Tel: (407) 935-9404
(Between 8am to 5pm EST)


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Advanced Pain Clinic, PA. "Quality care at affordable price".


Advanced Pain Clinic has been at the forefront of pain management in Florida for over 18 years, with a substantial commitment to pain management in a variety of treatments offered from three locations at Kissimmee, Poinciana and Haines City.

Early diagnoses and effective treatment for your pain conditions could avoid chronic (on going) pain and give better quality of life. Statistic shows that only one out of ten (10%) pain patients are able to get treatment at Pain Clinics by qualified pain doctors possibly due to poor referrals by Family Physicians, poor access and poor knowledge about the Pain Clinics. You want to be one of those 10% patients to control your pain effectively and minimize your on going pain by getting timely treatment at the clinic.

About Vraj L. Rajyaguru, MD (Dr. Raj)

Dr. Rajyaguru was born and raised in India. He finished his five year Medical School from India. He immigrated from India in 1987. He successfully passed the Foreign Medical Graduate Examination in Medical Science (FMGEMS) conducted by the US government in 1988. He conducted research in the medical field and helped publish multiple research papers in medical journals. He then underwent the residency program for five years in the New York Metropolitan area. In those five years , he received intense training in the field of surgery, anesthesiology and pain management. He received experience in Hospital based and free standing Pain Clinics and treated many pain conditions. Subsequently, he opened his own Pain Clinic in Central Florida in 1995, known as Advanced Pain Clinic, PA. Dr. Rajyaguru is the medical director of Advanced Pain Clinic, PA since the establishment of the clinic. He has been practicing pain management full time since then in Central Florida.

Dr. Rajyaguru performs all kinds of "nerve blocks" for complex pain conditions. The nerve blocks are done under fluoroscopic guidance to minimize injection pain and increase efficacy & safety of the procedure. Some of the "Nerve Blocks" he performs are : epidural injections, transforaminal nerve root injections, facet joint injections, sacroiliac joint injections, Carpal Tunnel injection, Stellate Ganglion Block, Sympathetic Block, Trigeminal nerve block, major or minor joint injections on medical necessity basis. He also treats chronic intractable headaches with different "nerve blocks" like Trigeminal nerve block, cervical nerve root and facet blocks etc. The nerve blocks are usually used in conjunction with pain medications or with physical therapy. Most of the "Nerve blocks" are being done with the thinnest possible needle along with numbing medication to keep it painless for the patients. Thorough evaluation and appropriate tests are being performed in order to diagnose your medical condition prior to or during your treatment. The clinic is conveniently located at three sites (Kissimmee, Poinciana and Haines City) in Central Florida to facilitate your care. Each clinic is equipped with state of the Art equipment like fluoroscopy and monitoring to make the treatment safe and effective for the patients. Most blocks are being offered at each location to make it convenient for the patients. Each patient is being followed up by Dr. Rajyaguru at each visit to assure continuity of care.

Dr. Rajyaguru has been implanting and managing Morphine Pump for chronic intractable pain, stimulator treatment for chronic nerve damage and rhyzotomy treatment for chronic arthritic back and neck pain for years. He is board certified by the American Board of Anesthesiologists and the American Board of Pain Medicine. Recently he was awarded Fellow degree by American Board of Disability Analysts. He has had privileges in Osceola Regional Hospital, Health Central Hospital and Heart of Florida Hospital for years. Dr. Rajayguru has achieved many awards in different fields by Who's Who over the years. He was appointed honorary Co-chairman in 2001 by the Physician Advisory Board of National Republican Congressional Committee. In subsequent years he was awarded "Physician of the Year" and "Honorary Chairman" by the same entity. He was also awarded the "American Medal of Honor" by American Biographical Institute in 2002. Dr. Rajyaguru provides medical care with dignity, proper discussion and information to the patient and relatives, with appropriate use of technology to diagnose and treat complex pain conditions accurately. He understands and recognizes that chronic pain conditions could lead to poor quality of life due to sleep disorder, depression, anxiety, economic deprivation, weight gain, marital and family problems and other serious medical conditions like hypertension, heart disease etc. Therefore, such pain conditions require aggressive treatment to prevent this type of outcome.

