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Pain Medicine

Pain Management and Medicine

The Florida Hospital Orlando Spine Center is dedicated to the treatment of back pain, neck pain and other spine conditions that too often keep people from living a normal life. While every case is unique, our goal is to give our patients the individualized care they need to start feeling like themselves again.

No matter your condition, the physicians at the Florida Hospital Orlando Spine Center have the expertise to create a treatment plan that meets your needs. Our physicians perform more than 8,000 procedures each year, making them among the most experienced pain management specialists in the area. In addition, all of our pain management physicians are board-certified and have fellowship training in interventional pain management, which means you can rest assured that you’re in good hands.

We provide patients with a wide range of both non-invasive and minimally invasive treatment options for back pain and other spinal conditions. And at Florida Hospital Orlando, you can be guaranteed access to the most advanced, cutting-edge technology and techniques available.

If you would like to learn more about our program, contact Florida Hospital Orlando today.

Conditions We Treat

The pain management specialists at the Florida Hospital Orlando can provide treatment for a number of common conditions, as well as many other complex diseases. Below are just some of the conditions we may be able to help you with.

Back pain

Roughly 75 percent of adults will experience back pain at some point in their life. Most commonly, it’s low back pain, or pain in the lumbar spine. Usually this back pain is the product of sprains and strains caused by stressful movements, such as lifting something without using the proper technique or engaging in a swift twisting motion.

Back pain caused by a strain or sprain usually heals on its own with rest, though over-the-counter or prescriptions medications are sometimes needed as well.

However, back pain that is caused by a more severe spinal condition such as a herniated disc or spondylosis may, depending on its severity require medical help, including physical therapy or even surgery.

Bulging discs

A bulging disc, also called a ruptured or slipped disc, is a disc that extrudes into the spinal canal. As it degenerates, the disc can herniate (meaning the inner core extrudes) back into the spinal canal, which in the lumbar area can cause pain that radiates all the way down the leg into the foot. If a bulging disc occurs near the cervical spine, the pain would radiate from the neck down the arm to the fingers.

In most cases, back surgery is recommended. In the procedure, the surgeon will remove the portion of the bulging disc that is pressing against a nerve and causing symptoms. By the removing or shrinking the disc, surgeons can decompress the spinal cord or nerve root that is being impinged. After that, excess disc material is removed, and the patient’s symptoms should disappear.

Facet disease

Also called facet arthritis, facet disease occurs when there is degeneration of the facet joint, or the structures that connect the vertebrae to each other. It is rarely the sole cause of lower back pain. In fact, patients with facet disease usually have other conditions, including degenerative disc disease, spinal stenosis and arthritis in other parts of the spine, which contribute to their pain. In addition, most people suffering from lumbar spinal arthritis will show signs of facet disease on their MRI or CT scan.

Because there are many causes of back pain, a correct diagnosis is key. The good news is that facet disease is relatively simple to diagnose. The physician will likely use a diagnostic facet injection, a numbing medication injected into the facet joint. If the pain is caused by facet disease, this injection should resolve it immediately. If the pain is still there, however, the culprit is probably something else.  

Herniated discs

A herniated disc, also called a ruptured disc or slipped disc, is a disc that bulges or breaks. This condition can affect any part of the spine, including the neck and, rarely, the upper back, though most affect the lower back. Herniated discs may be caused either by injury or simply by wear and tear, which is natural as the body ages and the discs dry out

In most cases, a herniated disc will get better on its own in a few weeks or months. About 10 percent of the time, however, surgery may be necessary. There are a few different surgical options. In many cases, surgeons will employ what’s called a discectomy, in which the herniated disc material pressing on the nerve root or spinal cord is removed.

Neck pain

For most people, some neck pain is unavoidable. It can either be acute, meaning it lasts just a few hours or maybe a few weeks, or chronic, meaning it lasts longer than several weeks. Neck pain can be caused by muscle strains, worn joints, disc disorders or trauma.

Most of the time, the causes of neck pain aren’t serious. Even little things like having poor posture at work can lead to neck pain. However, sometimes neck pain can portend something more serious, especially if it’s so severe that, for instance, patients can’t touch their chin to their chest after a few days of self-care. If your pain is that bad, please seek immediate medical attention.

Pinched nerve

A pinched nerve occurs when surrounding tissues such as bones, cartilage, muscles or tendons apply too much pressure to a nerve, disrupting the nerve’s function and causing pain, tingling, weakness or numbness. Pinched nerves can be found anywhere in the body—a herniated disc in the lower spine, for instance, may lead to sciatica, or pain that radiates down the back of the leg.

There are several conditions that can lead to pinched nerves, including injuries, poor posture, osteoarthritis, obesity and stress from repetitive sports-, job- or hobby-related activities. Most of the time, with rest of other conservative treatments, patients recover from a pinched nerve within a few weeks. In particularly severe cases, surgery may be necessary to relieve pain.


