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FAQs
Get answers about medial branch blocks, epidural injections, facet injections, spinal cord stimulation, and radiofrequency ablation at Peak Spine & Sports Medicine.

Frequently Asked Questions About Pain Management and Interventional Treatments

Pain often impacts multiple areas of life, including work, exercise, travel, sleep, and family time. At Peak Spine & Sports Medicine, we aim to identify the cause of a patient’s symptoms and create a treatment plan that supports their return to important activities.

These frequently asked questions offer clear information about our practice and the interventional treatments we provide, such as medial branch blocks, transforaminal epidural injections, facet joint injections, spinal cord stimulation, and medial branch radiofrequency ablation.

Peak Spine & Sports Medicine provides personalized, opioid-free pain management for patients in Marlton and Collingswood, NJ, as well as surrounding communities. Call (833) 377-7325 to speak with our team or schedule a consultation online today.

General FAQs

Peak Spine & Sports Medicine has offices in Marlton and Collingswood, New Jersey. We serve patients throughout South Jersey and the greater Philadelphia area, including Cherry Hill, Medford, Haddonfield, Moorestown, Mount Laurel, Voorhees, Northern Liberties, Fishtown, Rittenhouse Square, and Society Hill.

Telehealth appointments may also be available when an in-person examination or procedure is not required.

Dr. Milind Patel and Dr. Jill Kalariya are double board-certified pain management physicians. They work alongside physician assistant Brian Brown, PA-C, to provide coordinated care for patients experiencing back pain, neck pain, sciatica, neuropathy, joint pain, headaches, and other acute or chronic concerns.

Our providers use thorough evaluations, advanced interventional treatments, conservative care, and personalized follow-up appointments. Recommendations are tailored to each patient’s diagnosis, goals, and daily responsibilities.

We treat a wide range of conditions affecting the spine, nerves, joints, and musculoskeletal system. These include:

Many conditions can produce similar symptoms. A careful evaluation helps us identify the source of the pain before recommending treatment.

Our practice follows a concierge, white-glove model of care. We intentionally see fewer patients so that our providers can spend more time understanding each person’s symptoms, priorities, and treatment options.

Pain management should not feel like a factory where a diagnosis automatically produces the same recommendation for every patient. Patients may need to sit comfortably through a workday, travel for an upcoming event, return to exercise, coach their child’s team, or play with grandchildren. We use that information to determine which concern should be treated first and how each step fits into a patient’s life.

We coordinate imaging, authorizations, scheduling, and follow-up to reduce the burden on our patients.

Peak Spine & Sports Medicine is an opioid-free practice. We focus on identifying the source of pain and use targeted procedures, physical therapy, exercise, and other non-opioid options to improve function.

A problem in one specific spot often responds better to treatment aimed right at that area. Oral medication travels through the whole body and may not reach inflammation around a particular spinal nerve or joint as effectively. A carefully placed injection can deliver relief closer to the source and help avoid ongoing dependence on pain pills.

We primarily work with PPO and POS insurance plans that include out-of-network benefits. Our team can review coverage and explain what to expect before scheduling treatment.

Many patients believe out-of-network care is always more expensive, but this is not always true. Our selective insurance model allows us to remain a smaller practice, spend more time with each patient, and base recommendations on patient needs rather than insurance company guidelines.

A patient’s first consultation will include a detailed discussion of their symptoms, health history, previous treatments, imaging, daily activities, and goals. Our providers may also perform a physical examination and recommend additional diagnostic testing when necessary.

Initial visits at Peak are thorough and may last an hour or more. We ensure each patient understands their symptoms, available options, and the reasons for each recommendation. They will leave with a clear plan.

Many patients come to us with multiple concerns. They may have neck, shoulder, and lower back pain at the same time. Treating everything at once may not be practical or necessary, so we help patients decide what should be prioritized.

Prioritization is based on more than pain severity alone. Daily activities and responsibilities are also taken into account. Back or hip pain may be addressed ahead of upcoming travel, while shoulder treatment can be scheduled around work or family needs.

Telehealth visits may be available for initial discussions, imaging reviews, and certain follow-up appointments. A virtual visit can help expedite care when an in-person examination is not immediately necessary.

Some symptoms and procedures require an in-person visit. Our team will help determine the most appropriate appointment format.

Call Peak Spine & Sports Medicine at (833) 377-7325 or contact us online. Our team will inquire about symptoms, insurance, preferred location, and scheduling needs.

