Our full scope of services are offered across our UF Health Pain Medicine locations at Ayers and Springhill. We also work in tandem with the UF Health Comprehensive Spine Center in many cases to find an effective solution.
Right in line with our aim to deliver the highest quality of care to patients is the investment we make in the future of pain medicine. UF Health strives to lead by example when it comes to advancing the discipline, training its next generation of leaders and paving the way for groundbreaking discoveries in clinical, translational and basic research.
The UF Health Pain Medicine division falls under the specialties of Anesthesiology, Neurology and Psychiatry. Not only do our multidisciplinary pain experts specialize in common and complex complaints, they also address pain medicine addiction and/or fear of addiction.
To schedule an appointment at the UF Health Pain Medicine, please call (352) 265-7777.
At UF Health Pain Medicine, we work alongside the UF Health Comprehensive Spine Center to care for several patients with back-related issues. One of these conditions is spinal stenosis, which is a narrowing of the spine that stems from degenerative changes in the column associated with aging.
The different types of spinal stenosis are classified by the region of the spine that’s affected: cervical, lumbar and thoracic stenosis. Lumbar stenosis is the most common and UF Health Pain Medicine performs diverse techniques that could treat this ailment: minimally invasive lumbar decompression (mild), the interspinous spacer procedure and endoscopic decompression. Nonetheless, our highly trained UF Health physicians can use several interventions for all types of spinal stenosis.
Degenerative Disc Disease
Our spine is composed of multiple structures, among them are the intervertebral discs, which serve as cushions and shock absorption structures, located in between every vertebral body. They are crucial for the spine support and allow us to tolerate heavy loads on our spine. It is formed by a rigid outer ring, with a gel substance in the middle.
Unfortunately, this structure suffers wear and tear and the disc can dehydrate, its walls can crack or the gel can escape outside, creating a disc herniation. When there is disc degeneration, patients can feel back pain and it may be radiated to extremities if the disc degeneration generates pressure over nerve structures.
Our pain physicians can help you to find options for the management of this condition.
Also known as a slipped disk, a herniated disk occurs when the central part of the intervertebral disk (nucleus pulposus) protrudes into the spinal canal. This can happen in the lower portion of the spine or in the neck. Although aging is the most common cause, trauma, heavy lifting or twisting can also lead to disk herniations.
Conservative approaches like non-steroidal anti-inflammatory medication accompanied by physical therapy could be effective at treating herniated disk symptoms if the compression of nerve structures is mild/moderate. However, surgical approaches may be needed in more serious or complex cases. Regardless of what the issue calls for, UF Health is prepared to assist with your recovery and guide you to choose the best option.
Cervical herniated disk
The cervical (neck) section of the spine supports the weight of your head and together with other structures, allows you to bend your head forward and backward, from side to side and rotate. There are seven vertebrae that make up this section of the spine. Each one of these vertebrae is separated by disks that contain a gel-filled center called the nucleus pulposus.
A cervical herniated disk occurs when one of these particular nuclei ruptures through a tear or break in the disk wall. Simple solutions such as medication and physical therapy can be a remedy for many patients. Some of the symptoms could be alleviated with a cervical epidural steroid injection, however, others may require surgery. In any case, UF Health is ready to bring your quality of life back.
Lumbar herniated disk
The lumbar (lower back) section of the spine, just above the hips, refers to where the spine curves inward toward the abdomen. This part of the spine is designed for both power and flexibility, giving us the ability to lift, twist and bend. Herniated disks in this region are a common medical issue.
There are five vertebrae that make up this section of the spine. Each one of these vertebrae is separated by disks that contain a gel-filled center called the nucleus pulposus. A herniation occurs when one of these particular nuclei ruptures through a tear or break in the disk wall. While a lumbar herniated disk can be very painful, most people won’t experience long-lasting symptoms. Regardless of whether your situation calls for a simple solution or surgery, UF Health is ready to deliver exemplary care.
Regardless of where your joint pain is located (knee, elbow, shoulder, back, etc.), UF Health Pain Medicine can find relief.
If appropriate, our highly trained physicians will recommend a common technique to solve your joint pain. However, they are also trained in administering injections/interventions for small, medium and large joints. The same goes for facet joints (back), where our physicians can perform medial branch local anesthetic diagnostic blocks, as well as intra-articular facet joint injections and radiofrequency ablation. Most recently we have been able to use peripheral nerve stimulation to nerves conducting pain signals originating from these joints to control those painful symptoms.
Radicular pain and radiculopathy
Nerve pain that travels from the spine to the extremities is known as radicular pain or “sciatica” if it is mainly in the lower extremities. Most of the time this is due to compression of a spinal nerve. Several elements can be causing this compression, one of the most common is a herniated disc, however, the facet joints, a synovial cyst, bone osteophytes and trauma, could also be the reason for the radicular pain.