Sciatica refers to pain that radiates along the sciatic nerve, which runs from the spinal cord to the buttock and hip area down the back of each leg. The sciatic nerve is the longest nerve in the body.

While sciatica itself isn’t a disorder, it is a symptom of other nerve-related problems, such as a herniated disc. Symptoms include pain, numbness or muscle weakness, tingling and a loss of bladder control. Sciatica is most common among older people, as well as those with diabetes, individuals who sit for long periods of time, and those whose occupations require them to twist their back or frequently carry heavy loads.

Sometimes sciatica gets better on its own. However, some patients may need to seek medical attention.

Spinal stenosis

Spinal stenosis is the narrowing of one or more areas of the spine, usually in the upper or lower back. This narrowing puts pressure on the spinal cord or the nerves that branch out from the compressed area. This condition can lead to symptoms such as cramping, pain or numbness in the legs, neck, back, shoulders or arms; a loss of sensation in the extremities; and in some cases problems with bladder or bowel function.

Spinal stenosis is most often caused by osteoarthritis-related bone damage, and is commonly associated with aging; a person’s chances of experiencing spinal stenosis increase after the age of 50. Mild cases of spinal stenosis can be treated with pain relievers, physical therapy or a supportive brace. In more serious cases, however, surgery may be needed.


Cervical spondylosis, also called cervical osteoarthritis, refers to age-related wear and tear of the joints in the neck. This condition most commonly occurs in individuals over the age of 40 (though men are likely to develop it earlier than women) and progresses with age. This is because the bones and cartilage in the neck and backbone gradually deteriorate. In some cases they form bone spurs, or irregular bony outgrowths. While these changes are common, many people whose x-rays show signs of cervical spondylosis have no symptoms of the condition. Those who are symptomatic may experience pain, stiffness and muscle spasms

In severe cases, cervical spondylosis may compress the spinal nerves that branch of the vertebrae. This condition is called cervical radiculopathy. In addition, bone spurs caused by spondylosis can sometimes reduce the diameter of the canal housing the spinal cord, which causes cervical myelopathy. Both of these conditions can lead to permanent disability. However, this is rare. As many as 90 percent of individuals with cervical spondylosis never lose nerve function, even temporarily.


When one vertebrae slips forward in relation to an adjacent vertebrae, usually in the lumbar spin, this condition is called spondylolisthesis. The symptoms of spondylolisthesis including pain in the lower back, thighs and/or legs, as well as weakness, muscle spasms and/or tight hamstring muscles. Sometimes patients with this condition are asymptomatic, and only find out they have spondylolisthesis during an x-ray. At the other extreme, in advanced cases the patient may appear to have swayback—a condition in which the spine curves too far inward—with a protruding abdomen, and have a shortened torso and waddling gait.

This condition can be congenital or develop during childhood or later in life. In non-congenital cases, spondylolisthesis may be caused by physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma or simple wear and tear.


Whiplash, most commonly associated with a rear-end car crash, is an injury to the solve tissues of the neck caused by sudden extension and flexion. In severe cases, it can also include injury to the intervertebral joints, discs, ligaments, cervical muscles and nerve roots. In addition to neck pain, symptoms usually include neck stiffness, injuries to muscles and ligaments, headaches, difficulty swallowing, burning sensations, shoulder pain and back pain. The good news is, whiplash is very treatable, and most symptoms can be taken care of.

If you believed you’ve suffered whiplash, call the experts at the Florida Hospital Orlando Spine Center today.

Treatment Options

The Florida Hospital Orlando Spine Center is proud to offer patients a wide variety of the latest and most advanced treatment options available, from pain management to minimally invasive surgical procedures.

For patients experiencing neck or back pain, sometimes surgery is necessary. The Florida Hospital Orlando Spine Center is provide patients with access to our leading team of neurosurgeons. These skilled experts strive to provide the best care anywhere in the nation, while working closely with each patient. We offer many cutting-edge procedures that are only performed in a handful of centers in the country, with the goal of getting you back on your feet with minimal pain and scarring.

Below are just some of the procedures being performed at the Florida Hospital Orlando Spine Center.

Disc biacuplasty

Disc biacuplasty is a procedure in which heat is applied to the annulus, a specific area of the disc, rendering the nerves no longer able to send pain. The expert physicians at the Florida Hospital Orlando Spine Center use this procedure to reduce chronic back pain caused by either tears in the annulus or from disc herniations. This highly accurate, minimally invasive technique uses cooled radiofrequency to create a cooled heat lesion, and is performed with needles under live imaging, giving the surgeon the best possible view of the surgical area.

Epidural steroid injection

As the name suggests, an epidural steroid injection delivers steroids directly into the epidural space in the spine. These steroids function as a potent anti-inflammatory medication, and using live x-ray imaging the injection deposits this medication very close to the site of the pain. These injections control local inflammation and flush out inflammatory proteins and chemicals that may contribute to or worsen pain.