Medial Branch Block FAQs

A medial branch block is a targeted injection used to determine whether pain is coming from one or more facet joints in the spine. Facet joints are small joints located between the vertebrae that help the spine bend, rotate, and remain stable.

Small nerves called the medial branches carry pain signals away from these joints. During the procedure, medication is placed near selected medial branch nerves. Temporary relief suggests that the nearby facet joint may be contributing to the patient’s pain.

Medial branch blocks are commonly used to evaluate neck or lower back ache, stiffness, and localized pain. Facet-related pain may worsen when standing, twisting, arching the spine, looking upward, or moving after prolonged sitting.

Pain from the lumbar facet joints may remain in the lower back or spread into the buttocks and upper thighs. Cervical facet pain may affect the neck, shoulders, upper back, or back of the head.

Because disc, nerve, muscle, and joint problems can create overlapping symptoms, a physical examination and imaging review are important before treatment.

A medial branch block is commonly used as a diagnostic procedure because the patient’s response helps identify whether a facet joint is a likely pain source.

At Peak Spine & Sports Medicine, we may use a small amount of local anesthetic and anti-inflammatory medication when appropriate. This allows the injection to provide useful diagnostic information while also offering the potential for temporary therapeutic relief.

The local anesthetic temporarily interrupts the pain signals traveling through the selected medial branch nerves. After the procedure, we will monitor how symptoms change.

We are interested in more than whether pain feels somewhat better. We also want to know how much relief occurred, when it began, how long it lasted, and whether the patient could perform movements that normally cause discomfort. These details help determine whether the targeted joint is truly involved.

Patients will lie on a procedure table while the treatment area is cleaned and numbed. The physician uses live X-ray guidance to identify the correct spinal level and carefully place a thin needle near the selected medial branch nerve.

Contrast material may be used to confirm accurate positioning. Once the needle location has been checked, a small amount of medication is delivered.

Peak follows national guidelines and uses live imaging to double- and triple-check positioning throughout the procedure.

Patients may feel a brief pinch or burning sensation as the skin numbs. Some also notice pressure as the needle is positioned.

Most people tolerate the procedure well. We advise patients to let our team know if they feel especially anxious about injections or have had difficulty with similar procedures in the past. We want them to understand what is happening and feel as comfortable as possible.

The numbing medication may provide relief for several hours. When anti-inflammatory medication is included, some patients experience improvement for a longer period.

The duration of relief varies for everyone. Even a brief improvement can provide valuable diagnostic information if the patient’s typical pain decreases while the anesthetic is active.

Meaningful temporary relief suggests that the targeted facet joint and its medial branch nerves are contributing to a patient’s symptoms.

Depending on the response and insurance requirements, the provider may recommend another confirmatory block or discuss medial branch radiofrequency ablation. Radiofrequency ablation targets the same pain pathway but may provide relief for a much longer period.

A limited response may indicate that the targeted facet joint is not the main source of the symptoms. This information is still useful because it helps prevent us from continuing with an ineffective treatment plan.

The provider may evaluate other possible sources, including the spinal discs, nerves, muscles, or sacroiliac joints.

Preparation may include:

  • Providing a current list of medications and supplements
  • Asking whether blood-thinning medication requires special instructions
  • Telling our team about allergies, pregnancy, diabetes, infection, or recent illness
  • Arranging transportation if sedation will be used
  • Following all instructions regarding food, drinks, and medication
  • Planning to monitor symptoms and activity after treatment

It may also help to identify several movements that reliably cause pain. Carefully testing those movements after the procedure can help evaluate the response.

Transforaminal Epidural Injection FAQs

A transforaminal epidural injection is a targeted procedure that places anti-inflammatory medication near an irritated spinal nerve root. The medication enters the epidural space through the neural foramen, the opening through which the nerve exits the spine.

This approach allows the physician to focus treatment on a particular nerve rather than distributing medication throughout a broader area.

A transforaminal epidural injection may be recommended for:

  • Sciatica
  • Cervical or lumbar radiculopathy
  • Herniated or bulging discs
  • Spinal stenosis
  • Degenerative disc disease
  • Bone spurs affecting a spinal nerve
  • Persistent nerve pain after spine surgery

These conditions can cause pain, tingling, numbness, or weakness that travels from the spine into an arm or leg.

