• What are the risks of injections?
  • Will the injection be painful?
  • What do I do if I have a problem after the injection?
  • What is a facet injection?
  • How long does my procedure take?
  • Why do you insist on evaluating all patients before a procedure?
  • Why do I have to fill out so many forms?
  • What is sciatica?
  • Do you use physical therapy and how does it help?
  • Do you use chiropractic in your treatments?
  • What about psychology and psychotherapy?
  • What about psychology and psychotherapy?
  • What is a narcotic contract?


What are the risks of injections?

With any medical procedure, there is a risk of complications. By performing a complete evaluation before and after each procedure and by using state-of-the-art medical equipment in a fully credentialed surgery center, these risks are minimized.  In general, procedural risks include reactions to medications (allergic reactions), excessive bleeding (hematoma), and infection.  Again, these can be minimized by knowing your allergies, taking you off any blood “thinners,” and using aseptic technique in a sterile environment.  Other complications may result from the needle itself.   Most common among these is a dural puncture, that is the needle intended for the epidural space advances through the dura (the membrane that contains the spinal fluid) and results in a headache.  Occasionally, the site of injection becomes more painful after the injection, a process representing tissue irritation called a “flare.”  There have been reports of severe neurological injuries associated with spinal injections, perhaps related to inadvertent injections into blood vessels that supply the spinal cord.   By using contrast and real-time fluoroscopy to see exactly where the needle and the injected medication are at all times, potential complications are minimized.  In our experience, untoward reactions and complications are extremely rare.  The staff at McKenna, Ruggeroli & Helmi Pain Specialists will thoroughly evaluate your condition and inform you of the risks of any medical treatment recommended.


Will the injection be painful?

Every effort will be made to make your procedure comfortable.  This includes a pleasant and courteous staff to assist you, the use of local anesthetics to “numb” the skin prior to any needle placement and the judicious use of sedative medications.  Some procedures that are “diagnostic,” require that you be completely awake and responsive and, during such procedures, minimal sedation will be used.  Dr. McKenna, Dr. Ruggeroli and Dr. Helmi believe that each patient and each procedure is unique and, therefore, he uses a customized approach to each patient.  Our goal is to provide excellent medical care in a manner that is non-painful and safe. 


What do I do if I have a problem after the injection?

It is not uncommon to feel tired or to have some localized tenderness after an injection.  We recommend rest for at least four hours after your procedure and the use of ice for any areas of tenderness.  If you experience a fever, severe pain or any neurological change, please call our office immediately.  One of our staff providers will answer your questions and recommend a appropriate course of action.


What is a facet injection?

Please refer to the “Procedure Info” section of this web site for a complete explanation of all injections, including the “facet” joint injections.


How long does my procedure take?

Each procedure is different, but the typical time is ten to thirty minutes.  The total time in the Surgery Center is usually less than ninety minutes.  Please refer to the “Your Procedure”  section of this web site for details regarding the typical procedure process. 


Why do you insist on evaluating all patients before a procedure?

Interventional Pain Medicine is a sophisticated, highly specialized field.  Even though a primary care physician or specialist may recommend a specific procedure, it is imperative that the patient be thoroughly evaluated by the operating physician before this procedure.  While this evaluation may confirm the diagnosis and the suggested treatment, it is not uncommon for this evaluation to shed light on different aspects of the problem, resulting in different treatment options.  It is important for the patient to ask questions and explore all alternatives prior to consenting to any procedure.


Why do I have to fill out so many forms?

Paperwork has become an unpleasant but necessary part of modern medicine.  Insurance companies and governmental agencies require that certain forms be completed.  In order to properly bill your insurance company, we need specific information.  To expedite your evaluation, we ask that you fill out a questionnaire addressing your present and past medical conditions. 

While changes in health care improve some things, other aspects become more difficult.  As health care becomes more sophisticated, it becomes more expensive.  As such, insurance companies expend a great deal of effort to assure that health care expenditures are effective and appropriate.  As a physcian, these efforts of the insurance companies, commonly called "managed care," result in ever-increasing  difficulties to provide excellent and timely care.  Preauthorization and verification of insurance coverage have become inconvenient and time-consuming, but are necessary to assure that your medical procedure will be covered.   While these bureaucratic delays are frustrating and time-consuming, they are inevitable and McKenna, Ruggeroli & Helmi Pain Specialists will make every effort to work within the confines of "managed care" to provide excellent and timely treatment.


What is sciatica?

Sciatica refers to pain in a lower extremity caused by irritation of a spinal nerve, most commonly the fifth lumbar nerve or the first sacral nerve.  It’s commonly caused by a herniated lumbar disc, but may also occur with degenerative arthritic changes of the spine or, less commonly, with irritation of the sciatic nerve outside the spine.

Spinal nerve irritation may cause pain, loss of normal sensation, loss of muscle strength or any combination of these symptoms.  The pain is usually quite specific, occurring in a thin, band-like distribution from the lower back to the thigh, leg and foot.  It may come on gradually over time or rapidly after an acute injury.  The discomfort may vary from a mild tingling sensation in the foot to sharp, searing pains that shoot down the leg.

People who do a lot of heavy lifting, both young and old, are at risk for sciatica, as are older people with arthritis.  Sciatica in a younger person typically occurs from a herniated disc which pushes on the nerve or releases inflammatory chemicals that irritate the nerve.  In older people, sciatica may occur because of disc degeneration, the abnormal movement of one vertebral body over another, arthritis of the small joints in the back of the spine or thickening of the ligaments of the spine.  Or it may occur because of a combination of all of these things.


Do you use physical therapy and how does it help?

Active physical therapy represents a way for a patient with pain to increase activity in a safe, supervised and gradual fashion, strengthening the back muscles, correcting postural problems and educating the patient in ways to prevent recurrent injury.  In addition, passive modalities such as heat, massage and ultrasound may reduce the inflammation and pain. It is the philosophy at McKenna, Ruggeroli and Helmi Pain Specialists that the synergistic use of physical therapy and interventions optimize patient recovery in most conditions.  We work closely with several physical therapists. 


Do you use chiropractic in your treatments?

Like physical therapy, the combination of chiropractic care and injection therapy can have a synergistic response in certain painful conditions.  Chiropractors provide a broad range of services and the appropriate use of this type of treatment depends upon the specific pain problem.  We work closely with several excellent chiropractic clinics.


What about psychology and psychotherapy?

Pain is mediated by the brain and we know that emotions and thoughts significantly alter the sensation of pain.  This is a physiological fact.  Therefore, it is very important that a pain physician address psychological issues.  If our evaluation reveals psychological “barriers” to recovery, we may institute specific tests and/or refer the patient to a specialist for evaluation and/or treatment.  In this day of enlightened thinking, psychological therapy does not mean someone is “crazy.”  Some therapies, such as biofeedback and hypnosis, represent another modality to use in combination with medications, physical therapy and injections to decrease pain and improve function.


What is a narcotic contract?

Properly called an opioid agreement, this represents an understanding between the patient and medical provider regarding the use of certain medications.  Opioid medications are powerful and effective pain relievers that, unfortunately, have the potential for purposeful or inadvertant abuse.  While it is our assumption at McKenna, Ruggeroli and Helmi Pain Specialists that all patients are honest and responsible, it is important that patients understand the risks of analgesic medications and the limitations of our ability to write for such medications.  These limitations are established by governmental agencies and "best practice" guidelines.  In general, this agreement clearly defines the rules of medication prescribing and use.  Any breach of this agreement may result in discontinuation of these medications, referral to an appropriate behavioral health facility or, in some cases, discharge from our practice.