He screens all the referred patients and sees the one who he may be able to help. Any further question, please call (407) 935-9404 (Between 8am to 5pm EST).



Instructions to Avoid Low Back Pain:

1. Avoid sitting on sofas, recliners, Lazy-boy chairs, or rocking chairs. Use flat bottom chairs to sit on.
2. Avoid elevating your legs while sitting. Keep your feet on the ground while sitting.
3. Avoid reclining while driving or riding in cars.
4. When you go to restaurants, choose tables, not booths.
5. When lifting objects off the ground, do not lift from the waist, instead, use your knees.
6. Use a firm mattress with a 1” pillow top. If the mattress is not firm, place a sheet of plywood under the mattress.

7. Sit on a chair which has a flat bottom. Do not sit on chairs with curved/indented bottoms. If you sink into the chair while sitting on it, do not sit on it.
8. Daily stretching helps resolve inflammation.

Instructions to Avoid Neck Pain:

1. Use a medium-thickness pillow. Avoid using thick pillows.
2. Avoid watching TV while lying in bed or sitting on a recliner.
3. Maintain good posture. Adjust your computer monitor, keyboard, and mouse height to maintain a good, neutral position for you neck, shoulders, and arms.
4. Daily stretching helps resolve inflammation.

About Clinic

Advanced Pain Clinic, PA. was established in November 1995 in Kissimmee, FL to manage chronic intractable pain by Dr. Rajyaguru. He received experience in Hospital based as well as in free standing Pain Clinic and treated many pain conditions.

The clinic offers all kinds of pain management treatment like "nerve blocks" for complex pain conditions. The nerve blocks are done under fluoroscopic guidance to minimize injection pain and to increase efficacy & safety of the procedure. Some of the "Nerve Blocks" being offered are : epidural injections, transforaminal nerve root injections, facet joint injections, sacroiliac joint injections, Carpal Tunnel injection, Stellate Ganglion Block, Sympathetic Block, Trigeminal nerve block, major and minor joint injections on medical necessity basis. The clinic also offers treatment for chronic intractable headaches with different sets of "nerve blocks" like Trigeminal nerve block, cervical nerve root, facet blocks, Rhizotomy etc. The nerve blocks are usually used in conjunction with pain medications and or with physical therapy. Thorough evaluation and appropriate tests are performed in order to diagnose your medical condition prior to or during your treatment. The clinic is conveniently located at three sites.

505 W. Vine Street, Suite 301, Kissimmee, FL - 34741

339 Cypress Parkway, Suite 110, Poinciana, FL 34759

82 Maxcy Plaza Circle, Haines City, FL 33844

Each clinic is equipped with state of the Art equipment like fluoroscopy and Monitoring to make the treatment safe and effective for the patients.

In the clinic, more sophisticated treatment like implanting and managing Morphine Pump for chronic intractable pain, stimulator treatment for chronic nerve damage, rhyzotomy treatment for chronic arthritic back and neck pain for years are also being offered. The doctor in the clinic is board certified by the American Board of Anesthesiologists and the American Board of Pain Medicine. Recently he was awarded the Fellow degree by the American Board of Disability Annalists. The doctor has privileges in Osceola Regional Hospital, Health Central Hospital and Heart of Florida Hospital for years.

The clinic provides medical care with dignity, proper discussion and information to the patient and relatives, with appropriate use of technology to diagnose and treat your complex pain condition accurately. The clinic understands and recognizes that chronic pain condition could lead to poor quality of life due to sleep disorder, depression, anxiety, economic deprivation, weight gain, marital and family problems and other serious medical conditions like hypertension, heart disease etc. Therefore, such pain conditions require aggressive treatment to prevent this type of outcome.

Any further question, please call (407) 935-9404 (Between 8am to 5pm EST)

Patient Education
(1) What is a "Pain Clinic", and why do we need it?

