TREATMENTS

Chronic Pain Conditions We Treat

DISEASES OF THE SPINE

Degenerative Disc Disease
Bulging or Herniated Disc
Sciatica
Cervical Radiculopathy
Lumbar Radiculopathy
Spinal Stenosis
Arthritis of the spine
Facet Arthritis
Failed Back Surgery
Chronic Pain Conditions
Neck Pain
Back Pain
Spondylosis
Sacroiliac Joint pain and Sacroiliitis
Coccydynia (painful tailbone)

MUSCLE AND JOINT DISEASES

Rheumatoid Arthritis
Ankylosing Spondylitis
Lupus Arthritis
Osteoarthritis
Chronic Sprains and Strains
Pain from Tendon and Ligament tears
Tendonitis
Adhesive Capsulitis
Sports injuries
Fibromyalgia
Myofacial Pain Syndrome
Muscle Spasm
Meniscal tears
Chronic joint pain (knee, shoulder, hip etc.)

OTHER PAINFUL CONDITIONS

Spinal Cord Injury
Complex Regional Pain Syndrome (RSD)
Diabetic Peripheral Neuropathy
Painful Polyneuropathies
Post Herpetic Neuralgia
Carpal tunnel syndrome
Headaches
Greater occipital neuralgia
Stroke
Spasticity management
Central pain syndrome
Multiple Sclerosis
Traumatic Brain Injury
Intercostal Neuralgia
Greater Occipital Neuralgia
Trigeminal Neuralgia
Chronic pain syndrome
Brachial Plexopathy
Cubital tunnel syndrome/Ulnar neuropathy
Chronic abdominal pain
Tarsal tunnel syndrome
Myelopathy
Chest wall pain

PROCEDURES FOR NECK PAIN/UPPER EXTREMITY PAIN

Cervical Epidural Steroid Injection & Thoracic Epidural Steroid Injection Procedures:

These injections treat pain caused by irritation of nerves originating in the neck and upper back as a result of degenerative or herniated discs. The injection delivers a potent dose of anti-inflammatory medication directly into the epidural space next to the painful and inflamed nerve. Procedures are done using fluoroscopic guidance for safety and quality purposes.

Cervical Epidural Steroid Injection

Cervical Medial Branch Nerve Blocks:

These injections help your doctor determine whether your neck pain originates from painful and arthritic facet joints.  This is sometimes referred to as degenerative joint disease, spondylosis, or arthritis of the spine. These arthritic joints receive pain signals from medial branch nerves.  Local anesthetic injection to these nerves confirms whether your pain is coming from your facet joints or not.  Your doctor may proceed with more definitive treatments such as radiofrequency ablation if these nerve blocks help. Procedures are done using fluoroscopic guidance.

Medial Branch Nerve Block

Cervical and Thoracic Facet Joint Injections:

These injections treat pain due to painful and arthritic facet joints (degenerative joint disease, spondylosis, arthritis). Local anesthetics along with an anti-inflammatory medication are injected into the small facet joints to decrease inflammation and pain. Procedures are done using fluoroscopic guidance.

Facet Joint Injection

Radiofrequency Ablation of the Cervical Facets:

This procedure treats pain due to painful and arthritic facet joints after the origin of the pain has been confirmed by cervical medial branch nerve blocks. A special needle is advanced to the cervical medial branch nerves (which are small nerves which transmit pain from the facet joints). A probe which emits radiofrequency energy is placed inside the needle to deactivate pain sensation from those nerves. Procedures are done using fluoroscopic guidance and can provide relief for over a year.

Radiofrequency Ablation of the Cervical Facets

Spinal Cord Stimulator Trial:

In this procedure, a thin electrode is introduced into the epidural space of the spine and advanced to the appropriate level of the spinal cord. The electrodes are connected to a control unit which delivers electronic impulses to the spinal cord, interrupting the transmission of pain. The electrodes are kept in place for up to a week. If pain relief is significant, then a more permanent stimulator can be implanted. Procedures are done using fluoroscopic guidance.

Occipital Nerve Blocks:

These injections treat occipital neuralgia which is a common type of headache. The injection introduces a dose of local anesthetics along with an anti-inflammatory medication to the inflamed nerves. Procedure can be done with or without fluoroscopic guidance depending on the specific nerve involved.  Some common nerves involved would be Greater occipital, Lesser occipital, or Third occipital nerves.

