Epidural Injection
NCV / EMG Studies
First, a brief anatomy lesson. The spinal cord travels from the base of the brain, down the spinal canal, and is surrounded by spinal fluid. Encasing the spinal fluid is a sac called the DURA (simplified). Surrounding that sac is a space called the epidural space [(Epi - on top of) + DURA = EPI-DURAL]. This space has been used in the practice of medicine for decades to provide many forms of treatment, most commonly for pain relief (labor epidural analgesia, surgical anesthesia, post-surgery analgesia, and single shot injections for chronic pain). The effective difference depends on the technique used and the type of medication that is injected, as well as whether or not a catheter is left in the epidural space.

 Medications are injected via the needle or through a small, flexible catheter. The needle/catheter is then removed, dressing placed and the patient is then monitored for some time to ensure that there is no adverse reaction to the medication. The medication generally used is a combination of local anesthetic and "cortisone" type medication. There  is minimal pain involved in the procedure. The procedure is considered safe, such that it can be performed in the office setting by specialists. There is very little to no "down time". The patient may return to regular activity the following day.
In the treatment of chronic pain, a catheter may or may not be used but, generally no catheter is left in the epidural space if the patient is not hospitalized. The epidural procedure is generally performed in an outpatient setting under fluoroscopy (motion x-ray), using sterile technique in the prone (lying on abdomen) position. The skin overlying the location of the injured or arthritic area is numbed using a local anesthetic. A specialized needle is then used to enter the epidural space. The doctor has many ways of confirming proper placement of the needle, including fluoroscopy.
A nerve conduction study is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body.

The two types of tests performed at DPMA are the Nerve  Conduction Velocity (NCV) test and the  Electromyography (EMG) test.  The NCV test measures the electrical properties of the nerves themselves, while the EMG measures the electrical properties of the muscles that nerves are attached to.

Each test can help diagnose a particular disorder and assist the doctor in locating the specific nerve areas that need attention.
What is an Epidural Injection?
What are Nerve Conduction and Electromyleogram Studies?
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Services performed by Doctors' Pain Management Associates

Listed below are some of the procedures, therapies and modalities that will help you ease your pain and get you back to a better quality of life. 
Different therapies can:
  • Dull or mask the feeling of pain
  • Address the condition that is causing your pain
  • Promote the body's natural healing response
  • Reroute the physical and neurological mechanisms that are responsible for pain
  • Assist in mobility or stengthening of joints and muscles
  • Diagnose the root cause of your pain
Many patients will find that utilizing more than one therapy will accelerate relief.  Please allow Dr. Webster to assess and recommed the most effective course of action.
Services we provide:
  • Epidural Steroid Injections (ESI)
  • Facet Joint Injections/Small/Large Joint Injections
  • Neurostimulation/Spinal Cord Stimulator (SCS)
  • Intraspinal/Intrathecal Pump (ITP)
  • Radiofrequency Ablation (RFA)
  • Discography/ Partial Discectomy
  • Vertebroplasty and Kyphoplasty
  • Platelet Rich Plasma Therapy
  • Stem Cell Therapy
  • Nerve Conduction Velocity/Electromyleogram (NCV/EMG)
  • Hydrotherapy
  • Other Outpatient Therapies
Epidural Steroid Injections
Facet and Large/Small Joint Injections
Anesthesiologists have performed facet joint injections for more than 50 years. Fluoroscopic and Ultrasound guidance allows a precise needle placement for a small amount of local anesthetic and steroidal medication directly to the joint that is sending the pain signal. If successful, the block can be then followed by Radiofrequency Ablation, which is more of a permanent solution.

Additionally, joints such as knee, hip and elbow can be injected with medication to provide relief from chronic pain.
What is a Joint Injection?
Neurostimulation is a non-drug pain relief therapy that generates mild electrical pulses and sends them along your spinal cord to the brain, replacing the feeling of pain with a gentle massaging  sensation.

Neurostimulation is also commonly known as spinal cord stimulation (SCS)

  •     Your pain has lasted longer than the time needed to heal
  •     You have had limited pain relief from your current pain medications or pain therapies
  •     You have had multiple procedures, including surgeries that have not worked
What is spinal cord stimulation or neurostimulation?
 You May Be a Candidate for Neurostimulation if:
Intraspinal Pumps
In intrathecal pump is a small device that is placed above the hip and delivers a steady, low dose of medication directly to the spine of the chronic pain patient.  The major benefit of Intrathecal Medications are the small amounts needed to control pain. Apart from better pain control and fewer side effects, over time, this can save the patient a lot of money, time and inconvenience. Patient may only need to see the doctor every 3 to 6 months with as little as 1 mg per day of morphine. Addtional non-narcotic medication can be added or substituted.
  •      Pain relief where other therapies have failed
  •     Reduction in adverse effects from oral narcotic pain medication, such as nausea, vomiting, sedation, and constipation
  •     Decreased or elimination of oral analgesics
  •     Increased ability to perform activities of daily living - sleeping, shopping, family activities, exercise, sexual activity, work
  •     Improved social relationships with family and friends
What is an Intraspinal or Intrathecal Pump?