A Pain Clinic is a place where your chronic intractable pain is diagnosed and treated effectively, in a timely manner to avoid further long term problems. Pain is under recognized and under treated. As a result it costs Billions of Dollars to businesses & the Health care industry and causes long term pain related problems in patients. Some of these problems are : Weight Gain due to poor exercise endurance, Isolation leading to Depression, anxiety, Sleep Disorder, Economic deprivation, Sexual Dysfunction (due to pain or medications) leading to Marital problems. Other serious problems like Hypertension, Coronary Artery Disease, Diabetes Mellitus etc. may occur due to poor pain control.

(2) What kind of pain problems are being handled in a Pain Clinic?

All, but Chest Pain are handled in a Pain Clinic.

(3) Who runs a Pain Clinic?

Any Doctor now days could claim being a "Pain Management Specialist". Typically, the Pain Clinics are run by Anesthesiologists, who have a broad knowledge of Nerve Anatomy, good handle on needles for different procedures, appropriate Local Anesthetic use and side effects for the given procedure, Opioid use and abuse knowledge.

(4) What is an ideal Pain Clinic?

An Ideal Pain Clinic is one where an Anesthesiologist, Neurosurgeon, Orthopedic surgeon, Physiatrist, Neurologist, Psychiatrist, Psychologist, Physical Therapist, Chiropractor, Occupational Therapist, Pharmacist, and Nurse specialized in Pain Management are working under one roof. They manage each complex case after thorough discussion among themselves. It is difficult to find an Ideal Pain Clinic at this time.

(5) What is Narcotic (Opioid) medication? Why are doctors afraid to prescribe it?

Opioid is the appropriate term when it comes to medical treatment. It is a potent pain killer, if used appropriately. It does not work for all pain related symptoms. Examples: Headache. Headaches may get worse after inappropriate use of Opioid. It also causes lots of side effects like constipation, respiratory depression, disturbed sleep cycle, dependence, tolerance etc. It may help at first, but then the body gets used to the medication, therefore, it may require dose escalation to the Level where it would cause intolerable side effects. To avoid reaching that point, it should be prescribed appropriately by the physician who has experience and knowledge with that group of medication. Besides, the patient should get other modalities, i. e. "Nerve Block", Physical therapy, Biofeedback, Massage therapy, TENS application, etc to treat pain effectively and avoid opioid dose escalation. The doctors are afraid simply because some of them either do not have the required broad experience in prescribing these groups of medication or they do not have any other modality to offer for your pain along with the medication. There are also strict regulations and guidelines to prescribe the medication appropriately.

(6) What are different groups of Opioid?

There are many subgroups of Opioid, but for the discussion purpose, I like to divide it into two groups. One is Short Acting Opioid and second is Long Acting Opioid. In Chronic pain condition, the pain symptom is continuous. Therefore, you need a medication which works round the clock to treat your pain continuously. The Long Acting Opioid is appropriate for that. The Short Acting Opioid is normally prescribed by your Primary Care Physician for minor pain. Opioid are addictive by nature. Short Acting Opioid is relatively more addictive then Long Acting Opioid, since it cause more euphoric effects. Besides, Short Acting Opioid almost always have Acetaminophen, which could cause Liver problem in the long run with high doses. In conclusion, Long Acting Opioids are a better choice for chronic pain treatment and are commonly being prescribed by pain management physicians.

(7) What do I need to do to get an appointment at your clinic?

Advanced Pain Clinic accepts only those patients, who are referred by their health care provider. Therefore, you need to be referred on paper or verbally to get on the schedule. Moreover, you also need to submit your records pertinent to your pain symptoms, which will be reviewed by the doctor prior to your appointment at the clinic to make sure that the doctor can help your pain condition. That will save you time and money.

(8) What type of pain management procedures are being offered at Advanced Pain Clinic?

Please scroll below to "Nerve Blocks" section.

(9) Does your clinic uses Fluoroscope to do "Nerve Blocks"?

Yes. Both locations are equipped with fluoroscope. Use of fluoroscope enhances your results and improves safety from the procedure. I highly recommend its use for the pain management procedures.

(10) Do you do pain management related surgeries?

Yes. I do certain pain management related surgeries. Please scroll below to "Advance Pain Treatment" section.

(11) What is the advantage of being a patient at Advanced Pain Clinic?

