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Nerve pain? Experience an intercostal nerve block

An intercostal nerve block is a unique method to combat pain, persistent pain syndromes, either acute or chronic in the area of the chest. The procedure was first introduced by Heinrich Braun. Intercostal nerves lie below the lower margins of the ribs. Intercostal nerve blocks involves the injection of a local anesthetic, with or without a steroid in the area near to intercostal nerves. The procedure is a component of an integral method for the treatment and management of pain. Intercostal nerve blocks are sometimes the only prescribed treatment and blended with other treatments such as anti inflammatory medicines, chiropractic care, oral or intravenous Opioids, occupational therapy and antidepressants

Intercostal nerve blocks are often for treatment purpose, but it can be also used for diagnosis in some conditions. If pain is not reduced with injections an intercostal nerve might not be the root cause of the pain

If the pain is acute, an intercostal nerve may be the cause, with insufficient pain, recovery performed by the Co injected steroid. If the pain is alleviated for longer  periods such as hours, days and weeks an intercostal nerve is the root cause. If this is the situation repeat injections of the local anesthesia with or without a steroid

When should I avoid an intercostal nerve block?

Intercostal nerve blocks should not be taken by patients having any of the following symptoms

  • Allergy to any local anesthetic
  • Infections breakout whether bacterial or viral
  • Influenza A or B
  • Poorly controlled hypertension
  • Treatment with blood thinners
  • Poorly controlled diabetes

If you are taking any blood thinners, it is advised to stop taking the blood thinners at least a week before the  procedure

Risks and complications

An intercostal nerve block is a safe procedure, however, there are possibility of complications, which may include;

  • Bruising or soreness at injection site
  • Infection
  • Nerve damage
  • Collapsed lung
  • Bleeding
  • Systemic toxic reactions
  • Death (very rare)
  • Increased blood sugar levels

What conditions are treated with the intercostal nerve blocks?

There are several conditions that are treated from an intercostal nerve block which includes;

  • Post-traumatic pain from rib fracture, shingles (herpes zoster), or post herpetic neuralgia
  • Postoperative pain from chest wall surgeries or procedures
  • Chronic non-malignant pain
  • Pain from malignancies involving the chest wall

The above discussed conditions compresses the intercostal nerves and causes inflammation, which leads to pain in the chest wall

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Dress up by your spinal disc wall with IDET

Intradiscal electrothermal therapy or IDET is a comparatively new procedure devised to manage chronic lower back pain. It is slightly invasive surgery that makes use of heat delivered through the electrical device straight to the problem areas of your spine. Sometimes scar tissue formation and excessively grown nerve fibers from injury or chronic illness can cause debilitating disc pain. The fibers and nerve network get pinched by the disc causing severe pain

IDET works heating the outer most covering of the damaged disc. The heat helps reduce the fibers within the disc and impairs the pain receptors. Patients have reported significant pain relief in as quickly as three days and it can last up to six months

What is actually Intradiscal Electrothermal Therapy?

The slightly invasive procedure takes an hour and done on an outpatient basis. The procedure helps eliminate and manage lumbar back pain occur from a disease, injury or mild herniated disc. At the Pain Management Institute our Board Certified Anesthesiologist Dr Zaki Anwar. MD performs the procedure on an outpatient basis. During the procedure you can remain awake as he often uses local anesthesia and light sedation to minimize any discomfort. Discuss with your physician prior to the procedure about risk recovery and expectations. The detailed procedure is discussed in this blog, keep reading

Administering the needle

At The Pain Management Institute, we take advantage of the most modern technology to diagnose the precise point of the damaged disc in your spine. Once Dr. Zaki Anwar verifies the aimed point, he uses fluoroscopy X-ray imaging to administer a hollow needle straight to the disc

Inserting the heating wire

He then introduces the heating wire, that is an electrothermal catheter, with the needle steering it to precisely reach the damaged portion of the disc. You might not feel any pain at this point in the procedure

Dressing the disc wall

When the electrothermal catheter reached its aimed location, the power is turned on and the temperature of the wire is slowly increased to 90 degree Celcius. Dr. Zaki Anwar carefully monitors the process warming the damaged disc wall for about 15 to 20 minutes

Repairing the disc wall

The heat gradually shrinks and repairs the damage and torn disc wall area, it also slightly burns the nerve endings to make them less sensitive to pain. If you experience any pain during the procedure, it’s because of the heat applied to the disc


