Procedures for Diagnosing and Treating Pain

Our multi-specialty team of pain experts works together to accurately diagnose your pain and offer you the most effective treatments available.

Your healthcare provider at the OHSU Comprehensive Pain Center can give you more information on any of these procedures.

Diagnosis and treatment options include:

Transforaminal Epidural Steroid Injections

These injections treat pain that is caused by pressure on one of your spinal nerves. Herniated or bulging discs can irritate or put pressure on these nerves. With this condition, you often feel pain that starts in your back and spreads down your leg. Your pain might also start in your neck and spread down your arm.

Using an X-ray, your doctor guides a needle into your epidural space (near the spinal nerves, but not in your spinal cord). Your doctor then gives you a local anesthetic (numbing medicine) and a steroid to eliminate pain. These injections usually work better than taking steroids by mouth and have fewer side effects.

In most cases, you don't need to be sedated for this procedure. You can discuss that option with your doctor. You should not eat on the day of your procedure and you need a driver to take you home.

View an animation of the procedure.

Medial Branch Block and Medial Branch Denervation

This procedure is used to determine whether pain in your neck or back is coming from arthritis or from your facet joints. Facet joints are located in your spine from your neck to your tailbone.

These joints develop arthritic pain, just like any other joint in your body. With this nerve block, we inject local anesthetic (numbing) medication near the nerve supply for these joints so we can diagnose your problem. We are trying to find out if a temporary nerve block reduces the pain you feel when you move.

If you have a successful series of medial branch blocks, we may suggest a long-term treatment called medial branch denervation. In most cases, if your medial branch block injections reduced your pain, you will have a similar degree of pain relief for the long term (about 12 to 18 months) after a denervation procedure.

The denervation procedure is similar to a diagnostic block. However, instead of injecting anesthetic medication, your doctor uses a device that generates radiofrequency (RF) energy. This is inserted on the tip of a needle near the nerve supply.  

Radiofrequency Facet Denervation (RFD)

Radiofrequency facet denervation (RFD) is used to treat central neck or back pain associated with arthritis. Your doctor will first diagnose your nerve blocks and then perform the denervation treatment.

Facet joints, located in your spine from your neck to your tailbone, can become damaged during normal activities, with age or from inflammatory diseases, such as rheumatoid arthritis. Your doctor might suggest RFD if pain from your damaged joints does not improve with physical therapy, medication or both.

For the first part of your treatment, your doctor uses an X-ray to guide a needle to the nerve connected to your damaged joint. Once the needle is in place, the doctor injects local anesthetic to numb your nerve.

After the injections are complete, you are asked to compare your pain level before and after the procedure. The numbing effect from the injections is temporary, and it might take injections on separate days to make an accurate diagnosis.

If you experience a temporary improvement in pain, your doctor might suggest continuing. You are sedated for this part of the RFD. Using an X-ray, the doctor places a special needle in the nerve for your damaged facet joint.

After injecting local anesthetic to numb the nerve, your doctor heats the needle to damage a portion of your nerve. This does not damage nerves that go to your arms or legs and does not further damage your joint.

You might still have some pain for up to two weeks after an RFD and your doctor might prescribe pain medication for this period. Two weeks after your procedure, you will have physical therapy to help with pain and improve your movement.

You should not eat before your RFD procedure. You need someone to take you home.

Peripheral and Sympathetic Nerve Blocks

Peripheral nerves are the nerves outside of your brain and spinal cord. These nerves send sensation and are responsible for some of your movement. Trauma, surgery, scar tissue or illness can damage or change the function of these nerves. Blocking some of these nerves can help provide pain relief for you.

Chronic pain conditions can often involve changes in function of your sympathetic nerves. These nerves regulate blood flow, sweating and function of your glands. Sometimes blocking these nerves can provide diagnostic information as to what is causing your pain and provide pain relief for you.


Botulinum toxin (Botox), which is the same bacteria that can cause deadly food poisoning can also safely be used to relieve certain types of pain:

  • Headaches (migraines especially)
  • Piriformis syndrome (condition causing pain in the buttocks)
  • Myofascial pain (muscle pain)
  • Other pain problems

Often, your insurance does not cover botulinum toxin treatment. We help you pursue insurance authorization for this type of treatment. If you do not get insurance authorization, botulinum toxin injections may not be an option for you because of the expense.

Spinal Cord Stimulator (SCS)

Your doctor might use this to treat pain from nerve damage or an inadequate blood supply. A spinal cord stimulator (SCS) is a medical implant. Your doctor places one part of the SCS in your back and one somewhere else in your body.

SCS can help treat persistent leg or arm pain after low back or neck surgery. However, this treatment is not right for every patient with this type of pain. A doctor and a psychologist evaluate you and discuss other options such as medication, rehabilitation and injections with you.

You go through a two-phase process to determine if the implant will be effective. If it works, you then move forward with this procedure.

For first part of the procedure, your doctor uses an X-ray to guide a needle into the epidural space (near your spinal nerves, but not in your spinal cord). Once it is in place, your doctor inserts one or two spinal cord stimulator leads into the epidural space and connects them to a generator.

The generator is programmed to provide a safe, low dose electrical current to the leads. The electrical current helps relieve pain and improves circulation.

You are sedated (take medication to help you relax and minimize discomfort) for this procedure but must be able to communicate with your doctor. You should not eat on the day of the procedure and need a driver to take you home.

View an animation of the procedure.