Following advantages :

(a) Each patient will be interviewed by the same Doctor at each visit. There is continuity of care. The care is rendered with dignity.

(b) State of the Art technology is being used to diagnose and treat your pain conditions.

(c) The doctor is experienced in treating pain condition for more than 10 years. He is Certified by the American Board of Anesthesiologists and by the American Board of Pain Medicine.

(d) The clinic is located conveniently at three locations in Central Florida. Each clinic is equipped with fluoroscope to enhance safety and result of your pain management procedures. Doing those procedures in clinic makes it very economic for you and your insurance company.

(e) Only eligible patients are given appointments after thorough screening procedure to adequately accommodate truly needy patients and as a result it provides adequate attention to them.

Insurance Coverage

Advanced Pain Clinic, PA accepts following plans.

Care Plus
Optimum Medicare plan
Freedom Medicare plan
United Healthcare - Medicare plan
Blue Cross Blue Shield - Medicare plan
Simply Care
Worker’s Compensation
Beech Street
Champ VA

Please make sure you review your health plan participation requirements prior to making arrangements for your medical care at Advanced Pain Clinic, PA.

Please understand that you are financially responsible for all deductibles, co-payments, products and services not covered by your insurance company.

Please contact the clinic (407) 935-9404 (Between 8am to 5pm EST) to get updated insurance information it participates and varification of your benifits for the Pain Management treatment you seeking for.

Clinic Locations
505 W. Vine Street, Suite 301,
Kissimmee, FL 34741
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339 Cypress Parkway, Suite 110,
Poinciana, FL 34759
View Larger Map 
82 Maxcy Plaza Circle,
Haines City, FL 33844
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Contact Us

Tel : (407) 935-9404 -------- Fax : (407) 935-9304


Advance Pain Treatment
Dr Rajyaguru offers the following treatment modalities in operating rooms to treat certain pain conditions:

(1) Morphine pump implantation: This may be the treatment of choice for the patient who has failed all other conservative modalities. It is done in the Hospital operating room under anesthesia. This is a highly sophisticated treatment, requiring lots of commitment by the patient and doctor. It is considered invasive treatment and is reserved for stubborn pain in selected patients. Dr. Rajyaguru has been implanting and managing the pumps for years. It requires trial Morphine infusion prior to the implant to assess the efficacy of the treatment. More information could be obtained by visiting

(2) Spinal Cord Stimulator surgery treatment: Also known as Dorsal Column Stimulator treatment. This is implantation of a stimulator system in the spine to treat intractable nerve pain. The pain could be from nerve damage, previous spinal surgery, neuropathic pain, Shingles pain, pain from various nerve disease etc. This treatment is reserved for unresponsive pain from the other conservative modalities. Testing is done prior to implantation of the system. More information could be obtained by visiting

(3) Lysis of Adhesion treatment: This is not a surgery, however, it is done in the operating room, under anesthesia. This treatment is offered to the patient who has scar tissue formation after spinal surgeries. A special catheter is being used to break down the scar tissue and certain medications are injected to reduce the intraspinal inflammation. It is believed to be more effective then traditional "nerve blocks".

(4) Celiac Plexus block: It is done in the operating room under anesthesia to treat pain resulting from chronic Pancreatitis. This is a nerve block for chronic abdominal pain.

The Clinic offers the following treatment options to help improve your pain conditions:

Thorough evaluation.

Appropriate testing etc to come to the right diagnosis.

Formulation of treatment options, including appropriate Medications, Physical therapy, Nerve Block, Trasforaminal Nerve root Injections, Epidural Injections, as medically indicated by your specific pain condition.

Identification and appropriate guidance for potential drug abuse and psychological dependence.

The other sophisticated treatments offered in the clinic are:

(1) Rhizotomy (Deadening of the nerve) to treat chronic intractable joint pain in spinal area and spinal headache.

(2) Botox treatment for the chronic intractable headache.

(3) Trigeminal nerve block for chronic facial pain.

(4) Intraarticular joint injections for osteoarthitis pain in knees.