Epidural injections can be performed through several approaches. A transforaminal injection enters near the opening where a specific spinal nerve exits. An interlaminar injection enters between two vertebral structures, while a caudal injection reaches the epidural space through an opening near the bottom of the spine.

The best approach depends on the location of the suspected problem, the patient’s anatomy, imaging findings, prior surgery, and the area where the medication needs to reach.

The medication helps reduce inflammation surrounding the irritated nerve root. A local anesthetic may also provide temporary relief and useful diagnostic information.

Reducing inflammation may improve radiating pain and make it easier to participate in physical therapy, exercise, and other rehabilitation. The injection does not remove a herniated disc or reverse spinal degeneration. It is intended to calm the painful inflammatory response and create an opportunity for improved movement.

Patients will lie on a procedure table while the skin is cleaned and numbed. The physician uses live X-ray guidance to direct a thin needle toward the selected neural foramen.

Contrast material is used to confirm that the medication will spread through the intended area. Once the needle position has been carefully checked, the medication is delivered near the irritated nerve.

Patients may feel a pinch when the skin is numbed and pressure as the needle is positioned. Some patients briefly experience a sensation similar to their usual radiating pain when the medication reaches the affected area.

That feeling should be temporary. Patients should let their physician know immediately if they experience intense or unexpected discomfort.

The local anesthetic may provide temporary improvement shortly after the procedure. That effect may fade before the anti-inflammatory medication begins to work.

Steroid-related improvement often develops over several days. Some patients experience substantial relief, while others notice partial or limited improvement.

Relief may last from several days to several months. The response depends on the underlying condition, severity of inflammation, duration of symptoms, and several individual factors.

The purpose is not necessarily to repeat injections indefinitely. The provider will evaluate whether the procedure improved both pain and function before recommending another treatment.

There is no standard number that applies to every patient. Some people experience meaningful relief after a single injection. Others may be considered for another treatment when the first injection was helpful but temporary or incomplete.

Peak follows clinical guidelines and considers a patient’s overall steroid exposure. Additional injections are recommended only when there is a clear medical reason.

Helpful preparation includes:

  • Reviewing medications, supplements, and allergies with our team
  • Asking for specific instructions regarding blood-thinning medication
  • Telling us about diabetes, as steroids may temporarily affect blood sugar
  • Reporting fever, infection, antibiotics, or recent illness
  • Arranging transportation when required
  • Following instructions about eating, drinking, and regular medication
  • Avoiding strenuous activity for the remainder of the procedure day

Facet Joint Injection FAQs

A facet joint injection places medication directly into one of the small joints located along the back of the spine. These joints connect adjacent vertebrae, provide stability, and allow controlled movement.

Arthritis, injury, repetitive strain, and age-related changes can irritate a facet joint. The injection may help determine whether that joint is contributing to pain while also reducing inflammation within it.

Facet joint injections may be performed in the cervical spine of the neck, the thoracic spine of the mid-back, or the lumbar spine of the lower back.

The treatment is directed toward one or more specific joints based on the patient’s symptoms, examination, and imaging. Live X-ray guidance helps the physician accurately enter the intended joint.

Facet pain is often described as an ache, pressure, or stiffness. It may become worse when standing, twisting, arching the spine, looking upward, or remaining in the same position for a long time.

Cervical facet pain may affect the neck, shoulders, upper back, or head. Lumbar facet pain may remain in the lower back or spread into the buttocks and upper thighs.

These symptoms can resemble problems with the disc, muscles, nerves, and sacroiliac joints. An accurate diagnosis is necessary before treatment.

A facet joint injection places medication inside the joint itself. A medial branch block places medication near the small nerves that carry pain signals away from that joint.

Both procedures may help evaluate facet-related pain. Medial branch blocks are often used when determining whether a patient may benefit from radiofrequency ablation.

The right procedure depends on symptoms, anatomy, imaging, prior treatments, and overall care plan.

A local anesthetic temporarily numbs the joint, while an anti-inflammatory medication may reduce irritation in the joint. The response can help determine whether the joint is contributing to the symptoms.

Relief may also make it easier to participate in physical therapy and exercise. The injection does not permanently repair arthritis or reverse degeneration, but it may provide a window for improved movement and rehabilitation.

Patients will lie on a procedure table while the treatment area is cleaned and numbed. The physician uses live X-ray guidance to place a thin needle inside the selected facet joint.

