Epidural Steroid Injection (ESI)

Epidural Steroid Injection (ESI)


What is an epidural steroid injection (ESI)?

An injection of steroids includes both a corticosteroid, such as triamcinolone or methyl-prednisolone and an anesthetic, such as lidocaine (or bupivacaine). The drugs are injected into the epidural area of the spine. This is the space between the bony vertebrae and the dura sac that surrounds the spinal nerves.

Corticosteroid injections are effective in relieving inflammation. They can also be administered directly to the pain area. The injection will not shrink a herniated disc. It only affects the spinal nerves by flushing out the swelling proteins. You can expect pain relief to last for several days or even years.

Who are the candidates?

ESI may be beneficial for patients with neck, arm, leg, or low back pain (sciatica). These conditions are particularly suitable for ESI:

  • Spinal stenosis is a narrowing of the spine canal and nerve root canal that can cause leg and back pain, especially when walking.
  • Spondylolisthesis is a weakness or fracture that occurs between the upper and bottom facets of a vertebra. The nerve roots can be compressed if the vertebra moves forward.
  • Herniated disc: This is when the gel-like substance within the disc can burst or rupture through the weaker area of the surrounding wall (annulus). When this material comes into contact with a spinal cord, it can cause irritation, pain, swelling, and nerve damage.
  • Degenerative disc: The process of aging or breaking down of the intervertebral disc causing the space between the disc and the annulus to collapse, tear the annulus and the growth of bone spurs.
  • Sciatica is a condition that causes pain along the sciatic nerve, in the buttocks, and down the legs. It is often caused by compression of either the 1st or 5th lumbar spinal nerves.

Some patients have found ESI to be helpful in the treatment and prevention of painful inflammatory conditions. ESI can help to determine if surgery is necessary for the pain caused by a herniated disc. Epidurals are used to relieve pain that interferes with rehabilitation exercises.

ESI should not be performed on patients with bleeding or infection. Patients with diabetes may experience a slight increase in blood sugar. Patients with glaucoma may experience a temporary increase in blood pressure and eye pressure. Talk to your doctor about this. Tell your doctor if you suspect you might be pregnant. Fluoroscopy xrays can be dangerous for the baby.

Who is responsible for the procedure?

Epidural steroid injections can be performed by physiatrists, radiologists, surgeons, anesthesiologists and neurologists.

What happens before treatment?

To determine the best way to inject the needles, the doctor will review your medical history and any imaging studies. You are welcome to ask questions during this appointment.

Patients who use blood thinners (Coumadin or Plavix) may need to stop taking them. You may have to stop taking the medication several days before your ESI. Talk to your doctor about any medication you are taking, as well as the doctor who will administer the injection.

The procedure is typically performed in an outpatient facility using x-ray fluoroscopy. You can arrange for someone to drive you to the center on the day of the injection.

What happens during treatment?

You will need to sign consent forms and list any medications you are currently taking. The procedure can take between 15 and 45 minutes. After that, there will be a recovery period. It is important to get the medication as close as possible to the nerve.  The type of injection you choose depends on your condition, as well as whether or not you have had any previous surgery. The doctor will determine which type of injection is most likely to yield the best results.

Step 1: Prepare the patient

The patient lies down on an x-ray table. The local anesthetic is used for pain relief. To provide feedback to the doctor, the patient must remain awake and alert during injections. Based on the center, a low-dose oral sedative such as Valium and Versed may be offered.

Step 2: Insert the needle

The doctor uses an x-ray fluoroscopy to guide a hollow needle through skin between bony vertebrae and into the epidural space. Fluoroscopy allows doctors to monitor the needle on an x-ray monitor in real time, making sure that it goes to the right place. Although some discomfort may occur, patients feel more pressure than pain.

There are many types of ESIs.

  • Cervical ESI, neck. To reach the neural foramen, the needle entry point is located on the neck side. It is just above the opening of the nerve root. To confirm the location of the medication, a contrast dye is used.
  • Lumbar ESI (lower back). To reach the nerve canal, the needle entry site is located slightly above the midline of the back. To confirm the location of the medication, a contrast dye is administered.
  • Caudal ESI (tailbone). To reach the lowest spinal nerves, the needle is inserted into the sacral hiatus just above the tailbone. To confirm the flow of medication, a contrast dye is administered.

Step 3: Inject the medication

Once the needle has been correctly placed, the anesthetic medication and corticosteroid medication are injected into epidural space surrounding the nerve roots. The needle is then taken out. The procedure can be repeated on the justify or right side depending on where your pain is located. It is possible to inject one or more spinal levels.

What happens next?

