Pain Management services provided exclusively by

Ritesh R. Prasad, M.D. and East Texas Spine Institute, P.A.


Nerve roots are attached to the spinal cord. One exits each side of the spine at every vertebral level. These nerves carry signals throughout the body from the skin to the muscles. When one of the nerve roots is irritated, patients may experience pain, numbness, tingling, and sometimes weakness down an arm or a leg. A diagnostic selective block can be used to prove that a pinched nerve is the problem.

What is a selective nerve block and why is it helpful?

A selective nerve root block is an injection near the affected nerve (outside the epidural space) as it exits the spinal column. Selective nerve root blocks are used both for diagnostic purposes (to determine if a specific nerve root is the source of the problem) and to relieve radicular pain caused by irritation of a specific nerve root. If a specific nerve is actually the cause of pain the local anesthetic in the injection will give immediate relief. The steroids in the injection will reduce inflammation over the next few days and possibly provide relief of pain that lasts for weeks to months. Herniated disk in the lumbar spine causing low back pain with leg pain (sciatica) is a common condition treated by a selective nerve root block.





The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to your back and into your legs.

Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.

What is an epidural and why is it helpful?

An epidural injection delivers steroids into the epidural space around spinal nerve roots to relieve pain - back pain, leg pain, or other pain—caused by irritated spinal nerves. The steroid used in the epidural steroid injection reduces the inflammation of those nerves, which is often the source of the pain. It may provide permanent relief or provide a period of pain relief for several months while the injury or cause of your pain is healing.




The sacroiliac joint is a large joint in the region of the low back and buttocks where the pelvis actually joins with the spine. If the joints become painful they may cause pain in the low back, buttocks, abdomen, groin, or legs.
What is an sacriliac joint injection and why is it helpful?
A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate relief experienced will help confirm or deny the joint as a source of pain. Additionally, the temporary relief of the numbing medicine may better allow a chiropractor or physical therapist to treat that joint. Also, time release cortisone (steroid) will help to reduce any inflammation that may exist within the joint(s).


What are the medial branch nerves and why are medial branch blocks helpful?
Medial branch nerves are the very small nerve branches that communicate pain caused by the facet joints in the spine. These nerves do not control any muscles or sensation in the arms or legs. They are located along a bony groove in the low back and neck and over a bone in the mid back. If this procedure has been scheduled, there is strong evidence to suspect that the facet joints are the source of your pain. Unfortunately, facet joint injections and other treatments performed earlier have not provided long term relief. Therefore, benefit may be obtained from having these medial branch nerves blocked with an anesthetic to see if a more permanent way of blocking these nerves would provide pain relief long term. Blocking these medial branch nerves temporarily stops the transmission of pain signals from the joints to the brain.




As part of your treatment your doctor is considering performing a procedure called RFTC (radiofrequency thermal coagulation) or "medial branch neurotomy."

What is a Neurotomy (RFTC) and why is it helpful?

This procedure is done to treat pain caused by the facet joints by creating a lesion or burn in the pain fibers to the facet joint also known as the Medial Branch of the posterior primary ramus.

The purpose of RFTC of the medial branch is to decrease pain and improve function. This is done only if pain is relieved temporarily by facet joint injections and then by medial branch nerve blocks.