Contrast material may be used to confirm the needle location before the medication is delivered. More than one level may be treated when several joints appear to be involved.

A patient may feel a brief pinch from the numbing medication and some pressure as the needle is positioned. An inflamed joint may also feel temporarily sore while medication is being administered.

Most discomfort is brief. Mild tenderness may remain after the procedure but usually improves within a short period.

The local anesthetic may work for several hours. The anti-inflammatory effect can take several days to develop and may last for days, weeks, or months.

Some patients experience little improvement. That response may indicate that another structure is responsible for the pain or that further evaluation is needed.

Facet injections may be appropriate for patients with persistent neck or back pain that appears to come from one or more facet joints and has not improved enough with conservative care.

The provider will review each patient’s examination, imaging, health history, and prior treatment before deciding whether the procedure is appropriate for their condition.

Preparation may include:

  • Reviewing medications and supplements with our team
  • Following instructions regarding blood-thinning medication
  • Reporting infection, illness, pregnancy, or medication allergies
  • Arranging transportation if sedation is planned
  • Wearing comfortable clothing
  • Planning a lighter schedule on the treatment day
  • Monitoring changes in pain and movement afterward

Spinal Cord Stimulation FAQs

Spinal cord stimulation is an advanced treatment that uses mild electrical signals to change how pain messages are transmitted through the nervous system.

The system includes thin leads positioned near the spinal cord and a small generator that produces the stimulation. Rather than correcting a structural abnormality, the treatment alters how pain signals are processed before they reach the brain.

Spinal cord stimulation may be considered for certain cases of:

  • Failed back surgery syndrome
  • Persistent back and leg pain
  • Complex regional pain syndrome
  • Chronic neuropathic pain
  • Painful diabetic neuropathy
  • Non-surgical back pain
  • Nerve pain that continues after an injury or operation

Not every type of chronic pain responds to spinal cord stimulation. A detailed evaluation helps determine whether the patient’s diagnosis and pain pattern are appropriate for this treatment.

Candidates generally have chronic pain that has continued despite appropriate conservative care, injections, rehabilitation, or previous surgery.

The patient must also be able to understand the system, follow activity restrictions, attend programming visits, and maintain realistic expectations. Psychological screening may be required because sleep, mood, coping, and other factors can affect the experience of chronic pain and the response to treatment.

A trial allows one to test spinal cord stimulation before deciding whether to receive a permanent implant. Temporary leads are placed near the spinal cord and connected to a generator worn outside the body.

During the trial period, changes in pain, activity, sleep, medication use, and daily function will be tracked. Success is not based solely on a pain score. We also want to know whether patients can stand, walk, sleep, work, or complete meaningful activities more comfortably.

If the trial provides meaningful improvement, the patient and physician can discuss permanent implantation. The temporary leads are removed, and permanent leads and a generator are placed during a separate procedure.

The generator is usually positioned beneath the skin, in a location selected based on anatomy and comfort. Patients will receive instructions about incision care, activity restrictions, charging requirements, and use of the controller.

The temporary leads are removed, and a permanent system is not implanted. This is one of the primary benefits of the trial because it allows the patient to evaluate the treatment before committing to an implanted device.

An unsuccessful trial may lead the provider to reconsider the source of pain or discuss other treatment options.

Spinal cord stimulation does not remove a disc, fuse vertebrae, or change the structural anatomy of the spine. However, permanent implantation is still a medical procedure with surgical risks and a recovery period.

It is best described as a minimally invasive implant treatment rather than open spine surgery or a noninvasive therapy.

Yes. The system can be programmed to provide different stimulation patterns, strengths, and areas of coverage.

Settings may need to be adjusted after implantation as swelling decreases, activity levels change, or pain patterns evolve. The clinical team and device representative can help identify the most effective programming.

Possible risks include infection, bleeding, discomfort around the generator, movement of the leads, hardware problems, unwanted stimulation, loss of benefit, and the need for revision or removal.

There may also be device-specific instructions involving MRI scans, security systems, driving, and certain medical procedures. These details will be reviewed with the patient before implantation.

Preparation may involve:

  • Completing imaging and diagnostic testing
  • Reviewing previous procedure and surgical records
  • Completing psychological screening when required
  • Identifying specific goals for the trial
  • Asking how success will be measured
  • Reviewing device options and charging requirements
  • Planning transportation and help during recovery
  • Following medication and infection-prevention instructions

It can also be helpful to identify which activities pain currently limits. These real-world goals can make the trial more informative than focusing only on a pain score.

