Specialist spinal injections and radiofrequency treatments form a central part of the practice, alongside other targeted pain procedures and non-procedural care. Every recommendation begins with assessment and a discussion of the evidence.
With particular expertise in spinal pain, the aim is not simply to offer a procedure. It is to understand the likely cause of your pain, consider realistic benefits and risks, and choose the next step together. Select any treatment below for more information, evidence or a short educational animation.
Targeted spinal injections, sacroiliac procedures and radiofrequency techniques.
Radiofrequency treatment of selected nerves supplying spinal facet joints may help some people with persistent back or neck pain. It is considered after assessment and, where appropriate, diagnostic blocks.
Benefits vary, and the procedure is not suitable for every type of spinal pain.
Patient information: Radiofrequency denervation ↗ · Medial branch blocks ↗
External animation © Veritas Health. Illustrative only.A targeted epidural steroid injection may reduce leg pain caused by irritation of a spinal nerve, for example from a prolapsed lumbar disc. Relief is variable; the injection does not remove the disc.
The NERVES trial: In 163 patients with non-emergency disc-related sciatica, both transforaminal epidural steroid injection and microdiscectomy improved disability at 18 weeks. The adjusted between-group difference was not statistically significant (p=0.22), but the trial did not prove that the treatments are equivalent. Some injection patients later needed surgery.
Read the NERVES trial (Wilby et al., 2021) ↗
Patient information: Epidural injection ↗ · Nerve root injection ↗
External educational video by MediVisuals. New progressive weakness or cauda equina symptoms require urgent assessment.Image-guided sacroiliac joint injections may provide temporary relief or help clarify the pain source. Radiofrequency treatment of selected nerves supplying the posterior joint may be considered following appropriate assessment.
SI joint pain can be difficult to distinguish from other sources of lower back or buttock pain. Diagnostic assessment is important, and response to either treatment is variable.
Pulsed radiofrequency delivers short bursts of electrical energy through a needle placed near a selected nerve. Unlike conventional thermal radiofrequency ablation, it is generally intended to limit sustained tissue heating.
It may be considered for selected neuropathic or other pain conditions. Evidence of benefit varies considerably by indication, and durable relief is not guaranteed. The technique and risks are discussed individually.
Interventions for selected non-spinal pain conditions.
Depending on the diagnosis, options include occipital nerve blocks, C2/3 facet joint blocks and radiofrequency denervation, and botulinum toxin for selected non-migraine pain conditions.
The response may be temporary and can inform subsequent treatment. Headaches should be assessed to exclude other causes.
For selected patients with persistent shoulder pain, bipolar radiofrequency lesions target sensory articular branches of the suprascapular nerve near the glenoid. This differs from cooled radiofrequency treatment.
The aim is to treat pain-carrying articular branches while avoiding the main motor nerve. Evidence of clinical effectiveness is still developing. Published technical paper ↗
Local anaesthetic injections may help identify a potential pain source or provide temporary relief in selected conditions.
Botulinum toxin (often known as Botox) may be considered for certain carefully selected pain conditions. Its use for pain outside established licensed indications is often off-label, and the evidence is variable.
Dr Ward's pain practice focuses on selected pain indications rather than a chronic migraine Botox service. Suitability, alternatives, potential adverse effects and off-label use are discussed before treatment.
Medication review, rehabilitation and multidisciplinary approaches that can complement or replace an intervention.
A careful review of medicines, their effectiveness, side effects and whether a simpler or safer regimen might help.
Physiotherapy, supported activity, psychological approaches and self-management can be valuable parts of an individual pain plan.
Not everyone needs a procedure. Treatment is selected around the diagnosis, evidence and your priorities.
Explore Move forward: our practical exercise guide for back pain →
Practical recovery advice, common temporary symptoms and clear guidance on when to seek urgent help.
The Faculty of Pain Medicine ↗ provides patient information on injections, radiofrequency procedures and medicines. You can also explore our patient information resources. Not every procedure listed is suitable or available for every patient; this is discussed at consultation.
Assessment first. A clear explanation of your options. A plan built around you.
Information about common conditions and treatment decisions.