(5) Celiac plexus block

Pain Management
The word "Pain Management" with formal recognition and treatment for chronic pain came in the early 50s. It remained under developed and unrecognized for a long time there after. Untreated or under treated pain could cause Billions of Dollars in lost revenue for businesses and devastating psychological, social, monetary, marital, etc. consequences. With time, the western world realized the importance of treating the chronic pain effectively to avoid these consequences. As a result, many Pain Societies have been formed in the last few years. Appropriate qualification for the practitioner and standardization to practice Pain Management came to light recently by Pain Board, known as the American Board of Pain Medicine. "Pain" is recognized as the fifth vital sign by the American Medical Association lately. Pain Management is being practiced by many practitioners, mostly as part time for side income. I recommend that patients consult doctors who practice Pain Management as full time Pain Management doctors with set qualifications and experience. A full time Pain Management doctor with experience in the field would recognize the problem fully and would offer variety of treatment options for your pain conditions.

The common Pain Conditions being treated in the Pain Clinic are: Bursitis of joints, Migraineous Headache, Diabetic Neuropathy, RSD, Neuropathic pain, Chronic Pancreatitis, Small joint arthritis, Chronic facial pain, Chronic Pelvic pain, Tendonitis, Back and Neck pain due to arthritis, Scar tissue related pain in back & neck from previous surgeries. Headaches, Neck Pain, Shoulder Pain , Elbow Pain ,Wrist Pain ,Carpal Tunnel, Arthritic Pains, Back Pain , Disc Problems , Sciatica , Knee Pain , Foot & Ankle Pain, Arthritis, Bowel problems,Back and joint pains , Pinched nerve, Spinal Stenosis.
Nerve Blocks
Advanced Pain Clinic offers various pain management procedures to diagnose and treat your intractable pain in conjunction with Physical Therapy, Oral Medications, Home exercise program. Here are some of the procedures the Clinic offers to its patients.

Trasforaminal lumbar, Cervical or Thoracic selective nerve blocks to treat pinched nerve.

Lumbar, Thoracic, Cervical Facet blocks to treat Facetal pain.

Lumbar, Thoracic, Cervical Epidural injections.

Sacroiliac joint block to treat Sacroiliatis.

Major joint (Hip, Shoulder, Knee, Ankle, etc) injection to treat bursitis or joint pain.

Lumbar Sympathetic nerve block to treat "RSD", Diabetic Neuropathy etc.

Stellate Ganglion block to treat pain from nerve damage.

Celiac Plexus block to treat Chronic Pancreatitis, abdominal pain.

Hypogastric Plexus block to treat chronic pelvic pain.

Peripheral Nerve block.

Small joint (in hands or feet) injections to treat arthritic pain.

Carpal Tunnel block to treat Carpal Tunnel Syndrom.

Tarsal Tunnel block to treat Chronic foot pain.

Costochondral injection to treat chest wall pain.

Occipital Nerve block to treat upper neck pain and Headache.

Cervical 2nd Nerve root block to treat intractable headache from neck injury and Whiplash.

Trigeminal Nerve block to treat facial pain.

Different muscle injections to treat Myofacial Pain Syndrom.

Ilioingunal Nerve block to treat Chronic Groin pain.

Obturator Nerve block to treat inner thigh pain.

Lateral Femoral Cuteneous Nerve block to treat outer thigh pain.

Rhizotomy (Denervation of the Facet joints) (Deadening of the Nerve in spinal area) to treat pain resulted from spinal arthritis.

Dorsal Column Stimulator placement to treat neuropathic pain.

"Morphine Pump" implantation and Management to treat intractable stubborn pain.

Botox injections to treat chronic neck, lower back pain, Migrainous Headache.

Neurolytic Injections in scar or at Neuroma site to destroy the Neuroma related pain.

Lysis of Adhesion in spine caused by spinal surgery to treat stubborn nerve pain.

Physical Therapy
As we know, injuries (car accident, falls, occupational injuries) and stress (injury from daily activities) cause inflammation in swelling of the tissue. Then either it heals without problems or it could lead to pain and wasting of the tissue with weakening of the body part. If left untreated, the problem usually gets worse with time and may cause irreversible damage. Consultation with an appropriate doctor in a timely manner could prevent this domino effect.