PROCEDURES FOR BACK PAIN/LOWER EXTREMITY PAIN

Lumbar Epidural Steroid Injection:

These injections treat the pain caused by irritation of nerves originating in lower back as a result of degenerative or herniated discs. The injection delivers a potent dose of anti-inflammatory medication directly into the epidural space close to the painful and inflamed nerves. Procedures are done using fluoroscopic guidance.

Lumbar Epidural Steroid Injection

Lumbar Facet Joint Injections:

These injections treat pain due to painful and arthritic facet joints (degenerative joint disease, spondylosis, arthritis). Local anesthetics along with an anti-inflammatory medication are injected into the small facet joints to decrease inflammation and pain. Procedures are done using fluoroscopic guidance.

Facet Joint Injection

Lumbar Medial Branch Nerve Blocks:

These injections help your doctor determine whether your back pain originates from painful and arthritic facet joints.  This is sometimes referred to as degenerative joint disease, spondylosis, or arthritis of the spine. These arthritic joints receive pain signals from medial branch nerves.  Local anesthetic injection to these nerves confirms whether your pain is coming from your facet joints or not.  Your doctor may proceed with more definitive treatments such as radiofrequency ablation if these nerve blocks help. Procedures are done using fluoroscopic guidance.

Medial Branch Nerve Block

Lumbar Facet Radiofrequency Ablation:

This procedure treats pain due to painful and arthritic facet joints after the origin of the pain has been confirmed by Lumbar medial branch nerve blocks. A special needle is advanced to the Lumbar medial branch nerves (which are small nerves which carry pain from the facet joints). A probe which emits radiofrequency energy is then placed inside the needle to deactivate pain sensation from those nerves. Procedures are done using fluoroscopic guidance and can provide relief for over a year.

Lumbar Radiofrequency Ablation

Sacroiliac Joint Injections:

These injections treat inflammation and pain of the Sacroiliac joint. A solution consisting of a local anesthetic and an anti-inflammatory medication is injected directly into the joint using fluoroscopic guidance.

Sacroiliac Joint Injection

Spinal Cord Stimulator Trial:

In this procedure, a thin electrode is introduced into the epidural space of the spine and advanced to the appropriate level of the spinal cord. The electrodes are connected to a control unit which deliver electronic impulses to the spinal cord, interrupting the transmission of pain. The electrodes are kept in place for up to a week, and if relief is significant, then a more permanent stimulator can be implanted. Procedures are done using fluoroscopic guidance.

Diagnostic Lumbar Discography:

This procedure is done in cases of multiple torn or degenerated discs to confirm that pain originates from the disc and to identify the exact disc which is causing the pain. Once this disc is identified, the patient and the doctor can proceed with more definitive treatments.

Discography

Coccyx/Ganglion Impar injections:

These procedures are done to treat cases of tailbone and/or anal pain. Depending on the likely source of pain, a needle is introduced either on, in, or slightly through the sacrococcygeal joint above the tailbone to inject the inflamed ligaments, joint, or nerves of the Ganglion Impar with a combination of local anesthetics and anti-inflammatory medications. Procedures are done using fluoroscopic guidance.

Sacral Lateral Branch Nerve Blocks:

These injections help your doctor determine whether pain in the Sacroiliac joint and/or Sacrum are carried by the Lateral branches. If local anesthetic injection to these nerves help your pain, then more definitive procedures may be performed. Procedures are done using fluoroscopic guidance.

Sacral Radiofrequency Ablation:

This procedure treats pain originating from the Sacroiliac joint and/or Sacrum after the Lateral sacral branches have been confirmed by Sacral lateral branch nerve blocks to be the nerves transmitting the pain. A special needle is advanced to the Lateral sacral branches (which are small nerves which carry pain from the Sacrum and Sacroiliac joints). A probe which emits radiofrequency energy is then placed inside the needle to deactivate pain sensation from those nerves. Procedures are done using fluoroscopic guidance and can provide relief for over a year.

Radiofrequency of facet and Sacroiliac Joints

Genicular Nerve Blocks:

These injections help your doctor determine whether pain in the knee is carried by the Genicular nerves. If local anesthetic injection to these nerves block the pain signals, then you and your doctor can proceed with more definitive treatments. Procedure is done using fluoroscopic guidance.