Depending on the severity of the compression of the nerve, our physicians will decide among the different interventions available, ranging from conservative management, medications, injections, neuromodulation and endoscopic decompression, however, if the compression is too severe or if it is providing weakness to the extremity involved, we can also refer you to one of our spine surgeons to evaluate the best option for you.
Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome
At times, patients can have persistent pain after undergoing one or multiple surgical procedures on the spine. In some of these situations there is no clear explanation on the Xrays or MRI, but the patient can still perceive intense low back and lower extremity pain, or neck and upper extremity pain.
Our physicians will evaluate your situation and determine what would be the best procedure to relieve your painful symptoms. A special successful treatment for this condition is a spinal cord stimulator.
Compression fractures of the back
At UF Health Pain Medicine, we take pride in our continued advancement when it comes to treating compression fractures of the spinal vertebrae. These can be treated in a variety of ways, including three of our minimally invasive procedures – vertebroplasty, kyphoplasty and the spine jack. Aiming to provide strength to the bone and restore some of the lost height.
These options are typically explored if the patient is suffering serious and debilitating pain that stretches beyond a few weeks and doesn’t improve with other forms of basic care (rest, pain medication, braces, or physical therapy).
Complex Regional Pain Syndrome
After a trauma due to an accident or a surgical incision, there could be direct damage to a nerve. At times this can trigger an exaggerated reaction resulting in pain with a light touch, color changes, swelling and decreased range of motion of the affected structure (among others).
This type of pain is difficult to treat, however at UF we count with multiple interventions able to relieve this condition. Sympathetic blocks and neuromodulation (spinal cord stimulation, dorsal root stimulation, or peripheral nerve stimulation) are able to treat this.
Nerves are the structures responsible to generate and conduct sensations from different areas of our body carrying them to our brain where they will be processed. At times due to trauma, lack of vascular supply, or other chronic diseases, some of the nerve endings can be damaged, making these structures fire unusual signals that are perceived as pins, needles, tingling, burning and numbness. This is called neuropathy or neuropathic pain.
Our physicians can tailor the adequate management for this type of condition, there is a wide range of options that can be used to alleviate this type of pain.
Epidural injections for the back
At UF Health Pain Medicine, our highly trained physicians can administer all different forms of epidural steroid injections (interlaminar, caudal and transforaminal). We also offer other epidural interventions such as selective nerve root injections, blood patches and adhesiolysis.
These strategies may be used if your pain has not improved from more conservative methods and the pain is described as pins, tingling and buning radiating to the lower extremities, like sciatica.
Steroid injections for joints and bursa
Many times, inflammation from arthritis or inflammatory diseases may cause pain in joints, tendons, or cushions around joints (called bursa). The inflammation can cause pain, limiting the use of the joint and decreasing function overall. Treatment for this type of inflammation includes injection of corticoid steroids into the joint or bursa. This injection helps reduce the inflammation and therefore, restores mobility to the affected area.
Our team uses ultrasound and live X-rays to evaluate and treat the areas of inflammation. Steroid injections can be repeated throughout the year, but there is a limit to the total number of injections one can receive. Our pain experts will work with you to develop a plan for overcoming pain associated with this type of joint pain.
Every structure in your body that has sensation, has some conduction structures called nerves. They are the ones responsible to conduct the painful sensations to your brain. If a nerve is identified as the target to treat your pain, then a test block with local anesthetic can be performed to determine the amount of pain relief received. If there is a beneficial response to the block, then you could be a candidate for a radiofrequency ablation, where a needle is inserted close to the nerve and heat or cold is transmitted to the tip of the needle to “burn” the nerve, which will result in potential longer pain relief.
There are many different types of radiofrequency interventions that UF Health Pain Medicine offers. These interventions are most commonly used for nerve and joint pain that occurs in the spine, head, hips, knees and other sensitive areas of the body.
Neuromodulation is an expanding field of treatment with many new exciting advances on the horizon. Neuromodulation works by using electrical impulses to alter, or modulate, signals from the nerves. It has been used to treat a variety of diseases like Parkinson’s disease, Failed Back Surgery Syndrome, urinary incontinence and peripheral diabetic neuropathy. Devices include a neurostimulator (a battery pack), extension wires and leads. Leads are electrodes that are placed near the spinal cord, nerve roots, or peripheral nerves, depending on the nerves or areas of the body that are being treated.
From a chronic pain perceptive, neuromodulation may help in treating pain that is refractory to other treatments. Common pain syndromes that are typically amendable to neuromodulation are: failed back surgery syndrome, complex regional pain syndrome, arachnoiditis and peripheral neuropathy. At UF Health, we go to great lengths to make sure the treatment option is right for you. Workup for neuromodulation can be extensive, but our staff works with you every step of the way.
Spinal cord stimulation
Among the procedures that help UF Health Pain Medicine stand out is spinal cord stimulation (SCS), which helps our patients better manage their pain and potentially decrease the amount of medication they need. We accomplish this with a spinal cord stimulator, a device that is placed under your skin into the spinal canal and transmits a mild electric current to your spinal cord/spinal nerves to block the conduction and feeling of pain.
