Pain Management - Diagnostic

About Diagnostic Pain Management

General Information

Diagnostic pain management is an out-patient procedure that uses image guided injections to determine the cause of ongoing pain. It may also be used for surgical planning. Our diagnostic services include arthrograms, discograms, and myelograms.

Arthrogram

With an arthrogram, a series of images are taken of a joint after it is injected with a contrast medium. The contrast medium helps the radiologist see the soft tissues of the joint in addition to the bone.

Arthrograms are used to find the cause of various joint problems. These can include ongoing pain, abnormal movement, or swelling. Arthrograms may also be used to check needle placement for other procedures, such as steroid injections or joint fluid analysis.

Discogram

With a discogram, a series of images are taken of a disc in the spine after it is injected with a contrast medium. The disks are the cushions between the vertebrae. The contrast medium makes the disc more visible on the images which allows the radiologist to better see any abnormalities.

A discogram is used to find the cause of persistent back pain. This test is usually only done if treatment methods such as medication and physical therapy have failed.

Myelogram

With a myelogram, a series of images are taken of the spinal column after the spinal fluid is injected with a contrast medium. The contrast medium makes soft tissue in the spinal column more visible on the images which allows the radiologist to better see any abnormalities.

A myelogram is used to investigate disorders of the spinal canal, cord, nerve roots, and blood vessels. Potential disorders found through a myelogram include tumors, infection, herniated disks, and arthritis.

Risks Involved in Diagnostic Pain Management

Risks involved in pain management treatments include the following:

• Infection, bleeding, nerve injury, and injury to adjacent structures. These are uncommon.
• Risk of x-ray exposure; however, it is well below the level that generally causes adverse affects.
• Reaction to the contrast medium or medications used. This is rare.

Scheduling, Insurance and Preparation

Scheduling

• Medical Center of Aurora
• Sky Ridge Hospital
• Swedish Medical Center
• Porter Adventist Hospital
• Littleton Adventist Hospital.

Insurance Coverage

Pain management procedures are usually covered by insurance when ordered by a physician. Check with your insurance company to be sure. Please bring your insurance card with you to your exam.

Conditions to Let Us Know About

In advance of your procedure, let your scheduler, radiologist, or technologist know if any of the following circumstances apply to you:

• Currently pregnant
• Any allergies
• Any chronic medical conditions
• Using aspirin or anticoagulants such as Coumadin or Warfarin
• Dental work performed within the week prior to the procedure (this increases your risk of infection)
• Sick, taking antibiotics, or finished taking antibiotics less than a week before the procedure (we may need to reschedule your procedure)

Preparation Guidelines

Following are the general preparation guidelines for diagnostic treatments. You may receive additional or differing guidelines based on your specific situation. A technologist or nurse will contact you before your procedure as a reminder and to answer your questions. You may also contact the facility where you will have the procedure to have any questions answered.

All Diagnostic Procedures

• Stop taking blood thinning medications (such as aspirin, Coumadin, Warfarin) between 72 and 96 hours prior to the procedure. Contact your doctor first to make certain that you may safely stop these medications. If you cannot stop them, then a spine injection may not be the best procedure for you.
• Bring any prior imaging studies such as x-rays, MRI, or CT scans with you for your procedure. The radiologist will review these studies to make certain that the procedure is safe and determine the exact site for injection.
• Bring a list of your medications and allergies with you.
• Wear comfortable clothing.
• If you are receiving conscious sedation, arrange for someone to drive you to and from the procedure.

Additional Guidelines

Following are additional guidelines for specific procedures. These should be followed in addition to the “All Diagnostic Procedures” guidelines listed above.

What to Expect

During the Procedure

Your experience will differ, depending on the type of procedure you are having.

Arthrogram

Here is generally what will happen during an arthrogram:

1. A technologist will obtain a medical history and ask you some questions.
2. If your physician requested that you receive conscious sedation, a small IV will be placed in your hand. Conscious sedation will help you relax; however, you will remain awake for the procedure.
3. The technologist will position you on the exam table.
4. The technologist will sterilize and drape the area to be treated.
5. The radiologist will anesthetize the area to be treated.
6. A fluoroscope will be moved into position above the area to be injected.
7. Using the fluoroscope images, the radiologist will carefully guide the needle to the correct location.
8. After the needle is properly place, the contrast medium will be injected into the joint and images will be taken. You may feel pressure during the injection, but it should be relatively painless.

After the arthrogram you may be sent to another area in the imaging center for a CT scan or MRI. The entire procedure including preparation takes less than 30 minutes. If you received conscious sedation, you will be observed until you are alert.

Discogram

Here is generally what will happen during a discogram:

1. A technologist will obtain a medical history and ask you some questions.
2. A small IV will be placed in your hand. This IV will be used to give you antibiotics and conscious sedation. The conscious sedation will help you relax; however, you will remain awake for the procedure.
3. The technologist will position you on the exam table.
4. The technologist will sterilize and drape the area to be treated.
5. The radiologist will anesthetize the area to be treated.
6. A fluoroscope will be moved into position above the area to be injected.
7. Using the fluoroscope images, the radiologist will carefully place a needle into each disc that needs to be checked.
8. After the needles are in place, each disc will be separately pressurized to determine the pain levels. Images will be obtained during the procedure. Pain medications will be administered as required.
9. You will undergo a CT scan of your spine.

You will be observed after the procedure until you are alert. Typically the entire time you will need for this procedure is 3 hours.

Myelogram

Here is generally what will happen during a myelogram:

1. A technologist will obtain a medical history and ask you some questions.
2. If your physician requested that you receive conscious sedation, a small IV will be placed in your hand. Conscious sedation will help you relax; however, you will remain awake for the procedure.
3. The technologist will position you on the exam table, generally on your stomach.
4. The technologist will sterilize and drape the area to be treated.
5. The radiologist will anesthetize the area to be treated.
6. A fluoroscope will be moved into position above the area to be injected.
7. Using the fluoroscope images, the radiologist will carefully place a thin needle into the sac around the nerves of the spinal cord.
8. After the needle is in place, contrast medium will be injected into the sac. You may feel pressure during the injection, but it should be relatively painless.
9. You will undergo a CT scan of your spine.

You can expect to be in the imaging center for approximately 1 1/2 hours for the procedure. The procedure itself takes only a few minutes.

After the Procedure

Recovery

After any pain management treatment, please follow these instructions:

• Rest at home for 24 hours
• Refrain from any strenuous activity or impact exercise for 48 hours
• If you underwent a myelogram, please limit your activity for 24 hours after the procedure
• Do not take aspirin products for 48 hours
• Do not apply any direct heat to the injection site for 48 hours, including hot tub, hot bath, or heating pad. A shower is okay. Ice is fine.

If you are given a pain journal, please complete and return it to your referring physician.

If you received conscious sedation during the procedure you will be given additional after care instructions by the technologist.

If you have any questions or problems, please call your referring physician or the Invision Sally Jobe location where your procedure was performed (Centrum DTC at 720-493-3324 or Littleton at 720-493-3257).

Procedure Results

Your doctor will receive a written report from a Radiology Imaging Associates spine interventional radiologist. Please follow-up with your referring doctor. Your feedback is important to your treatment plan. If a diagnostic procedure is performed, the radiologist will dictate a report which will be provided to your physician. In turn, your physician will pass the results onto you.

During the exam, our radiologists and technologists will be happy to answer questions about the exam itself; however, they will not immediately provide you with the results of your exam.

Jump to a Service