A joint is a part of the body where two bones connect. The bone ends where a joint is formed are covered with cartilage to allow pain-free movement, and they are surrounded by muscles, ligaments and tendons. To reduce friction caused when the muscles and tendons move, we have bursae, small sacs of fluid found near each of the larger, movable joints in the body (e.g. the hips and knees).
When the cartilage in a joint is damaged or affected by a disease like arthritis, the joints become stiff and can cause pain. You may also experience pain around the joints if the bursa gets injured, becomes inflamed, or is affected by repetitive motion or strain.
To diagnose joint pain and manage symptoms, joint and bursa injections may be effective.


A joint injection is the injection of medication (typically a steroid) into a joint space that is thought to be causing pain. The injection can reduce tissue swelling in the joint and surrounding areas, alleviating pain and other symptoms.
Depending on the joint that is being injected, you may be asked to lie down (e.g. for hip, ankle or toe joints) or you may be asked to remain in a seated position (e.g. for shoulder joints). For the procedure, the doctor will insert a needle into the affected joint and inject the medication. Local anesthetic may be used beforehand to numb the skin and tissues to make you more comfortable during the procedure.
Joint injections typically take a few minutes to perform and are done on an outpatient basis. You may feel immediate pain relief due to the anesthetic, but that will wear off a few hours after the procedure. The steroid will likely start working after three days, but it may take longer. How long your pain relief lasts can range from several days to a few months.


Bursa injections can help reduce swelling and relieve joint pain caused by bursitis, arthritis and other inflammatory health conditions.
The procedure is usually performed in an ultrasound room, and you will either be asked to lie down or to sit in a comfortable chair. To get started, the doctor may numb your skin with a local anesthetic. A thin needle will then be inserted and guided to the affected bursa using fluoroscopy (X-ray guidance).
Contrast solution may be injected into the bursa to make sure the right nerve is targeted. The doctor will then inject a mixture of steroid medication and anesthetic. The procedure takes only a few minutes.
You may experience pain relief soon after the injection due to the anesthetic, but that will wear off after a few hours. It typically takes about three days for the steroid to start working and produce more long term results.
Your pain may go away permanently after a bursa injection, but it is also possible that it may return after a few months. If the pain comes back, you can get another injection.


Paradigm Pain and Spine’s double and triple-board certified pain management specialists are experts at diagnosing joint and bursa pain. We offer diagnostic and therapeutic injections for the hips, shoulders, knees, elbows, wrists, and ankles – and we also provide other innovative treatment options.

To schedule a consultation and to learn more about effective procedures for bursitis and joint pain, contact our office.


A peripheral nerve block is an injection of regional anesthesia around a group of nerves in order to numb the area and block the nerves from sending pain signals to the brain. Peripheral nerve blocks may be used for diagnostic purposes, or treat severe or long-term pain that stems from one of a variety of different nerves, including the suprascapular, occipital, ilioinguinal, intercostal, supratrochlear, supraorbital, mental, and genitofemoral nerves.

If medication is not effective in providing pain relief caused by nerve damage, deterioration or compression, a nerve block may be used to help manage symptoms. Depending on how effective the treatment is, your doctor may suggest further injections for more long-term results pain management.

Peripheral nerve blocks may also be used during surgery to reduce the risk for nausea, drowsiness, and post-surgical pain. They have been found to be effective for pain relief when used for operations such as knee surgery, shoulder surgery, ankle surgery, wrist surgery, and arm and hand surgeries.


Peripheral nerve block procedures are performed on an outpatient basis. For the procedure, an IV may be inserted into your arm so that you can get medication to help relax you. Your vital signs will be monitored continuously.
After the area where the needle will be inserted is cleaned and numbed, the doctor may use real-time X-ray, an ultrasound, or a nerve stimulator to find the right nerves. Anesthesia medication will then be injected into the tissues near the nerves. You may feel a tingling sensation before the area becomes numb.


To learn more about peripheral nerve blocks and to find how they might help you, contact us to schedule a consultation with a pain management expert. Our board certified anesthetists are specially trained and highly experienced in performing nerve blocks and diagnosing nerve-related pain.