Genicular Radiofrequency Ablation:

This procedure treats chronic knee pain after the Genicular nerves have been confirmed by Genicular nerve blocks to be the nerves transmitting the pain. A special needle is advanced to the Genicular nerves, then a probe that emits radiofrequency energy is placed inside the needle to deactivate pain sensation from those nerves. Procedure is done using fluoroscopic guidance and can provide relief for over a year.

PROCEDURES FOR MUSCULOSKELETAL ULTRASOUND GUIDED INJECTIONS

Peripheral Nerve Blocks:

Ultrasound-guidance allows providers to directly see peripheral nerves, resulting in better outcomes when performing nerve blocks to Suprascapular, Median, Ulnar and/or Peroneal nerves.

Peripheral Joint Injections:

Ultrasound-guidance allows providers to directly see the joints which they are injecting.  This results in better outcomes when performing injections of the shoulder, elbow, wrist, hip, knee and ankle.

Trigger Point Injections:

Ultrasound-guidance allows providers to directly see the muscles which they are injecting, resulting in better outcomes when performing trigger point injections, especially when done along the chest wall.

Trigger Point Injections

Viscosupplementation:

Ultrasound-guidance allows providers to directly see the joints which they are injecting.  This results in better outcomes when performing Hyaluronic acid (Synvisc, Hyalgan, Supartz) injections.

Mesenchymal Stem Cell Therapy

What are Stem Cells?

Our body is made up of trillions of cells. These cells begin as stem cells which then replicate and mature into many different types of cells in the body. Hematopoietic stem cells give rise to all of the blood cells in our body. For regenerative pain purposes, however, we use a different type of stem cell called mesenchymal stem cells. These mesenchymal stem cells have the ability to help the body repair itself. Mesenchymal stem cells communicate with other damaged cells through a process called “paracrine signaling”. This paracrine signaling process directs and controls the natural regeneration or healing process in our bodies. Nashville Stem Cell Therapy utilizes these mesenchymal stem cells to help the body naturally repair itself.  Our Nashville Stem Cell Therapy provides a natural source to help with pain and various disease processes.

What are the benefits of Nashville Stem Cell Therapy?

  1. Stem cells are anti-inflammatory and immunomodulatory. They can decrease swelling and inflammation in the body by downregulating/decreasing the T-1 helper cells (pro-inflammatory cells) and upregulating/increasing the T-2 helper cells (anti-inflammatory cells). Many chronic pain states and systemic diseases have an imbalance of T1/T2 helper cells. Stem cells can help restore balance, thus decreasing inflammation and swelling in the body. This is especially helpful with chronic pain states and many autoimmune disorders.
  2. Stem cells have trophic/growth factors that help nourish nearby cells that are damaged.  They increase blood supply to damaged tissue and can help reduce scar tissue formation.
  3. Stem cells signal nearby cells that are about to die and help rescue those cells from cell death. They cannot heal cells that are already dead, but they can help save those damaged cells that are about to die.
  4. Stem cells have antimicrobial properties that help fight bacterial infections. This is very beneficial for wound healing.
  5. Stem cells have the potential to do many functions that other cells in your body already do. They have the potential to regenerate damaged tissues and help avoid surgery.
  6. Research studies have shown patients to have significant improvements in pain and function.  Studies have also shown improvements on MRI several years after only one stem cell injection. Stem cell therapy is very exciting because it has the potential to help correct the source of your pain.

What medical conditions could potentially benefit from Nashville Stem Cell Therapy?

  • Osteoarthritis
  • Degenerative joint disease
  • Knee pain including knee osteoarthritis, degenerative joint disease, meniscal tears and ACL/PCL tears.  Research studies have shown cartilage growth and repair after just one stem cell injection.
  • Shoulder pain including rotator cuff injuries, arthritis etc.
  • Hip pain
  • Chronic lower back pain.

How are stem cells collected?

There are multiple ways that mesenchymal stem cells can be collected in order to inject or infuse into your body. Stem cells are collected from four sources for the purpose of regenerative therapy.  These four sources include bone marrow, adipose tissue, amniotic fluid and umbilical cord blood.

1. Stem cells can be extracted from your bone marrow.  This technique involves puncturing a needle through your bone and extracting the marrow.  The marrow is then filtered to get the stem cells.