Unfortunately, the effects of the injection are temporary. The injection typically provides pain relied for between one week and a year. However, despite its limitations this treatment method can be very beneficial for acute episodes of back or leg pain, and can assist patients progress with a rehabilitative stretching and exercise program. If an initial injection is helpful, the experts at the Florida Hospital Orlando Spine Center may recommend repeated treatments—up to three over a six-month period.

Intrathecal opiate trial

Opiates, which are powerful medications, are sometimes used to treat chronic spinal pain. This potent class of drugs, however, has some drawbacks. Over time, for example, patients can develop a significant tolerance to them, meaning that higher doses are needed to achieve the same effect. In addition, they can also have series side effects, such as sedation, nausea, constipation and breathing difficulties, especially at these higher doses.

At the Florida Hospital Orlando Spine Center, we use a method of intrathecal opiate delivery, in which substantially lower doses of opiates are given directly into the spinal fluid, proving the pain relief without the side effects. This procedure can be tested during a brief trial performed by a needle while under living imaging. It the trial is successful, a minimally invasive surgery may be performed, in which surgeon will place a small, refillable pump under the skin. This pump continuously administers pain medication directly into the spinal fluid.


There are a number of medications that can provide relief from chronic spinal pain. Opiates, for example, can work well for both short-term pain relief and, in some cases, long-term treatment as well. A separate class of medications, such as Cymbalta and Gabapentin, can be used to treat neuropathic pain, or pain associated with damage to or irritation of nerves. Anti-inflammatories such as ibuprofen, muscle relaxers such as Skelaxin and topical medications such as Lidoderm are sometimes used as supplements to other medications.

Used alone or in conjunction with rehabilitations programs and/or therapeutic injections, can provide significant long-term relief of chronic back pain.

Provocative discography

Discograms are diagnostic tests used to view the internal structures of intervertebral discs so doctors can tell if they are the source of a person’s pain. At the Florida Hospital Orlando Spine Center, this procedure is performed via live x-ray using small needles. These needles are guided into the discs, after which a radiocontrast dye in injected into the disc under live imaging. Once the dye has been injected, a CT scan is performed to evaluate the anatomy of the disc.

At the Florida Hospital Orlando Spine Center, we use this procedure in two ways: to determine which discs are causing pain, and to evaluate the exact internal structure of the disc to determine the exact source of the problem. Based on the results of this test, we will be able to formulate a treatment plan that best serves the patient’s needs.

Radiofrequency facet joint denervation

The spine’s facet joins contain a capsule that can develop degenerative arthritis. When this happens, the medical branch nerves transmit pain signals, which the brain can read as either neck or back pain. If a facet point injection indicates that these joints are the source of a patient’s pain, a procedure called radiofrequency facet joint denervation may be used.

In this procedure, a small needle with a radiofrequency tip under live x-ray imaging is used to create a small heat lesion. This lesion can block pain signals while preventing the total destruction of the nerve pathways, allowing the facet joint to function without creating pain. In time, the nerve grows back, which means the clinical effects of this procedure only last between three months and three years.

Spinal cord stimulation

Spinal cord stimulation is a therapeutic technology used for patients with spinal pain secondary to chronic nerve pain—especially patients for whom more conservative treatments, such as injection-based therapies, have failed. In this technique, electrical leads are inserted into the epidural space via a needle under live imaging. Then, small electrical currents are applied to the areas of the spinal cord causing the pain. These currents interfere with the transmission of pain signals to the brain, relieving pain without the side effects of medications. The pain is replaced with a mild, pleasant tingling sensation.

For the first three to 10 days, an initial trial is performed, in which the electrical leads are connected to an external generator. If the patient notices a significant reduction in pain or medication usage, as well as an improvement in function, a small, permanent, programmable generator will be implanted under the skin for long-term relief.

Total disc replacement

Eventually, the discs that cushion the spinal bones can become damaged or suffer from degenerative diseases. This can lead to pain and lack of mobility. In recent years, it has been possible to replace these damaged discs with artificial ones—similar to how knees and hips can be replaced.

As a leader in spinal care, the Florida Hospital Orlando Spine Center is one of just a few facilities in the United States that provides this cutting-edge procedure. Total disc replacement is a reversible alternative that avoids many of the drawbacks of spinal fusion, while preserving motion, restoring height and keeping the stress along the spine in balance.

Trigger point injection

Myofascial trigger points are very irritable areas in muscles that are associated with tight muscle bands. If these trigger points exist in the spine muscles, it can cause significant neck or back pain. Trigger point injections are a treatment option reserved for patients who have not responded to the first four to six weeks of conservative therapies such as medications and a rehabilitation program.

In a trigger point injection, a local anesthetic and small amounts of cortisone are injected into the trigger point to break up the area of hyperirritability and provide long-term pain relief.