The greater and lesser occipital nerves are two nerves located at the back of the head. The nerves originate in the cervical spine and work their way up into the scalp, sometimes as far up as the forehead. They are responsible for providing sensation (including pain) to the top and back of the head. When the occipital nerves are compressed or inflamed, they can cause tension headaches, migraines and other pain symptoms in the regions they supply feeling to. Even though they do not reach the face, occipital nerve-related pain can sometimes spread as far as the eyes.
An occipital nerve block is often used to treat pain in the back of the head and to diagnose whether the occipital nerves are what is causing it. The nerve blocks involve injecting medication directly into the affected nerves to relieve pain. For occipital nerve blocks, the injections may include an anesthetic and a corticosteroid. The purpose of the steroid is to help reduce swelling, while the anesthetic produces a numbing effect to reduce or eliminate pain.


Occipital nerve blocks are typically performed on individuals who are experiencing nerve-like pain at the back of the head and most often just on one side. The injections tend to have the best effect on patients who describe their pain as shooting, burning or stinging.
Our spine and pain specialists have also had success using occipital nerve blocks to treat patients with:

  • Migraines and cluster headaches
  • A tender scalp (indication of an inflamed nerve)
  • Spondylosis of the cervical facet joints
  • A variety of other painful conditions

An occipital nerve block injection takes only a few minutes to perform. It is an outpatient procedure that may be performed using local anesthetic to numb the skin where the block needle will be inserted.
For the treatment, you will be asked to lie down on an examination table, and the area at the back of your head will be cleaned with antiseptic. The doctor will then locate the site of the nerve and perform the injection. The procedure involves inserting a thin needle through the skin into the area where the occipital nerves are located.


You may feel pain relief immediately after the injection, as a result of the anesthetic. Longer term results may vary from one person to another. While some individuals experience pain relief for just a few days after an occipital nerve block treatment, others may remain pain-free for several months. More than one injection may be necessary to keep symptoms under control.
If your symptoms do not improve after an occipital nerve block, it may be that the occipital nerves are not the source of the problem. If this occurs, your doctor may request additional tests to fine the cause of your pain.
To find out whether an occipital nerve block can help treat your pain, contact us today to make an appointment with one of our pain management experts.


The trigeminal nerves supply the front half of the head, including the face, mouth and tongue. They are responsible for helping you bite, chew and swallow; and they also produce the sensations you feel in your face. When these nerves are compressed, deteriorate, or get damaged, they can cause pain. Blocking them can help relieve pain symptoms.
A trigeminal nerve block is an injection of local anesthetic that is typically used for patients who are experiencing shock-like electrical pain in the face. These injections are primarily used to treat trigeminal neuralgia; however, patients with facial pain symptoms caused by herpes zoster infection (shingles) or other atypical facial pain syndromes may also find trigeminal nerve blocks to be effective in relieving pain.


For the procedure, you will lie on your back on an X-ray table, and the doctor will inject anesthetic into the side of your face using a thin needle. A separate needle will then be inserted using X-ray guidance, and the steroid pain medication will be injected. You may feel some pressure or tingling as the needle gets close to the nerve.
Trigeminal nerve block injections may be administered around one or more of the superficial trigeminal nerve branches, depending on the source of your pain. The areas of the face where you might receive an injection include the forehead, surrounding the eye, the side of the face, the ear, cheek and chin.
The procedure usually takes about 30 minutes. You should not drive or perform strenuous activity for 24 hours after you get the trigeminal nerve block, so you will need to arrange a ride home the procedure. You may resume your regular activities the next day.


The trigeminal nerve block’s effect can last for days or even weeks. How long the pain relief lasts varies from one patient to another. Some people may need several treatments to see desired results, while others may only require two or three.
To find out whether you are a candidate for a trigeminal nerve block, contact us to make an appointment with one of our pain management experts. Let us help you restore your quality of life.

More information coming soon on the following procedures:
  • Epidural Blood Patch
  • Gassarian Ganglion Blockade
Abdominal and pelvic