Physical therapy with a prescribed home exercise program is an integral part of pain management. Physical Therapy has mainly two purposes : (1) to help heal the pain causing by inflamed and wasted tissue and (2) restoration of the normal function of the injured or wasted body area. There are several types of physical therapy modalities, (1) passive therapy like TENS, SMP, Massage etc, (2) Active therapy, i.e. tred mill, Stationary bicycle, range of motion exercise etc, and (3) Aquatic therapy, i. e. therapy in water. It is crucial that the patient get the right therapy at the right time. When the patient has severe pain with acute inflammation, certain kinds of therapy modalities usually aggravate the pain symptoms. The inflammation needs to be controlled aggressively either by medication and or by time and or by "nerve blocks" in severe cases prior to initiating the therapy. Even one type of pain symptom will require a different type of physical therapy at different times of the healing course. This is the reason therapy should be done under direct supervision of the doctor to gain the maximum benefit out of it and avoid re-injury.

Advanced Pain Clinic is equipped with state of the art equipment to provide full a range of Physical therapy right under one roof, starting mid 2006, under direct supervision of the doctor to help improve your pain. The Clinic also plans to offer access to the Wellness center after hours to all the patients to keep their pain away and help keep them healthy.

If the right treatment is done at the right time for your pinched nerve, the chances for spinal surgeries diminish tremendously. The Clinic is committed to make this happen for its patients.

Non-Surgical Treatment
What are your options for back pain?
Home exercise, Medications, Nerve blocks, Acupuncture, Biofeedback etc.

How does "nerve block" work?
Nerve block means the injection of certain medication at the problem site in the body. The medication helps heal the swelling, thus reducing the pain, restriction of range of motion. i.e. treating the root of the problem (inflammation)....and NOT masking it.

Why would I avoid spinal surgery? Why would I consider non-surgical treatment over the spinal surgery?
Spinal surgery is indicated only when traditional conservative treatment fails. Spinal surgery is known to cause scar tissue in the spine, around the nerve which could cause worse pain than the original one. And unfortunately it is irreversible. I normally recommend that my patients get a second opinion for spinal surgery prior to having it done.

Does herniated disc always require back or neck surgery?
No. 9 out of 10 herniated discs heal with conservative, non-surgical treatment.

What medication is being used for "nerve block"?
Normally cortisone is being used with numbing medication to treat the problem.

Is cortisone (steroids) bad for you?
Yes, excessive use of steroisd is bad. Limited amounts of steroid use to improve the quality of life is acceptable. Continuous oral steroid and cortisone could cause many of side effects.

Things You Can Do To Make Yourself Better!!

While waiting for your pain to improve, you may be able to make yourself more comfortable if you:

Wear comfortable, low-heeled shoes.

Make sure your work surface is at a comfortable height for you.

Use a chair with a good lower back support that may recline slightly.

Walking is an excellent exercise since it is gentle on the back yet helps bring oxygen to the soft tissues in your back and stimulates a healing response.

If you must sit for long periods of time, try resting your feet on the floor or on a low stool, whichever is more comfortable.

Too high of a pillow or none at all is seldom recommended except in very unusual circumstances.

When sleeping on one’s back a pillow that provides gentle neck support is ideal.

If you must stand for long periods of time, try resting one foot on a low stool.

If you must drive long distances, try using a pillow or rolled-up towel behind the small of your back. Also, be sure to stop often and walk around for a few minutes.

If you have trouble sleeping, try sleeping on your back with a pillow under your knees, or sleep on your side with your knees bent and a pillow between your knees.


A gradual return to normal activities, including exercise, is recommended. Exercise is important to your overall health and can help you to lose body fat (if needed). Even if you have mild to moderate low back symptoms,

The following things can be done without putting much stress on your back:

Walking short distances.

Using a stationary bicycle.


It is important to start any exercise program slowly and to gradually build up the speed and length of time that you do the exercise. At first, you may find that your symptoms get a little worse when you exercise or become more active. Usually, this is nothing to worry about. However, if your pain is still severe, contact Advanced Pain Clinic, PA .

