Our Neurological Services

Cervical Pain Management Procedures


Preventive and Doagnostic
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.

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.

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

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® 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 Pain Management Procedures


Restorative
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.

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

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.

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 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.


Lumbar Pain Management Procedures


Interceptive Orthodontics
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.

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.
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

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.

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

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

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.

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.

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


Neurological Pain Management Procedures


Aesthetic
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 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.

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.
Carotid duplex is a procedure that uses ultrasound to look for blood clots, plaque buildup, and other blood flow problems in the carotid arteries. The carotid arteries are located in the neck and supply blood to the brain.

Transcranial duplex is a procedure that uses ultrasound to look for blood clots, plaque build up, aneurysms, vasospasms, and other blood flow problems in the intracranial arteries.

  • 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.
  • 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.

 


Pain Management for Specific Types of Pain



Aesthetic
Dr. Igor Turok specializes in back pain treatment in Wallingford, CT and Stamford, CT.

Click here to learn more about back pain treatment.

Dr. Igor Turok specializes in neck pain treatment in Wallingford, CT and Stamford, CT.

Click here to learn more about neck pain treatment.


Additional Procedures & Treatments


Aesthetic
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.

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.

Medical Marijuana

The State of Connecticut passed a piece of marijuana legislation that effectively establishes a state-regulated medical marijuana program. While the measure itself narrows down the amount of qualifying diagnoses or conditions that would qualify a patient for the therapeutic used of cannabis within the state, the CT program was drafted with careful and strict controls that operates under a very tight regulation and oversight.

For the pain patient, physical therapy is a critical element in the quest to regain the function that has been lost. In many cases, it hurts so much to move that the patient stops moving – for fear that increased movement will increase the pain. However, in many cases, the way to reduce pain and increase function is to start moving again under the direction of a trained physical therapist

Working with the physical therapist to establish goals, you can gradually begin to rebuild strength, coordination and flexibility, while being educated on how each modality is helpful and how to continue therapy at home.

Magnesium infusions can be an effective treatment for migraine headaches.
Multivitamin Infusions can be an effective treatment for peripheral neuropathy.
An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post-dural puncture headaches caused by a lumbar puncture procedure (spinal tap).
A Lumbar Puncture (spinal tap) is performed in the patient’s lower back, or the lumbar region. During the procedure, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluiid, the fluid that surrounds your brain and spinal cord to protect them from injury. This procedure can be used to help diagnose meningitis and other infections or other central nervous system disorders such as Guillain-Barre syndrome, Multiple Sclerosis or cancers of the brain or spinal cord.
Dr. Turok offers a complimentary consultation to determine each patient’s special esthetic concerns. After carefully reviewing each patient’s concerns and needs, he will work to develop an individualized treatment plan to achieve their aesthetic goal. Therapy is tailored during each visit to reach the desired look and follow up appointments are provided at no additional charge. Dr. Turok is committed to ensuring that each patient is comfortable with the procedure, understands exactly what they are getting and that every patient gets the result they desire. Dr. Turok has extensive experience in treating both genders and he understands the distinct needs of each patient and is able to provide a safe, well tolerated and financially appealing aesthetic treatment plan.

Injectable Dermal Fillers

Dermal Fillers are used to fill wrinkles and soften the appearance of lines or folds, providing our clients with younger-looking, firmer skin and can even provide results comparable with those from a face lift- but without the surgery and recovery.

  • We offer Juvederm®, Voluma®, Radiesse® and Belotero® because we believe these fillers, as the latest in dermal filler technology, provide the best results for our patients.
  • While the number of syringes each patient needs will vary, 1-2 syringes is considered typical.
  • Juvederm® Ultra XC and Ultra Plus XC and Voluma® XC are delivered in 1.0cc syringes that are premixed with Lidocaine®, a local anesthetic, to provide increased patient comfort.
  • Radiesse® comes in both .08cc and 1.5cc syringes and Belotero® is offered in 1.0cc syringes.

Botox® and Xeomin®

  • May be used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines), around the side of the eyes (crow’s feet lines), and smooth away wrinkles around the mouth and nose in adults for a short period of time (temporary).
  • May also be used to treat gummy smiles and to soften clefts in the chin.
  •  Tiny injections are administered in and around the treatment area. You should experience little to no discomfort and usually takes around 20 minutes.
  • Patients can expect to see results in 7-14 days.

Learn More about Esthetic Services

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 Fasciilis
  • Joint Pain Caused by Wear and Tear
  • As a complement to aesthetic injectable procedures (i.e. Botox®/Dermal Fillers) 

AmnioFix® is a human amniotic membrane allograft that has been used to successfully treat:

  • Modulation of Inflammation
  • Reduction of Scar Tissue Formation
  • Enhancing Healing

Allografts have been used extensively for surgery and wound care, and amniotic membranes have been used in the medical field for over 100 years. AmnioFix® contains some of the most important growth factors needed for healing. Growth factors are powerful agents that our bodies produce to signal cells to come to the target site, help the site to heal, help your own cells regenerate the damaged tissue.

AmnioFix® may be an effective solution for patients if:

  • A patient has been diagnosed with inflammation from an injury
  • Conservative treatments such as anti-inflammatories, physical therapy, and bracing have been ineffective
  • A patient is seeking a non-steroidal option or has reached the limit for steroid injections

Treatment Procedure:

Following an evaluation and consultation to determine if AmnioFix® is a viable treatment option for the patient, the entire AmnioFix® treatment process is very short and is generally performed on an outpatient basis. After treatment, the site might appear red and be tender to the touch. Patients can apply ice and elevate the treated area as needed. Patients may initially experience some localized soreness and discomfort that may last 2-3 days.

Following treatment, Dr. Turok may prescribe some rehabilitation exercises or direct you to a rehabilitation facility. For AmnioFix® to work optimally, it is important that you follow post-treatment care completely.

All of the amniotic membrane tissue for AmnioFix® is donated by healthy consenting mothers. The amniotic membrane is the cover (membrane) surrounding the baby, is typically discarded after the baby is born and it’s recovery does not affect the baby or the delivery process. Therefore, the donation process does not share the ethical concerns associated with embryonic tissue. Additionally, all tissue donors are tested for infectious diseases and then thoroughly cleansed and preserved. AmnioFix® allografts are procured and processed in the United States according to the standards and/or regulations established by the American Association of Tissue Banks {AATB) and the United States Food and Drug Administration (FDA).