Interventional Pain Management

Interventional Pain Management

Is joint or spine pain limiting your lifestyle? If you’re looking to find effective pain relief and improve your quality of life, turn to the pain management specialists at New Hampshire Orthopaedic Center (NHOC). Our experts specialize in treating arthritis pain, sciatica, herniated discs, spinal stenosis and all other types of neck and back pain.

Pain Management Excellence in New Hampshire

Interventional pain management techniques can help you find relief from pain caused by arthritic joints and compressed spinal nerves. If nonsurgical treatments like oral pain medication are no longer effective and physical therapy is too painful, you may benefit from minimally invasive procedures. NHOC offers:

  • Skilled physicians: All our pain management doctors are board certified in anesthesiology with additional certification in pain management. We perform hundreds of interventional treatments and minimally invasive procedures each year, so you can trust our experience.
  • Customized care plans: Our pain management experts are dedicated to understanding what causes your pain and how it affects your life. We learn about your lifestyle and recovery goals so we can tailor a care plan that’s best for you.
  • Improved quality of life: We aim to get you moving again, free of pain and limitations. The treatments we offer can help you participate in physical therapy, go about your daily activities and enjoy time with loved ones.
  • Minimally invasive procedures: Joint injections, nerve blocks and nerve ablation are nonsurgical, office-based procedures. There’s no anesthesia involved, and you go home the same day.

Diagnosing Neck and Back Pain

Diagnosing spine pain can be difficult. It can affect many areas of your body, including your neck, shoulders, arms, hands, abdomen, hips, legs and feet.

Our pain management specialists begin by asking questions about your lifestyle, activity level, when the pain started, where you feel it and what activities make it worse. During a physical exam, they check to see if you’re able to sit, stand, walk and lift your arms and legs.

To help locate where the pain is coming from, our doctors may order one or more tests, including:

  • Spine X-ray: These images show your vertebrae (spinal bones). We use them to check for or rule out arthritis or broken bones.
  • CT scans or MRI: These scans create detailed images of all the bones, muscles, tendons, ligaments, nerves and blood vessels in and around the spine.
  • Electromyography (EMG): This test stimulates nerves and measures how your muscles respond to the electrical impulses produced by those nerves. EMG can confirm nerve compression caused by conditions such as herniated discs or spinal canal narrowing (spinal stenosis).

Interventional Pain Management Procedures We Offer

At New Hampshire Orthopaedic Center, we offer numerous minimally invasive procedures. Some, like injections and nerve ablation, are nonsurgical, and we do them in our office. The most common office-based procedures we perform include:

Transforaminal epidural steroid injection

An epidural steroid injection (ESI) helps relieve pain, numbness and tingling from inflamed spinal nerves. The injection contains a corticosteroid (anti-inflammatory) medication and numbing solution. It’s injected into the area of the spine where the nerve is compressed:

  • Cervical spine (neck): We may recommend a cervical ESI for pain in the neck, shoulders, arms or hands.
  • Thoracic spine (upper- to mid-back): We may perform a thoracic ESI for pain in the upper back, ribs or abdomen.
  • Lumbar spine (low back): You may have a lumbar ESI for low back or leg pain.

“Transforaminal” refers to the injection approach we use. For a transforaminal ESI, our doctors place the needle through the side of the spine into the foramina, the openings where nerve roots exit your spine.

Many conditions can compress nerves, causing inflammation and pain. An epidural steroid injection might be right for you if you have a herniated disc, degenerative disc disease, spinal stenosis, spondylosis (spinal osteoarthritis) or sciatica.

The medication typically takes a few days to begin working. Epidural steroid injections provide temporary pain relief, enabling you to participate in physical therapy and other daily activities. Many people experience pain relief and improved function for several weeks or months.

Intra-articular steroid injection

Corticosteroid (cortisone) shots can help relieve osteoarthritis pain and inflammation in any joint – knee, hip, shoulder, elbow, wrist, ankle and even toe and finger joints. They are injected directly into the affected joint. Corticosteroids may provide arthritis pain relief for several months.

Medial branch block injection

A medial branch block injection provides temporary pain relief from facet joint pain. A pair of facet joints are located between each bone in your spine (vertebrae). They connect the vertebrae and allow the spine to bend and twist.

Medial nerves run through the facet joints. Over time, the medial nerves can become pinched and inflamed from spinal osteoarthritis, degenerative disc disease and joint strain.

A medial branch block works by temporarily blocking pain signals sent from the medial nerves to the brain. The injection is primarily diagnostic, though. If we suspect your pain is coming from the facet joints, we do a medial branch block to confirm this and pinpoint the exact location of your pain. Once we verify the facet joints are the problem, we may recommend radiofrequency ablation for longer-term pain relief.

Radiofrequency ablation

Radiofrequency ablation interrupts pain signals sent from the affected spinal nerve to the brain. Our experts insert a hollow needle into the painful joint. An electrode at the needle tip sends a gentle electrical current to the targeted nerve. This creates a heat lesion on the nerve, preventing the pain signal from traveling to the brain.

We typically recommend radiofrequency ablation for facet joint pain and sacroiliac joint pain. You may experience pain relief for six months to two years.

Sacroiliac joint injection

The sacroiliac (SI) joints are located at the end of your spine. They connect the large, triangular bone (sacrum) to the hip (pelvic) bones. The hip is a large, weight-bearing joint, and the SI joints act as shock absorbers. They can cause pain in the low back, buttocks or hip.

If we suspect your pain is coming from one of your sacroiliac joints, we might recommend an SI joint injection to diagnose and treat low back pain, pelvic pain or sciatica. The injection contains corticosteroid medication to decrease inflammation and relieve pain.


17 Riverside Street, Suite 101
Nashua, NH 03062
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9 Washington Place, Suite 101
Bedford, NH 03110
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Contact Us About Pain Management

For questions about our interventional pain management services, or to make an appointment with one of our pain specialists, call or text 603.883.0091.

Interventional Pain Management Physicians

Our Interventional Pain Management Specialists

  • Stephen J. Dainesi, MD

    Stephen J. Dainesi, MD is an interventional pain management specialist practicing at the New Hampshire Orthopaedic Center in Nashua. He is also the founder of the Pain Management Center in Manchester, New Hampshire, which opened in 1991.

  • Joseph T. Hyatt, MD

    Joseph T. Hyatt, MD is an interventional pain management specialist practicing at the New Hampshire Orthopaedic Center in Nashua. Dr. Hyatt is Board certified in anesthesia and has received additional qualifications in pain management by the American Board of Anesthesiology (ABA).

  • Syed A. Razvi, MD

    Syed A. Razvi, MD is board certified by the American Board of Anesthesiology and specializes in anesthesiology and pain management. He has been practicing both for more than 25 years and is well respected throughout the community for not only his knowledge and experience, but also his communication and demeanor with patients.

  • Brian D. Klagges, MD

    Brian D. Klagges, MD is an interventional pain management specialist practicing at the New Hampshire Orthopaedic Center. Dr. Klagges is board certified by the American Board of Anesthesiology (ABA). He is also a Diplomate of the American Board of Anesthesiology.

  • Molly Grillakis, FNP-C

    Molly Grillakis, FNP-C is a pain management specialist practicing at the New Hampshire Orthopaedic Center. Grillakis is board certified by the American Association of Nurse Practitioners.