Pain Management & Spine Care

Targeted Relief for Neck, Back & Spine Pain

Maryland Orthopedic Specialists offers comprehensive interventional pain management and spine care for patients throughout Montgomery County, MD, with appointments available at our Bethesda and Germantown locations. Our approach addresses the full spectrum of musculoskeletal and spinal pain — from acute disc injuries and radiculopathy to chronic facet arthropathy and sacroiliac joint dysfunction — using a range of minimally invasive, precisely targeted procedures designed to reduce pain and restore your ability to function. We do not rely on a single intervention or a one-size-fits-all protocol; instead, we combine image-guided procedures with physical therapy, activity modification, and appropriate medical management to create a multimodal care plan tailored to you.

Understanding Chronic Spine & Joint Pain

Back and neck pain are among the most prevalent health conditions in the United States — research consistently shows that up to 80 percent of Americans will experience at least one significant episode of back pain during their lifetime, making it the leading cause of disability in people under 45. While many episodes of acute pain resolve on their own within four to six weeks, a significant portion of patients go on to develop chronic pain — defined as pain persisting beyond three months — which can lead to progressive loss of mobility, diminished sleep quality, depression, and a reduced capacity to participate in work, family, and recreational activities. Acute pain is typically a direct signal of tissue injury; chronic pain involves more complex changes in how the nervous system processes pain signals, which is why a generic approach rarely works. Seeing an orthopedic specialist who is trained in musculoskeletal and spinal pathology offers advantages over relying solely on primary care: we can identify the precise anatomical source of your pain through physical examination and targeted diagnostic procedures, and we have access to a broader array of interventional options that primary care providers typically do not perform. Early, accurate diagnosis and targeted treatment can interrupt the cycle of pain and deconditioning before it becomes entrenched.

Procedures We Offer

1. Epidural Steroid Injections (ESI)

An epidural steroid injection delivers a corticosteroid medication — along with a local anesthetic — directly into the epidural space surrounding the spinal cord and nerve roots, where inflammation is causing pain. ESIs are among the most widely used and evidence-supported interventional treatments for radicular pain (commonly called sciatica), herniated disc, and spinal stenosis; the anti-inflammatory medication reduces nerve root swelling and irritation, providing a window of pain relief that can last weeks to months. Both cervical (neck) and lumbar (low back) approaches are available, with the specific route — interlaminar or transforaminal — selected based on your anatomy and the location of pathology. When clinically appropriate, fluoroscopy (live X-ray) or ultrasound guidance is used to ensure precise needle placement and maximize both safety and effectiveness.

2. Facet Joint Injections

The facet joints are small paired joints running along the back of the spine at each vertebral level; they guide spinal motion and are common sources of localized spine pain, particularly in patients with facet arthropathy or degenerative disc disease. A facet joint injection delivers a corticosteroid and local anesthetic directly into or around the affected joint, serving a dual purpose: it provides therapeutic anti-inflammatory relief while also confirming the facet joint as the pain generator if significant relief is achieved. Facet injections are available for both the cervical and lumbar spine and are typically performed with fluoroscopic guidance to ensure accuracy. When multiple facet levels are involved, a phased approach is used to identify and treat the most significant contributors to pain.

3. Medial Branch Blocks

The facet joints are innervated by small nerves called medial branches of the dorsal rami; blocking these nerves with a local anesthetic provides targeted pain relief and — importantly — is used as a diagnostic test to predict whether radiofrequency ablation (RFA) will be effective for a given patient. Medial branch blocks are performed under fluoroscopic guidance, with precise needle placement at the standard anatomical target points adjacent to the affected facet joints. When a patient achieves significant, reproducible pain relief from two sets of diagnostic medial branch blocks, they become a candidate for RFA, a procedure that uses heat energy to interrupt the pain signal from those nerves for an extended period — often 12 to 24 months or longer. Our team will walk you through this diagnostic-to-treatment pathway so you understand the rationale for each step.

4. Selective Nerve Root Blocks

A selective nerve root block (SNRB) targets a specific spinal nerve root with a combination of local anesthetic and corticosteroid, providing both diagnostic and therapeutic value. Diagnostically, an SNRB confirms which nerve root is generating a patient's arm or leg pain — information that is especially useful when imaging findings are ambiguous or when multiple levels are potentially involved. Therapeutically, the anti-inflammatory medication bathing the inflamed nerve root can provide weeks to months of meaningful pain relief, allowing the patient to engage more effectively in physical therapy. SNRBs are performed under fluoroscopic guidance and are one of our most useful tools for refining surgical decision-making in patients considering decompression procedures.

5. Trigger Point Injections

Trigger points are discrete, hyperirritable spots within taut bands of skeletal muscle that produce local pain and — when pressed — a characteristic referred pain pattern. Trigger point injections deliver a small volume of local anesthetic directly into the trigger point, releasing the taut band, interrupting the pain cycle, and immediately reducing pain intensity. This procedure is particularly effective for myofascial pain syndrome involving the muscles of the neck, upper trapezius, and paraspinal region — a common source of chronic neck and upper back pain that often coexists with structural spinal pathology. Trigger point injections are quick, well-tolerated, and can be repeated at appropriate intervals; they are most effective when combined with a stretching and postural rehabilitation program.

6. Sacroiliac (SI) Joint & Hip Injections

Not all pain perceived in the low back, buttocks, or leg originates from the lumbar spine. The sacroiliac joints — where the sacrum connects to the iliac bones of the pelvis — are responsible for an estimated 15 to 25 percent of chronic low back pain, and hip joint pathology can produce referred pain down the leg that mimics lumbar radiculopathy. SI joint injections deliver corticosteroid into or around the SI joint under fluoroscopic or ultrasound guidance, providing both diagnostic confirmation and therapeutic relief for sacroiliac joint dysfunction. Hip joint injections similarly target intra-articular hip pathology contributing to groin pain or referred leg symptoms. Accurately identifying these extra-spinal pain sources avoids unnecessary spinal procedures and directs treatment to the correct anatomical location.

Conditions We Treat

• Herniated disc (cervical and lumbar)
• Spinal stenosis (narrowing of the spinal canal)
• Sciatica (lumbar radiculopathy with leg pain and numbness)
• Facet joint arthropathy (degenerative facet disease)
• Sacroiliac (SI) joint dysfunction
• Degenerative disc disease
• Cervical radiculopathy (arm pain and numbness from neck pathology)
• Lumbar radiculopathy (leg pain and numbness from low back pathology)
• Myofascial pain syndrome
• Post-surgical spine pain (persistent or recurrent pain following prior spine surgery)

Our Approach: Pain Management as a Bridge, Not a Destination

One of the most important things we communicate to our patients is that interventional pain procedures are most effective when they are used as a bridge — not as a permanent solution in isolation. A well-placed epidural steroid injection can dramatically reduce inflammation around an irritated nerve root, but that relief creates an opportunity, not an endpoint. When the acute pain is reduced to a manageable level, patients become able to actively engage in physical therapy, pursue postural correction, strengthen the supportive muscles around the spine, and address the functional movement patterns that may have contributed to their injury. The physical therapy component is where lasting improvement is built. Our practice works in close coordination with our in-house physical therapy team to ensure that the window of comfort created by a procedure is used effectively. We measure success not by how many injections a patient receives, but by how few they ultimately need — because our goal is always to reduce your dependence on procedures over time, not to sustain it.

Frequently Asked Questions