Medial Branch Radiofrequency Ablation FAQs

Medial branch radiofrequency ablation is a minimally invasive procedure that may provide longer-lasting relief from confirmed facet joint pain. It may also be called radiofrequency neurotomy or radiofrequency denervation.

The procedure uses controlled radiofrequency energy to heat a small section of a medial branch nerve. This interrupts the nerve’s ability to carry pain signals from the affected facet joint.

A medial branch block is generally performed first to determine whether the targeted nerves are carrying pain signals from a facet joint.

If the block produces meaningful temporary relief, radiofrequency ablation may be recommended to interrupt the same pain pathway for a longer period. Insurance plans may require one or more successful diagnostic blocks before authorizing ablation.

The procedure is used for facet-mediated neck or back pain. It may be appropriate when arthritis, degeneration, injury, or repeated mechanical stress causes ongoing pain within the facet joints.

Radiofrequency ablation is not designed to treat every source of spine pain. A herniated disc, compressed nerve, spinal stenosis, muscle injury, or sacroiliac joint problem may require a different treatment.

After the needle is placed near the selected medial branch nerve, radiofrequency energy creates a small, controlled area of heat. This reduces the nerve’s ability to transmit pain signals.

The procedure does not remove the facet joints or alter the structure of the spine. It targets a specific pain pathway while avoiding the larger nerves responsible for movement and sensation in the arms or legs.

The patient lies on a procedure table while the treatment area is cleaned and numbed. The physician uses live X-ray guidance to position specialized needles near the selected medial branch nerves.

Sensory and motor testing may be performed to confirm that each needle is close to the intended nerve and away from nerves that control the limbs. Once the location has been checked, radiofrequency energy is delivered.

Peak customizes the equipment and needle selection according to the patient’s anatomy, body type, and number of levels being treated. The same setup is not used for every patient.

The patient may feel pressure, brief muscle twitching, or discomfort during needle positioning and testing. A local anesthetic is used to improve comfort.

The treatment area may feel sore or irritated afterward. This temporary discomfort does not mean the procedure was unsuccessful. The surrounding tissues need time to settle before the full result can be evaluated.

Some patients notice improvement within several days. Others may need two to four weeks or longer.

Temporary soreness can initially make the result difficult to judge. The local anesthetic used during the procedure may also provide short-term relief that fades before the effect of the ablation develops.

Relief commonly lasts for several months and may continue for a year or longer. Results vary depending on the patient, diagnosis, spinal level, and rate of nerve regeneration.

The medial branch nerve can eventually regrow and resume transmitting pain signals. The underlying changes in the facet joints may also continue over time.

The procedure may be repeated if the pain returns and the original ablation provided meaningful relief.

The provider will confirm that the returning symptoms remain consistent with facet joint pain. Another diagnostic block may occasionally be recommended before repeating treatment.

Most patients return home the same day. Tenderness, bruising, numbness, or temporary muscle tightness may develop around the treated area.

Light movement is usually encouraged, although strenuous activity and heavy lifting may need to wait. Physical therapy or a structured exercise program may be recommended as discomfort improves.

Possible risks include bleeding, infection, temporary numbness, increased pain, nerve irritation, allergic reaction, and injury to surrounding structures.

Live X-ray guidance, sensory and motor testing, careful needle placement, and individualized equipment selection help improve precision and safety.

Before treatment, patients should:

  • Review medications and supplements with the Peak team
  • Follow instructions concerning blood-thinning medication
  • Report fever, infection, antibiotic use, or recent health changes
  • Arrange transportation if sedation will be used
  • Wear comfortable clothing
  • Prepare for temporary soreness
  • Plan time away from strenuous activity
  • Ask when physical therapy and exercise may be resumed

Improvement may develop gradually, so patients should allow enough time before judging the final result.

Schedule a Consultation with Peak Spine & Sports Medicine

Effective pain management begins with understanding what is causing the symptoms and how those symptoms are affecting the patient’s life. At Peak Spine & Sports Medicine, every treatment plan is intentionally designed around the individual rather than the diagnosis alone.

Call (833) 377-7325 or use the online form to schedule a consultation in Marlton or Collingswood, NJ. The Peak team will take the time to answer questions, explain the available options, and help each patient move forward with a clear plan.

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