2. Stem cells can be extracted from your adipose tissue.  This technique involves using a needle to remove fat cells from your body.  The fat cells are then filtered to obtain stem cells. Both bone marrow aspirate and adipose derived fat stem cells can be a painful and time consuming process. The stem cell count from both of these methods is variable.  The cell count varies according to the patient’s age, health, and technique of the provider extracting the stem cells.

3. Stem cells can be extracted from amniotic fluid.  This method involves collecting stem cells from amniotic fluid in a pregnant woman. This method has a potential risk of causing an autoimmune reaction in your body due to HLA antigens in cellular debris.  The stem cell count from amniotic fluid is variable. These three methods produce a variable number of stem cells.  An accurate cellular count is important because some joints require more cells than others.

4. The last way to obtain stem cells is through the umbilical cord of live, healthy birthed babies.  There is both blood and Wharton’s Jelly found inside the umbilical cord.  Both sources have mesenchymal stem cells in addition to other cytokines and growth factors.  Wharton’s Jelly has been shown to be the richest source of donor mesenchymal stem cells.  It is also very nutrient rich with growth factors and cytokines that help create a safe environment for the stem cells to flourish.

These Wharton’s Jelly stem cells are not from aborted fetuses and are in no way related to abortions.  The umbilical cord is removed after a live, healthy child is born. The Wharton’s Jelly from within the cord is saved and sent to a tissue bank.  The tissue bank runs tests on the Wharton’s Jelly to ensure that it is healthy and free of disease. The Wharton’s Jelly is then frozen and stored at a tissue bank under strict FDA compliance.  

Which type of stem cells does Nashville Stem Cell Therapy use?

Nashville Stem Cell Therapy uses umbilical cord Wharton’s Jelly derived stem cells. We believe that cord Wharton’s Jelly is the superior method for extracting stem cells. These umbilical cord jelly stem cells are young, healthy and robust cells. Stem cells from bone marrow and adipose tissue are the same age as the person donating them. HLA antigens are attached to cells and are what our bodies use to recognize a cell as being foreign and therefore reject.  These umbilical cord jelly stem cells do not have HLA antigens attached to them.  This means that an adverse reaction to the stem cells from umbilical cord jelly is far less likely and much safer.

Umbilical cord derived Stem Cell with fluorescent staining
Umbilical cord derived Stem Cell with fluorescent staining

Another advantage of umbilical cord jelly derived stem cells is that the cell count is more accurate and customizable for individual needs. For example, a large joint would require more cells than a smaller joint would. We can approximate the number of cells you may need for your specific disease process. We offer Nashville Stem Cell Therapy at our Nashville and Hendersonville interventional pain management clinics.

Final comments

We believe that regenerative medicine with treatments such as stem cell therapy are the future of medicine, personal health and longevity. Nashville Stem Cell Therapy is an exciting, regenerative treatment that has the potential to help with knee pain, back pain, hip pain and shoulder pain. Dr. Brad Wilson, an interventional pain specialist, would be happy to discuss whether Nashville Stem Cell Therapy could help your pain.  The goal for our patients at our interventional pain clinics is to help reduce pain, improve function and improve quality of life. Nashville Stem Cell Therapy has the potential to help with all of these. If you would like more information or would like to set up an appointment to discuss our Nashville Stem Cell Therapy with one of our board-certified physicians, please call us at Interventional Pain Center (615) 972-1100 located in Nashville and Hendersonville, TN.

Platelet-Rich Plasma (PRP)

Platelet Rich Plasma Therapy (PRP) is a regenerative medicine technique using platelets which are concentrated from a blood sample and then injected into injured tissue to stimulate healing. The technique was first used clinically in 1987 and has found many applications in cosmetic surgery, dentistry, orthopedics, pain management and has even been used for sports injuries in many professional athletes.

PRP uses the body’s own healing response in order to repair injured tissue for our Nashville patients. After an injury, platelets (which are present in the bloodstream) will attach to broken blood vessels to stop bleeding and bruising. Platelets attach to the injured vessels, stop the vessels from bleeding and then release growth factors to stimulate the injured tissue to repair or replace the injured cells.