Dr. Zaki Anwar, MD removes the electrothermal catheter and needle within 15 to 20 minutes. The injection point is covered with a small bandage and you can return home the same day

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A twenty five year old talked about her painful journey to Intercostal Nerve Blocks

For the past few months I felt like someone has been piercing in my lower right rib. Or sometimes it felt like someone has just hit me in the ribs with a baseball bat. The pain often varies during the day in intensity. The recent diagnosis showed up nerve pain from post procedure scar tissue formation from my gall bladder surgery. During my surgery a few years ago I wasn’t even aware of the scar tissue formation as a possible side effect. During the whole day the pain makes me feel like being stabbed in the ribs with an imaginary knife

Last week I had a very slightly invasive procedure called an Intercostal Nerve Block performed by Dr Zaki Anwar, Founder of the Pain Management Institute Anesthesiologist and Pain Management Specialist, which is what I can say was the only hope for me. And to my expectation the pain relieved I had my mother and brother accompanied me an hour drive to The Pain Management Institute, Chicago, Frankfort as, at first the procedure seems like a bit frightening

Dr Zaki Anwar, MD told me in advance that I may be put to sleep, but when I reached there on the day of the procedure he only discussed my medical history and gave me some relaxants and local anesthetics

The procedure was split into a few steps

The very first I was given an IV sedation that helped me relax without putting me to sleep, I was directed to lay on my stomach on the examination table wearing a hospital gown. The my back and rib area was marked and I was told, I was about to be injected with local anesthesia. At first the injected anesthesia burned really bad, all in all the local anesthetics were three. And after a burning sensation I felt like my ribs and back has been numbed.

The most important part of the whole procedure was the intercostal nerve blocks, I was lying still stomach down as if I had moved there might be chances of needle damage my lungs, and Dr. Zaki Anwar, MD uses the X-ray guidance for the intercostal nerve blocks. When Dr. Zaki administered the injection I felt pressure as I was told before. During the whole procedure of performing Intercostal Nerve Blocks Dr. Zaki Anwar kept asking me if it hurts and I answered that I only felt pressure

After the intercostal nerve blocks I was under observation for half an hour, meanwhile the sedation wear off. Dr Zaki Anwar already told me for a couple of days the pain may increase, but soon after I will feel better

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2018-04-07 (1)

Kyphoplasty help patients regain lost mobility and become more active

Kyphoplasty is the procedure used to treat painful vertebral fractures caused by excessive pressure in the spinal column, which commonly results in osteoporosis. The kypholplasty is done by a physician using imaging guidance to inject a cement mixture in the fracture bone. With the help of Kyphoplasty the patients regain lost mobility and become more active

At the Pain Management Institute, the Kyphoplasty procedure is done by Dr Zaki Anwar, Anesthesiologist,  Founder of the Pain Management Institute. He will first diagnose your condition with  the help of imaging or physical exam. He will instruct you how to prepare and discuss with your physician if there is any possibility of you being pregnant or any prior medical records and breakout. He might advise you to stop taking any blood thinning medications or pain killers are restricting you from eating or drinking anything a few hours before the procedure take regular medications with a sip of water, don’t wear any jewelry or metallic objects, wear light loose clothes take someone to drive you home

What is Kyphoplasty?

When the vertebral disc is fractured the bone becomes compressed causing severe pain. These compression fractures leads to collapse the disc space between one or two vertebrae and result in osteoporosis in the long term. Osteoporosis is a disease that causes the normal bone to decay and becomes vulnerable to breaking easily

During the Kyphoplasty an air balloon is first inserted to create a space in the fracture and then the cement is injected into the space following the removal of the balloon. Generally Kyphoplasty is recommended after other conventional treatments have failed such as plenty of bed rest, wearing a brace, physical workout and pain killers. Kyphoplasty can be performed instantly in patients with unbearable pain who require hospitalization or other conventional treatments have failed

Kyphoplasty is also performed on patients who:

  • Are elderly or frail and will likely have impaired bone healing after a fracture
  • Have a vertebral compression due to a malignant tumor
  • Suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder

Kyphoplasty should be completed within eight weeks of the acute fracture for the highest chances of successful treatment.


Any procedure where the skin is injected involves a risk of infection, however this only happens in 1 of 1000 patients. A very negligible amount of cement can leak from the vertebral bone, potentially it doesn’t cause any problem, but if the leakage spreads to the spinal canal, blood vessels and lungs resulting in perilous consequences

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The Microdiscectomy procedure reduces the stress on the spinal nerves

Commonly performed for a Herniated disc, the microdiscectomy procedure reduces the stress on the spinal nerve network by removing the substance that is the root cause of pain

The Microdiscectomy procedure as elaborated by Dr.Zaki Anwar, MD:

A microdiscectomy procedure uses minimally invasive techniques to provide relief from pain caused by a lower herniated disc.