Most patients are able to walk immediately following the procedure. After a brief stay in the center, most patients can walk away. You should always be accompanied by someone to drive you home if there is any temporary weakness or numbness in your legs.

Patients can resume normal activities the next day. Ice and Tylenol may help to ease soreness around the injection site. It may be a good idea to keep track of your pain levels over the next few weeks using a journal. As the numbing medication wears off, you may feel a slight increase or numbness. After the procedure, patients should make an appointment to see their treating physician for a follow up appointment. This will allow them to verify the effectiveness of the treatment and discuss any future plans.

What were the results?

Many people experience pain relief from ESI [1,2]. If you experience mild pain relief, two to three additional injections may be required, typically in intervals of 1-4 weeks. This will give you the full effect. The duration of pain relief can vary, and may last for weeks or even years. To prevent future pain episodes, injections can be combined with a physical Therapy or home exercise program.

What are the potential risks?

ESI has few risks and is recommended for certain patients. There are rare risks involved in inserting the needle. These include spinal headaches from a puncture, bleeding and infection. Nerve damage/paralysis is also possible (rare).

Side effects of corticosteroid may include weight gain, flushing (hot flashes), flushing, mood swings, insomnia, elevated blood sugar in diabetics, and water retention. The mild numbness and weakness in the affected leg or arm usually disappears within 8 hours.  This is similar to facial numbness after dental work. For patients with chronic conditions such as heart disease, diabetes, or rheumatoid arthritis, it is a good idea to consult your physician.

What are epidural steroids injections?

An epidural corticosteroid injection places medication directly around pinched nerves as they exit the spine in the epidural space. The epidural space lies between the spinal cord and nerves, between the discs and bones of the spine. This is where disc tissue can protrude and cause pressure or inflammation around spinal nerves.

What is the purpose of epidural corticosteroid injections?

The most common use of epidural steroids is to treat back pain due to a herniated disc, lumbar radiculopathy, spine stenosis, or sciatica. Corticosteroids, which are powerful anti-inflammatory medications, can be injected into the epidural space to reduce inflammation around an irritated neuron that causes back or leg pain and discomfort.

Who could benefit from an epidural injection of steroids?

An epidural injection may be beneficial for patients with common conditions, such as lumbar disc 

herniation and degenerative disc disease, sciatica, sciatica, postherpetic neuralgia, lumbar spine stenosis, lumbar radiculopathy, lumbar radiculopathy, lumbar radiculopathy, lumbar radiculopathy, lumbar synovial cysts, and lumbar radiculopathy.

 An epidural injection of steroid may be a nonsurgical treatment that is effective or can aid in surgical planning.

How does epidural corticosteroid injections work?

The epidural steroid injections deliver a powerful anti-inflammatory to nerve impingement sites in the spine. The injections may contain saline, local anesthetics, or steroids. They can also vary in volume and concentration depending on the individual.

There are three routes that can be used to administer epidural injections to the lumbosacral spinal cord:

  • caudal
  • Interlaminar (also called translaminar).
  • Transforaminal

Based on your condition and any previous spine surgery, your physician will determine which method is best for you.

  • The caudal injection, while the most straightforward way to access the epidural area, is also the most specific. This can be helpful if multiple parts of the spine are involved, or if other options are not possible.
  • Interlaminar or translaminar injections deliver the medication directly to the epidural space at affected levels. They can target one side or both and can treat multiple levels simultaneously.
  • Transforaminal injections deliver the medication to the affected area of the nerve root. This is done by compressing the disc. This is the first option for epidural injections.

How often can you receive epidural steroids injections?

It is recommended that epidural steroid injections be given up to three to six times per year. If a disc herniation is a new one, the injections can be administered several weeks apart to achieve quick and complete relief. It is not uncommon for chronic conditions to go longer than three to six months between injections.

How long can epidural injections for back pain last?

Patients with new disc herniations who are responsive to epidural steroids injections may experience permanent relief of their pain. Patients with chronic pain and recurrent disc herniations should expect to see an effect for three to six months.

What are the potential risks associated with epidural steroids injections?

There are risks associated with any procedure that involves a needle, including bleeding, infection, and nerve damage. If performed correctly, the risks of any of these are minimal and often outweighed by the potential benefits of the procedure.

There are some contraindications to epidural steroids injections.

  • Anticoagulation or bleeding disorders
  • medication allergies (rare)
  • Systemic infection or localized infections in the vicinity

What side effects can epidural steroids injections have?

Side effects that are common include slight injection site pain, temporary worsening or usual pain, flushing and insomnia, as well as increased blood sugar. These side effects are usually temporary and disappear within one to three working days. Headache is a less common side effect.

