head rotation by causing the eyes to move in the opposite direction of the head motion. The main purpose of the VOR is to allow clear vision during movement by sending signals to move the eye muscles to compensate for the small rapid head movements that occur in everyday life. However if the speed or timing is off, even slightly, vision is distorted because of apparent movement of the visual fields. The VAT tests the normal, everyday range of head motion where many balance disorders occur. The computer analyzes head motion and simultaneous eye movements. Electrodes record eye movement while a velocity head sensor records head movement. The VAT is used in the diagnosis of inner ear disturbances and also to monitor changes during vestibular rehabilitation.


CALMARE uses a biophysical rather than a biochemical approach. A 'no-pain' message is transmitted to the nerve via disposable surface electrodes applied to the skin in the region of the patient's pain. The perception of pain is cancelled when the no-pain message replaces that of pain, by using the same pathway through the surface electrodes in a non-invasive way. Regardless of pain intensity, a patient's pain can be completely removed for immediate relief. Conditions treated include:

  • Chemotherapy-induced peripheral neuropathy (CIPN)
  • Phantom Limb Syndrome
  • Sciatica
  • Post-surgical Neuropathic Pain
  • Low back pain (LBP)
  • Neck pain
  • Reflex sympathetic dystrophy
  • Postherpetic Neuralgia (PHN)
  • Chronic Cancer Pain
  • Failed Back Surgey Syndrome (FBSS)
  • Brachial Plexus Neurapathy
  • Chronic Neuropathic Pain
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