During the course of procedure, a tiny part of the bone over the nerve root or the disc substance from beneath  the nerve root is removed out. A microdiscectomy is also known as the micro decompression as compared to other conventional treatments  is potentially efficient  for reducing leg pain that is sciatica or radiculopathy


  • For leg pain, patients report relief in leg pain immediately after the microdiscectomy. They leave for home with potential pain relief
  • For deadness, feebleness, and other nuerological symptoms in the leg and foot. It may take several weeks and months for the nerve root to completely heal and any numbness and weakness may subside

Usually, microdiscectomy is known as quite reliable surgery for quick relief or almost quick relief of sciatica pain from lower herniated disc

Slightly Invasive Microdiscectomy

There are generally two common options in an outpatient lower spinal Discectomy

  • Microdiscectomy
  • Endoscopic Discectomy

A Microdiscectomy is often treated as the most remarkable and pocket friendly procedure for removing the herniated part of the spinal disc that puts pressure on the nerve. Compared to other open surgical procedures the Microdiscectomy involves a slightly small incision and insignificant tissue damage and disturbance. A handful of surgeons has now achieved the adequate experience and skills with endoscopic and slightly invasive techniques which include performing surgery through tubes administered into the targeted area, instead of an open incision. A Microdiscectomy is generally performed by an orthopedic surgeon and pain management specialist

Implications for Microdiscectomy

If an individual’s leg pain is due to disc herniation, it will alleviate within 6 to twelve weeks of the pain arising. As long as the pain is bearable and the patient does not lose mobility , it is highly advisable to delay surgery for a short period of time to determine if the pain will resolve with nonsurgical treatment alone. If the pain is debilitating and severe, it is practical to consider surgery sooner

There are potential reasons why microdiscectomy is beneficial :

  • Leg pain has been experienced for at least six weeks
  • An MRI scan or other test shows a herniated disc
  • Leg pain (sciatica) is the patient’s main symptom, rather than simply lower back pain
  • Non surgical treatments such as oral steroids, NSAIDs, and physical therapy have not brought sufficient pain relief
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2018-03-29 (1)

The best features of the P-Stim makes it stand among the pain sufferers

P Stim is a tiny battery operated device created to serve auricular point stimulation treatment for several days. P-Stim is placed behind the patient’s ear and connected to stimulation needles on the auricles. The benefit of using the ear for such treatment is that it grants several points of stimulation within such as small area. The P- Stim device transfers low intensity electric pulses to bare nerve endings, which stimulate the release of endorphins a natural pain killer. The installed microchips create intervals of stimulation and rest. Each stimulation last on an average of 3 hours

Use, indications and treatment

Point stimulation with the help of P-Stim is primarily used to treat pain. Application of the device is recommended for pre-operative, intra- operative and post operative pain management as well as a remedy for the chronic pain. P-Stim is non- drug treatment for pain and wound healing. Simultaneously, there are also prospects of using this device in the future for the treatment of addiction and severe allergies in the spheres of anesthesiology. P-Stim is also helpful in treating gangrene and the severe pain arising from it

Current clinical studies show that P-Stim is highly effective in treating

  • Fibromyalgia
  • Diabetes
  • Blood pressure
  • Anxiety and Depression
  • Insomnia
  • Allergies
  • Increased cholesterol in the blood
  • Slimming
  • Crohn’s disease

Patients’ quality of life

P-Stim helps facilitate continuous point stimulation over a span of several days and provides the patient with high potency comfort and mobility. An advantage of P-Stim over drug therapy is that the patients, don’t suffer any of the potential side effects of pain killers such as harmful reactions. Conversely the patients can continue to lead his life as usual, without the losing quality of life

How will your pain patients benefit from The P-STIM™?

Some of the best features of the P-Stim makes it stand among the pain sufferers. The P-Stim is non invasive and can be applied within the minimum time frame and is pocket friendly. The device is removable and disposable by the patient after four days. It’s light weight that is equal to 7 grams, granting patients to enjoy their routinely activities without hindrance or pain. The patients no longer suffer any potential after the affect as associated with the pain killers such as damaging reactions. In many cases, the patient reported an enhancement in overall clarity and quality of life. The P-Stim is often well, bearable and can be blended with other kinds of remedies. After the initial treatment, most patients report a remarkable reduction in pain symptoms

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2018-03-21 (2)

Are you also experiencing post procedure back pain?