Once you are able to return to normal activities comfortably, We may recommend further aerobic and back exercises.

Nerve Blocks Treatment
"Nerve Blocks" Information :

Steroid (cortisone) injection is a method of injecting one form of powerful anti-inflammatory medicine into the spinal area, namely epidural space, facet joints, sacroiliac joints, etc. The epidural space is a space which exists between the bony roof (lamina) of the spine and actual spinal sack. The epidural space is a site where medications can be delivered via epidural injections, epidural catheter and transforaminal nerve root injections. One of the medications used in "Nerve Block" is steroid, which is a very powerful anti-inflammatory medication. The steroid (cortisone) can be instrumental in reducing swelling caused by certain types of chemicals released by ruptured disc, stress or wear and tear due to aging and mechanical injury or compression in the case of disc herniation and bone spur. Thus, injection of the steroid in the area can reduce pain related to the inflammation as a result of a ruptured disc, osteoarthritis, or spinal stenosis. Unlike opioid pain medications, steroid injection in the spine treats the root cause of pain which is swelling, rather than masking it. Usually the patient who receives spinal steroid injections is one that has undergone conservative management in the form of non-steroidal anti-inflammatory, and physical therapy without significant reduction in pain. The steroid injection can be considered at peripheral nerves like Carpal Tunnel, Tarsal Tunnel, Groin nerve block to treat groin pain, Scar Neuroma to treat surgical scar pain etc to achieve pain relief.

There are several types of steroid "Nerve Block" injections:

* Lumbar or thoracic or cervical facet joint as well as sacroiliac joint injections: The facet joints are located on the back and side of the bony spinal column on both sides. Spinal injury, age related wear and tear or stress, inflammatory disease, etc. could cause swelling and then arthritic changes into the joints. Cortisone injection into the joints under fluoroscopic guidance relieves swelling and pain. If pain relief does not last following the series of cortisone injections, then deadening of the nerve (denervation) for the joints would be considered to achieve lasting pain relief from the arthritic joint pain.

* Transforaminal approach requires needle placement into the opening (foramen) of the spine where the spinal nerve roots come out. This technique is especially useful when the patient has one sided pain with a high degree of suspicion for particular nerve roots as being causative in the pain complaint in the legs(sciatica) or arms. This technique should be performed with fluoroscopic guidance. Because of the use of fluoroscope and much thinner needle compared to the traditional epidural needle, the tissue trauma and incidence of thecal sac puncture is less in the transfoaminal approach. Besides, this approach delivers medicine closer to the problem site (ruptured or herniated disc) than epidural approach. Because of great efficacy and safety, this approach is being used more and more by pain physicians.

* The Caudal injection technique is used for very low lumbar spine pathology such as L5-S1 disc herniation. The needle is passed into the sacral canal, which is essentially near the tailbone area. The procedure may or may not be performed with fluoroscopy. This procedure is relatively safe because the spinal cord is far from the needle.

Spinal injections are associated with risks and potential complications. With x-ray guidance, and with experienced hands, the complication rate is felt to be lower. This is especially true when a transforaminal approach is utilized. The risks and complications are as follows: increased pain, bleeding, infection, failure to produce desired result, puncture of the spinal sac causing spinal headache, spinal cord injury causing paralysis, infection of the spine (meningitis), and reaction to medications resulting in anaphylactic reaction with a possible heart attack, stroke, or death. The excessive steroid use could cause weight gain, temporary increased blood sugar and blood pressure.

The patient is placed on his / her stomach, fluoroscopy is placed to visualize the spinal elements. The area of the injection is prepared with disinfectant. Local anesthetic is injected for the epidural injection. Under direct fluoroscopy imaging, the needle tip is advanced either into epidural space, foramen (for the transforaminal nerve block) or into the facet or Sacroiliac joint. Then the steroid medication mixed with saline and local anesthetic would be deposited. Contrast dye may be used to confirm the needle tip placement if it is in question.

Following the procedure, the patient will be observed for 30 minutes in the office. All vital signs will be checked to assure the patients well-being. After confirmation of no problems related to the "Nerve Block", the patient will be released home with all necessary instructions. The next block will be scheduled in a week to 10 days for a total of three times. More pertinent information would be discussed with the individual patient for the pertinent "Nerve Block".