If the tissue does not fully repair itself after an injury, pain can persist for months or maybe years. Nashville PRP increases the platelets up to seven times the normal concentration and allow us to deliver a large concentration of growth factor-filled platelets directly to the injured tissue so that the healing process can resume.

Healing Cascade Prolotherapy Nashville
Platelet Rich Plasma (PRP) concentrates platelets for injection into joints and other tissue

The process is simple. Whole blood, which is first drawn from one of our Nashville patients, then undergoes two stages of centrifugation (spinning down) to separate platelet-rich plasma from platelet-poor plasma and red blood cells. Once the PRP is separated from the rest of the blood components, Nashville PRP is drawn into a syringe. We then use either ultrasound or fluoroscope (x-ray) to help guide our injection so that the platelets can be delivered to the precise area of injury where they release their growth factors to re-start the healing process.

Nashville PRP at our interventional pain clinics can be used to treat chronic musculoskeletal pain or injuries of the joints, ligaments, tendons and muscle. It has been shown to be beneficial for pain due to osteoarthritis of the neck, back, shoulders, hips and knees. PRP has also been used successfully to treat partially torn ligaments or tendons throughout the body.

Nashville Platelet-Rich Plasma Therapy is a safe and effective procedure with a long track record of success in the treatment of joint, tendon, or ligament pain due to either trauma or age-related degeneration. At our interventional pain clinics located in Nashville and Hendersonville, we are committed to identifying the cause of your pain and utilizing various treatments such as our Nashville Platelet-Rich Plasma Therapy to help your pain. If you would like more information or would like to set up an appointment at one of our interventional pain clinics to discuss Platelet-Rich Plasma Therapy with our Nashville or Hendersonville board-certified physicians, please call us at Interventional Pain Center (615) 972-1100.

Prolotherapy

Prolotherapy, also known as Proliferant Injection Therapy, is one of the oldest forms of Regenerative Medicine. Prolotherapy in its modern form was first developed in the 1950s by Dr. George S. Hackett, a surgeon who discovered that by injecting certain substances which he called Proliferants into chronic injuries of tendons and ligaments, he could induce a tissue response which would provide improvements of pain and dysfunction.

In a typical tendon or ligament injury of our, some of the cells break open, releasing proteins, fatty acids, and other substances into the region. Platelets aggregate at the site of injury followed by an inflammatory response which attract other cells such as fibroblasts, which then proliferate (or make additional copies of themselves) to produce collagen and form connective tissue.

Prolotherapy uses this natural tissue response to re-start the healing process in chronic injuries (due both to trauma and age-related degeneration) for our Nashville patients. In a typical treatment, the site of greatest pain and tenderness is identified, and sometimes visualized using ultrasound. The Proliferant in our Nashville Prolotherapy is chosen, drawn into a syringe, and injected into the injured tissues using either ultrasound or palpation techniques.

The Proliferant in our Nashville Prolotherapy induces a mild inflammatory response at the sites of injection, which will attract other cells such as platelets, white blood cells, and fibroblasts. The cells then undergo their typical healing cascade as described above to repair the injured tissue.

There are many different types of Proliferants in Prolotherapy that can be used. Common Proliferants include Sodium Morruate, Phenol, P2G (a mix of phenol, glucose and glycerine), and Dextrose. At our pain clinics in Nashville and Hendersonville, we use Dextrose at 12.5% and 25% concentrations as our Proliferant. Dextrose has what we believe to be the best efficacy and safety record.

Nashville Prolotherapy is a safe and effective procedure with a long track record of success in the treatment of joint, tendon, or ligament pain due to either trauma or age-related degeneration. At our interventional pain clinics located in Nashville and Hendersonville, we are committed to identifying the cause of your pain and treating your pain at the source. Nashville Prolotherapy is one of our cutting-edge, pain management treatments that stimulates your own body to heal itself. If you would like more information or would like to set up an appointment to discuss Prolotherapy with one of our Nashville or Hendersonville board-certified physicians, please call us at Interventional Pain Center (615) 972-1100.

Prolotherapy restarts the body’s normal healing process

OTHER TREATMENTS

  • Pain Medication Management
  • Durable Medical Equipment (DME): We dispense back braces, knee braces, and wrist braces.
  • Regenerative Therapy: Platelet rich plasma injections, prolotherapy, stem cell therapy
  • Osteopathic Manipulative Treatment