At UF Health Pain Medicine, our patients go through a staged process to determine if the spinal cord stimulator is an ideal option. The first and most important step is a discussion with our pain physician, where it would be determined the pertinence of the procedure and if additional imaging is required. Step 2: if the decision was made to proceed with the stimulator then you would be scheduled for a trial stimulation that lasts 3-8 days; Step 3: if the trial was able to provide you with good relief, then the last step is the permanent implantation of the device including the battery, where it will remain for the following years.
Dorsal root ganglion stimulation
For those focal areas that are difficult to treat like inguinal pain after hernia repair, knee pain after knee replacement, complex regional pain syndrome and some pelvic and feet pain. There is an alternative method of neuromodulation called Dorsal Root Ganglion (DRG) stimulation. This procedure is very similar to the spinal cord stimulator, with the main difference being that the electrodes that are used are smaller and the usage of energy is less.
Peripheral nerve stimulation
All the parts of our body that have sensation, conduct these signals via nerves. At times these nerves could become damaged or hyperactive, providing the sensation of pain in a specific area. This neuromodulation option uses cylindrical electrodes that are placed in the vicinity of the affected nerve(s) attempting to suppress the conduction of those painful signals. Compared to the spinal cord stimulator, this therapy does not involve the placement of a battery inside of the patient as this is worn on the outside.
The shoulder, knee and ankle are some of the areas that can be beneficial, as well as for occipital neuralgia and headaches when targeting the occipital nerve.
UF Health specializes in an advanced, minimally invasive procedure that helps patients to restore their functionality. Vertebral compression fractures are a common condition mainly related to the weakening of the bones or osteoporosis. These fractures can be painful and provide deformity to the spine. In some of these instances, when pain does not improve, kyphoplasty can re-expand the vertebral body and boost its strength by injecting bone cement.
This technique, also known as vertebral augmentation or balloon kyphoplasty, is done with an injection into the fractured vertebrae. As a highlighted operation within UF Health Pain, kyphoplasty aims to address three problems: back pain, the further collapse of the fracture and irregular spinal alignment.
Minimally invasive lumbar decompression (MILD procedure)
MILD is a minimally invasive way to treat one of the underlying causes of lumbar spinal stenosis, or LSS, specifically the narrowing of the spine canal secondary to ligament bulkiness. This FDA-approved procedure involves an incision smaller than the size of a baby aspirin, where we introduce diverse instruments to remove portions of the redundant ligament. You won't need stitches or general anesthesia and it is performed in our ambulatory center, so you can go home the same day.
As we age, the central canal of the spine gets narrower due to degeneration, causing compression of the nerves from the spine, which is manifested as pain and inability to walk long distances. The Vertiflex® procedure uses a minimally invasive spacer implant that is located on the back of your spine to provide relief from leg and back pain associated with lumbar spinal stenosis. This ambulatory procedure requires a small incision to deploy the implant and patients go home on the same day.
Endoscopic decompression spine surgery
Endoscopic decompression spine surgery is performed to alleviate pain stemming from spinal stenosis, herniated discs, or other pathologies. This is a minimally invasive spine surgery that uses small surgical incisions that are usually 0.5 inches. Patients may be a candidate if they have tried other types of nonsurgical spine treatment without finding relief and they require removal or decompression of structures compressing the spinal nerves. This procedure is ambulatory and the patients go home on the same day.
One of the components of your spine are the vertebral bodies, which are rigid structures made of bone that help hold your weight. However, with degeneration and changes in your spine, these structures can present with inflammation on the edges that can be the cause of pain, this is called vertebrogenic pain.
At UF Health we have an available technology that with a small incision (the size of a baby aspirin) a cannula is introduced into the vertebral body, close to the nerve that conducts these painful sensations and using radiofrequency ablation, we are able to stop the transmission of these signals providing pain relief. This is an ambulatory procedure and does not require stitches or general anesthesia.
Cancer pain management
In the vast majority of cancer cases, pain can be managed with drug and non-drug therapies and there is a wide array of pain medications and interventional techniques that physicians can choose from. However, efficient pain management is typically a result of a well-devised treatment plan.
Cancer pain is unique as it involves different structures and pain sensations. At UF Health Pain Medicine, we are able to help with diverse interventions, including sympathetic blocks and intrathecal pump implantation.
Botox injections for headaches
If you are diagnosed with migraine, which is a class of headache characterized by a throbbing feeling with hours of duration that could be associated with light or noise discomfort and this does not respond to medications, then you may be eligible for botox injections.
Botox is a toxin that paralyzes the muscle when injected directly into it and has been proven to be effective in cases of muscle dystonia and chronic migraines when the episodes of these headaches take place more than 14 days per month.
After our physicians perform the injection in multiple places around the muscles of your head, you could experience months of pain relief.