V. L. Rajyaguru, MD, DABPM.

Rhizotomy Treatment
Radio Frequency Rhizotomy Information

What is Rhizotomy (RF)?

Normal: Radio frequency rhizotomy or lesioning is a therapeutic procedure designed to decrease symptoms arising from facet joints and or sacroiliac joint arthritis.The procedure involves destroying the nerves called Medial branches that supply the facet joints and SI joints with the sensory that registers pain. This is done by a special needle and by a radio frequency machine. Once these nerves are destroyed, the communicatin link between the joints and the brain can be broken and pain reduced significantly. Numbing medicine is used prior to the nerve destruction to allay pain. This procedure will be done in the office under X-ray equipment.

Preliminary Testing

Normal: Before any RF procedure can be performed, it is vital to dermine the actual source of the pain. This can be done by injecting a small quantity of local anesthetics onto the Medical branches. If pain relief is deemed to be good, even though the relief may be very transient after the testing injections, you may be considered a candidate for this procedure.

What to expect during the procedure?

Normal: Your doctor will perform the placement of a special needle using X-ray imaging. The area to be worked on will be cleansed with an antiseptic solution. Special testing will take place to ensure that the needles are properly positioned and therefore it is very important at this point in the procedure that you are alert and able to communicate with your doctor. Stimulation of the nerve to be lesioned documents good plcement of the needle, as you wil feel a pressure, burning, or tingling sensation confined to your back and or hip. If you feel the stimulation going into your leg, the needle will be re-positioned to achieve the proper response. Once this has been done, a small amount of local anesthetic is passed through the needle to numb the nerve and the RF procedure is started and will last from 60-90 seconds for each nerve. Your doctor will discuss more on it with you prior to the procedure. This procedure is reserved for stubborn arthritic spinal pain.

Congratulations and Many Thanks to Dr. Rajguru and Staff On my behalf and on behalf of the many hundreds, perhaps thousands of those in suffering and pain, which you and your wonderful staff have served, we express our sincere gratitude and continual in-depth patience, professionalism, and personal sacrifices in learning the advanced level of professional knowledge, skills, and abilities, and of their compassion and attentiveness, and generally well expressed “sense of caring”.

Some of us have endured excruciating pain for years, ignorant of the availability and advantages of Pain Management. For many of us it has been an unbelievable life changing event. The results for some have been freedom of assisted walking devices.

We are now free and happy and will ever be grateful to our Maker who arranged it for our lives to cross with Dr. Rajguru and his remarkable staff. Thank you God and thank you Dr. Rajguru and Staff. You have been truly blessed with a holy purpose in life. -
Cindy Bolduc

Dear Mrs. Rajyaguru, I am a patient of your son, Dr. Rajyaguru, and have been for several years now. I asked his permission to write you a letter and asked him to please read it and translate it for you. I have never written a letter like this before, but I wanted to say Thank you to you for all the love and sacrifice you gave in raising your son. The love and care you gave has gone on to touch the lives of so many others. I know you are very proud of him and all his achievements. He is a wonderful doctor and so much more. His office walls are covered with certificates and awards that show years of study and hard work. But what those plaques don’t show you are the endless, he puts in helping people, just like me. I know everyone has had a doctor at one time or another that seemed not to care at all if you died right there in front of them. Then there are the few, who, like your son, who put their whole heart into helping.

I have looked through so many books and still cannot find enough words to convey the dept of gratitude and love that my family and I have for you and your family. Please know that the sacrifices you make are greatly appreciated and touch the lives of so many.

I know its extremely difficult for you to say good-bye after a short visit on vacation, but when he is leaving, its certainly not because he is ready to go, but because of me and so many other patients that depend on him. I would not be here today if it were notand their amazing staff. So Thank you so much for the sacrifice given by you and your family, that literally means the world to me and so many other. God Bless you and your family! - Sheila Hopkins

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Our goal for managing pain in terminally ill patients is to provide the best possible quality of life by assessing and treating the physical and psychological factors contributing to the patient's pain.

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