The Racz epidural Neurolysis Procedure is used to eliminate scar tissue formation around the capture nerves in the epidural space of the spine. So that the medication such as cortisone can reach the aimed location. The procedure brings a potential decrease in pain caused by scar tissue formation

The cause of Epidural scarring

The epidural scar tissue formation often occurs from bleeding into the epidural space following a back surgery and the consecutive healing process where epidural fat is covered with fibrotic tissues. The scar tissue often forms naturally after a surgical intervention. In some cases scarring occurs due to a rupture disc and the leakage of its inner material

The procedure at PMI

The procedure usually takes between an hour or half. It can be done once, or in a series of up to three injections scheduled in a period of twelve months. At The Pain Management Institute the procedure involves implanting a catheter in the epidural space and guided up to the area of scarring. The whole procedure is done in our fluoroscopy costumes under sterile conditions with IV sedation

What is injected in Racz Epidural Procedure?

The Racz epidural injections composed of the following

  • A mixture of local anesthetic
  • Steroid medications
  • A contrasting pigmentation so that the scar tissue formation can be easily recognized in the fluoroscopy
  • Concentrated sterile salt solution to soften scar tissue

Will I feel pain?

The procedure involves administering a needle under the skin and deep into the tissue. There is some uneasiness involved, that might feel like getting a tetanus shot or skin prick. The tissues under the skin are deaden with a local anesthetic before inserting a spinal needle and catheter

What are the risks and side effects?

Overall, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of side effects. Fortunately, the serious side effects and complications are rare. Risks and side effects may include the following:

  • Pain/soreness, occurs most often, however, it is temporary
  • Urinary difficulty – Occasionally, people report some difficulty urinating for the first several hours, post procedure,

Other risks associated with the Racz procedure can include:

  • Spinal puncture risks
  • Headaches
  • Infection
  • Bleeding inside the epidural space with nerve damage
  • Worsening of symptoms

Cortisone injection risks/side effects, such as:

  • Weight gain
  • Increase in blood sugar (mainly in diabetics)
  • Water retention

Retardation of the body’s own natural production of cortisone

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2018-03-14 (1)

End you suffering with radio Frequency Lesioning

Patients who endure chronic back pain and cervical pain, who have tried several conventional treatments such as medications and physical workout sessions should once try radio frequency lesioning

Radiofrequency lesioning or RFL is a process that  takes advantage of electrical impulses to mask nerve transmission. RFL is mostly used on the to treat facet joint nerves, sacroiliac joint nerves and peripheral nerves. Radiofrequency Lesioning treatment provides long term relief from pain by masking the pain signals for 6 to 9 or even 18 months in some cases

The basic purpose of Radio frequency Lesioning

The Radio Frequency Lesioning does not harm the nerves instead retards their ability to transmit pain signals to the brain, providing a better and quality pain relief for up to 18 months

The procedure details

Radio Frequency Lesioning is carried under the fluoroscopic guidance to make sure that the needle reached the aimed point. By using the special Radio frequency needles and Microelectrode, the tissues and  nerves the pain site is accelerated by a low intensity current. This current produces heat and blocks the pain transmitters. Local anesthesia is used to numb the area before the procedure is initiated. At the pain management institute RFL is  done on an outpatient basis. The procedure takes only 30 to 60 minutes. The patient can go home soon after the procedure.

Almost 80 to 90%  of the patients get potential relief from the chronic back and neck pain with Radio Frequency Lesioningsays Dr. Zaki Anwar, MD

Though the pain relief is longer as compared to many other procedures, however it is not permanent. Sensory nerves reproduce over time and cause pain symptoms to reappear

Risks and complications

There are few risks associated with Radio frequency Lesioning involving pain and numbness, bleeding and allergic reactions on the treated area

Other rare complications include nerve damage, that may cause chronic inflammation and numbness

Conditions that can be well treated with Radio Frequency Lesioning

There are several conditions that are successfully treated with Radio Frequency Lesioning, including

  • Facet joint pain
  • Discogenic pain
  • Sympathetically generated pain

Final thoughts

A huge number of adults endure chronic pain conditions in the United States. The patients are not only a victim of physical agonizing also they are under emotional suffering if their pain doesn’t respond to the conventional treatments