Do I need to prepare? Do I need to eat before or after an epidural steroid injection?

Specific instructions will be given by your doctor. These will depend on the facility and the type of epidural (lumbar or thoracic, cervical). Fasting is not a problem since the procedure is typically performed under local anesthesia.

What is the use of anesthesia? Is epidural steroid injection painful?

The epidural needle is placed and a local anesthetic is administered to the skin. The procedure is not painful and may cause mild discomfort.

Do I need to be flat on my stomach during and after the procedure?

The procedure takes between 10 and 20 minutes. Patients will need to lie down if they are able to receive fluoroscopy (X-ray guidance). After a brief monitoring period, you will be able to stand and walk again as normal.

Who does epidural steroids injections?

HSS epidural steroid injections can be performed by a variety of doctors, including pain management physicians, interventional radiologists, and physiatrists. All of these doctors are qualified to safely perform the procedure.

Potential benefits of epidural steroid injections

An epidural injection is a good option for acute leg or back pain. The downsides to epidural injections include that they may not be always effective and that the pain relief can last anywhere from one week up to one year. 

If the first injection is successful, you may need to give up to three injections in a year.

Steroid injections can be administered in the lumbar epidural area and may provide the following benefits:

  • Inflammation and nerve pain can be reduced. Steroids can reduce nerve pain and inflammation.
  • Limit oral medication. These injections can be used to reduce or eliminate the need for oral medication, some of which may cause side effects if taken long-term.
  • Continue to engage in physical therapy or re-engage. Continue or re-engage in physical therapy.
  • Postpone surgery. Postpone surgery.

There are many methods that can be used to administer epidural injections depending on the patient’s condition and their needs.

Epidural Injection Approaches

This injection delivers a strong anti-inflammatory steroid medication directly to the pain area. It can provide significant and immediate pain relief. One of these approaches may be used to give an epidural injection:

  • Transforaminal route : This technique allows for precise administration of the steroid solution to the epidural area, close to the area that is most likely be irritated. This technique injects specific nerve roots to reduce inflammation and pain.
  • Interlaminar route : The needle is inserted at the back of your spine, and the medication is then deposited in the epidural area. This method is less precise as it doesn’t deposit medication near the target nerve root. Also, the steroid solution does not spread within the epidural area.
  • Caudal route. This is a simple approach that can be used to treat pain. However, medication is not directed to the epidural space or around the nerves. Although it may not be as effective, the caudal approach is safer and more convenient. This may be a good option to manage widespread or diffuse pain.

The route of administration will be determined by the doctor’s experience, skill, use of guided fluoroscopy and the diagnosis of the patient.

Effectiveness of Injections

Research suggests that these injections have generally positive results. Typically, up to three injections may be given over a 12-month period. 

Although many studies have shown epidural steroid injections to be effective in short-term pain relief, long-term results are not as convincing. There is still much debate about their effectiveness in relieving pain and improving function.

There are also limitations to the research, such as:

  • Despite the fact that fluoroscopic guidance can be used in many cases, not all studies include fluoroscopy.
  • Other studies don’t classify patients based on diagnosis. They tend to lump different types of pain together.

These methodological weaknesses can limit the utility of the research. To fully understand the role of epidural steroids in sciatica and lower back pain, more research is needed.

Use of Epidural Steroid Injections

The treatment of lower back pain and inflammation caused by irritation or inflammation of the spinal nerve roots, including leg and lower back pain, is commonly called Lumbar Epidural Injections  are the most common lower back conditions.

  • Lumbar Herniated disc(s).
  • Lumbar Degenerative disc Disease
  • Lumbar Spinal Stenosis

These injections may also be used to treat localized back pain ( Axial back pain) or neurogenic claudication (back and leg pain while you walk) less frequently. 

Who Injects?

This type of injection is administered by spine and pain management specialists such as anesthesiologists and radiologists, spine surgeons, and physiatrists. The procedure is usually performed in a hospital, surgery center or physician’s office.

Potential risks and contraindications of epidural injections

The epidural steroid injections can be considered safe and minimally invasive. Some cases may experience temporary side effects, including but not limited to:

  • Post-injection pain
  • Nausea
  • Headache
  • Dizziness
  • Fainting (vasovagal attack).
  • Flushing of the Face

These side effects usually resolve within minutes to hours. These side effects usually resolve in a few minutes to hours.

Lower risk at L4 and lower spinal levels

Epidural injections for spinal levels L4 and lower have a lower risk of complications. Fluoroscopy is used to guide the needle and prevent nerve or artery damage.

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Michael Wolff, M.D. - Southwest Spine & Sports