Ahmed H. Ghaleb, M.D. Medical Director, Center of Pain Medicine (Curriculum Vitae)

Juan Firnhaber, M.D. (Curriculum Vitae)
Assistant Professor, Center of Pain Medicine

Team Members
Leta Peterson, RN
Cheryl Schilb, RN
Mary Lamb, Office Coordinator
Shanna Cranford, Clinical Technician

Contact Information
501-686-8818

The following procedures are performed by the Pain Medicine team:

Occipital Nerve Block
Indications:

• Occipital neuralgia
• post-herpetic neuralgia

Cervical Facet Block
Indications:

• Arthropathy/arthritis
• Headaches from cervical region.

Cervical Epidural Steroid Injection
Indications:

• Cervical radiculitis/radiculopathy
• Post herpetic neuralgia
• +/- cervical disc annular tear

Cervical Selective Nerve Root Block-Transforaminal Epidural
Indications:

• Cervical radiculitis/radiculopathy
• Post-herpetic neuralgia
• Diagnostic

Cervical Medical Branch Block and/or Radiofrequency Ablation
Indications:

• Diagnostic/therapeutic for cervical facet arthropathy.

Thoracic Epidural Steroid Injection
Indications:

• Radiculitis/radiculopathy
• Post-herpetic neuralgia
• Herpes zoster (+/-)

Intercostal Nerve Block
Indications:

• Anesthesia of chest wall
• Post - herpetic neuralgia
• Neuritis

Lumbar Facet Block
Indications:

• Lower back pain felt to arise from lumbar facets
• Facet arthropathy demonstrated on radiological studies that corresponds to level of pain (Facet pain is a diagnosis of exclusion and facet block is diagnostic and sometimes therapeutic)

Lumbar Epidural Steroid Injection
Indications:

• Radiculopathy/Radiculitis, spinal stenosis, possible benefit in discogenic pain

Lumbar Transforaminal Epidural Steroid Injection
Indications:

• Radiculopathy/Radiculitis
• Spinal stenosis
• Possible indication in discogenic pain
• Post-surgical back where anatomical considerations make translaminar approach unfeasible
• Procedure preference

Lumbar Selective Nerve Root Block
Indications:

• Diagnostic/therapeutic for radiculopathy/radiculitis
• Symptomatic foraminal stenosis

Lumbar Medial Branch Block and/or Radiofrequency Ablation
Indications:

• Pain associated with lumbar facets.

Sacroiliac Injection
Indications:

• Lumbar back pain off neuraxis often with radiation into groin
• Sacroiliac arthropathy

Piriformis Injection
Indications:

• Chronic strain of muscle
• Piriformis stretch maneuver

S1 Transforaminal Injection
Indications:

• Sacral radiculitis/radiculopathy
• Lumbosacral discogenic pain

Caudal
Indications:

• Lower lumbar or sacral radiculitis/radiculopathy
• Previous lumbar laminectomy with potential extensive scarring

Trigger Point Injections
Indications:

• Painful muscular contractions with definable trigger points?

Ilioinguinal, Genitofemoral, Iliohypogastric Block
Indications:

• Pain in groin
• Base of penis
• Mons pubis
• Scrotal sac
• Labia majora

Lateral Femoral Cutaneous Nerve Block
Indications:

• Meralgia paresthetica-sensory changes in antero-lateral thigh and hip with pain and/or numbness

Stellate Ganglion Block
Indications:

• Diagnosis and treatment of complex regional pain syndrome (CRPS) of the upper extremity
• Perfusion abnormalities of the upper extremity.

Celiac Plexus, Lumbar Sympathetic, Superior Hypogastric
Indications:

• Celiac: acute and chronic pancreatitis, pancreatic carcinoma, upper abdominal malignancies
• Lumbar Sympathetic: Complex regional pain syndromes of the lower extremity, vascular insufficiency
• Superior hypogastric: Mid-gut and colon malignancies, sometimes rectal and pelvic malignancies