Radio Frequency Lesioning is a slightly invasive method that is implied to effectively treat pain that has been chronic and unresponsive to other treatments. The procedure is generally safe and involves negligible risks if done by an expert physician

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2018-03-08 (1)

Your Pain Stops Here

A selective nerve root block is a slightly surgical procedure that is done to diagnose and treat cervical and lumbar pain and related pain suffering areas. The procedure includes injecting local anesthesia straight into the expected problematic nerve root of the spinal column to help recognize the cause of a patient’s pain also it helps to relieve pain for the shorter period

Symptoms of an irritated nerve root

The spinal pain happens when any of the spinal nerve becomes irritated, inflamed or compressed. The pain may spread in the upper and lower areas depending on the location of the nerves

If a nerve is damaged in the cervical region, the pain and other symptoms will be felt in the neck, shoulder and arms, whereas the nerve irritation in the lower spine causes numbness, tingling in the lower back, hips, buttocks and legs

Sometimes it becomes difficult for a physician to identify the exact nerve causing pain, at times MRI may not indicate the problematic nerve. In such condition a selective nerve root block is recommended to restrict the nerve root that is the source of pain

How a selective nerve root block is performed

A selective nerve block involves injecting a local anesthetic formulated with Corticosteroid to the targeted nerve root. The local anesthesia numbs the nerve sensation, while the steroids help in decreasing inflammation and the pain arising

The selective nerve root blocks are much the same as the epidural injections, however the medications are administered in the pain causing nerve root and not in the epidural space. The selective nerve root block results may vary from person to person as some nerve roots are difficult to reach and administer

What to expect after the procedure?

Many patients undergoing selective nerve root block can resume their routinely activities following the procedure. Some patients may report a sudden relief from the symptoms that is because of the numbness. The pain may reappear until the steroid shots initiate its effects. The relief of pain symptoms from a selective nerve root block depends on the levels of your pain and lasts from several days to several months

What will happen following the procedure?

Soon after a selective nerve root block, patients may experience incremental pain at the site of injection, pain while movement, lightheadedness, nausea, headache and vomiting all these symptoms will last in a day

Risks and complications

Risks related to selective nerve root block are very rare, including, infection, bleeding and allergic reactions with the medications applied during the procedure. Very rare and serious complications include, nerve damage and paralysis

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How helpful are the sympathetic nerve blocks

The sympathetic nerve spreads from the front exterior of the spinal column and not in the spinal canal with the nerves that allow sensation and strength to your legs. The sympathetic nerves are a component of the self-governing nervous system that controls functions such as blood flow and temperature adjustment on the arms and legs, sweating, heart rate, digestion and blood pressure
The self governing nervous system is responsible for regulating bodily function that is involuntary. However, the sympathetic nerve has no connection with the central nervous system. When regulation of the sympathetic nervous system is disturbed pain conditions occur, including; complex regional pain syndrome

How the sympathetic nerve blocks are done

A sympathetic nerve block counts in injecting numbing medicine around the sympathetic nerve in the low back or neck. With the injections the sympathetic nervous system in the corresponding area is for the time being is retarded for reducing and eliminating pain. If the pain is significantly relieved after the sympathetic nerve block, then the physician will move towards the diagnosis of the treated pain, the anesthesia injected may last longer than normally expected. The purpose of sympathetic nerve block is to bring the sympathetic nerve tone to its normal state of regulation. If the first block is successful, then further blocks may be administered if the pain continues to significantly reduce
What will happen to me during the procedure?
The procedure will be started with an IV and relaxation medication is given to ensure your comfort at The Pain Management Institute. You will be asked to lie on an X-ray table and the skin where the injections will be administered is cleaned with an antiseptic solution. Dr. Zaki Anwar, Medical Director at the Pain Management Institute will then numb the skin, which stings for a few seconds and guides the needle to to the sympathetic nerves to ensure that the medicine reaches the aimed location
What should I do and expect after the procedure?
A few minutes after the procedure, Dr Zaki will ask to mobilize your treated area to provoke usual pain. You may not feel improvements for the first few hours after the procedure. You might feel increased heat in the affected areas for a day after the sympathetic nerve blocks. If the injections are given in the neck you might notice slight drooping of the eyelids and redness in the eyes for a couple of hours. All these symptoms are normal and resolve within a day. Discuss any remaining pain and notice the pain relief every day so that Dr Zaki Anwar, MD get knowledge about your results and devise future tests, treatment plan if needed

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