Benefits of Intraspinal Pumps:
Intraspinal/Intrathecal Pump (ITP)
Radio frequency ablation (RFA) is a treatment method where part of an injured nerve is disabled  using the heat generated from a high frequency radio wave. RFA has become increasingly accepted in the last 15 years with promising results. RFA procedures are performed with guidance from ultrasound or fluoroscopy.
What is Radiofrequency Ablation?
Radiofrequency Ablation
 Discography is a diagnostic procedure for evaluation of multiple vertebral discs to narrow down the specific area of injury when traditional imaging tests are inconclusive.  The test is performed prior to surgery on the suspected disc to identify where treatment is to be concentrated.

Needles are inserted through the back into the disc near the suspect area, guided by fluoroscopic imaging. Fluid is then injected to pressurise the disc, and any pain responses are recorded.

This procedure is repeated on multiple discs in a random sequence to assess the pain response and gauge the success rate for other treatments.
What is Discography?
Discography / Partial Discectomy
Vertebroplasty and Kyphoplasty
Vertebroplasty is an outpatient procedure for stabilizing compression fractures in the spine. Bone cement is injected into back bones (vertebrae) that have cracked or broken, often because of osteoporosis or tumors. The cement hardens, stabilizing the fractures and supporting your spine. Vertebroplasty can greatly reduce pain and allow you to return to normal activity.

Kyphoplasty is a modified form of the Vertebroplasty procedure where a surgical baloon is inserted into a fractured vertebrae.  After the baloon has been expanded, the resulting area is filled in with bone cement.  This procedure results in pain relief and correction of alignment for patients with a bone fracture that has not responded well to traditional spine treatments.
What are Vertebroplasty and Kyphoplasty?
Nerve Conduction Velocity and Electromyleogram Studies (NCV/EMG)
Platelet Rich Plasma or PRP is a relatively new treatment option for various injuries and conditions that have traditionally required surgery or other extensive treatments. Using the patient's own blood, sterilely prepared platelets are concentrated and then reinjected into the affected area. The platelets in turn release substances known as growth factors that lead to improved natural tissue healing.
What is Platelet-rich Plasma?
Regenerative Joint Injection (PRP and Stem Cell Therapy)
What is Stem Cell therapy?
Adult stem cells can be extracted from bone marrow or fat through simple methods. It's then concentrated and injected into the knee with image guidance, usually to successful results.
Although natural deterioration of the joint continues, one study showed that at five years, those joints that are injected with stem cells are in better shape than they were before the injections.

Stem cell therapy for joints works by:
  • developing into essential cartilage cells
  • thwarting the inflammation that can worsen arthritis
  • releasing proteins called cytokines that slow degeneration of cartilage and reduce pain
Hydrotherpy takes advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes.  Hydrotherapy stimulates blood circulation and can treat the symptoms of certain disorders.  As part of DMPA's physiotherapy, our hydrotherapy table uses water jets programmed to bring maximum releif.
What is Hydrotherapy?
We also provide:
● Massage Therapy
- Manual manipulation of soft body tissues (muscle, connective tissue, tendons and ligaments) to increase blood flow and reduce inflammation
● Exercise and Rehab
Increases muscle support for joints and increases blood flow
Therapeutic Ultrasound
Increases blood flow and decreases inflammation
● Manipulation
Relieves pressure on joints, reduces inflammation, and improves nerve function
● Biowave Therapy
Delivers electrical signals through the skin to the nerves inhibiting the pain signals, resulting in increased range of motion, decreased stiffness and reduction of muscle spasm for up to 24 hours following a single 30-minute treatment.
● Gait Training
Reconditions the muscles and joints to aid in walking after an injury
● Parrafin Bath
Relieves chronic arthritis pain using heat therapy
● On-Site X-Rays
Diagnostic imaging can narrow down the cause of pain in the spine and joints
● Ki
nesiology Taping
Can be worn 24 hours a day to Increase muscle support, reduce swelling and engage the lymphatic system to promote healing

Doctors' Pain Management Associates
825 E Oak Street
Kissimmee, FL 34744
321-442-8009 (tel)
321-442-8012 (fax)

601 S. Semoran Blvd
Orlando, FL 32807
321-442-8009 (tel)
321-442-8012 (fax)

Mailing Address:
P.O. Box 420037
Kissimmee, FL 34742

© 2015 Doctors' Pain Management Associates
Doctors' Pain Management Associates
3324 Commerce Center Lane
Sebring, FL 33870
321-442-8009 (tel)
321-442-8012 (fax)