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Oxford Valley Pain & Spine Center's Blog

What are Nerve Blocks?

What Are Nerve Blocks?

A nerve block is an injection of a nerve numbing drug into a group of nerves that creates pain to a specific body are or organ. The group of nerves are known as a plexus or ganglion.

How Are Nerve Blocks Used?

Different nerve blocks are used for different problems. They can be helpful in avoiding surgery or making surgery more effective.

  • · Therapeutic nerve blocks have local anesthetics that are used to attack acute pain areas. They are used to treat painful conditions.
  • · Diagnostic nerve blocks are used to help determine the real sources of the pain. These blocks usually also contain an anesthetic.
  • · Prognostic nerve blocks are used to determine what further steps, such as surgery, might be helpful to the patient.
  • · Preemptive nerve blocks are meant to prevent subsequent pain from a procedure that can cause problems including phantom limb pain.

Side Effects and Risks

  • · Bleeding
  • · Elevated blood sugars
  • · Rash
  • · Itching
  • · Weight gain
  • · Extra energy
  • · Soreness
  • · Death (in rare cases)


Nerve blocks work best when the pain is localized to a set of nerves.

Nerve Blocks

Types of Nerve Blocks

Various areas of pain require different nerve block types.

  • · Neck and Back: Cervical epidural, thoracic epidural, and lumbar epidural block
  • · Shoulder and Upper Neck: Cervical plexus block and cervical paravertebral block
  • · Shoulder, arm, hand, elbow and wrist: Brachial plexus block, elbow block, and wrist block
  • · Abdomen and Pelvis: Subarachnoid block and celiac plexus block
  • · There are also nerve blocks that target the face, eyelids, scalp, forehead, jaw, nose and palate.


Other Nerve Blocks

Sympathetic nerve block: Used to see if there is damage to the sympathetic nerve chain (a network of nerves extending the length of the spine). These nerves manage control of some of the involuntary functions of the body.

Stellate ganglion block: Used to see if there is damage to the sympathetic nerve chain supplying the head, neck, chest, or arms and if it is the source of pain in those areas. The primary usage of this nerve block is diagnostic though it may also give some temporary help.

Facet joint block: Please see our brochure on facet joint injections. Facet joints help with spine mobility.



This information is for educational purposes only. Please make an appointment so we can formally review your medical condition.


We are located in Langhorne, PA. We see patients throughout Bucks County and patients from Philadelphia, Mercer, and Montgomery County including Newtown, Levittown, Doylestown, Hamilton, and other locations. You can reach us at 215.741.4410


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When to Consider Lumbar Steroid Injections

Signs that a Lumbar Epidural Injection May Be Worth Considering

There are many reasons why low back pain occurs or sciatica occurs. Some of these conditions can benefit from a steroid injection. Our doctors may recommend lumbar epidural injections if you have:

  • A lumbar disc herniation. A herniated disc happens when the soft, spongy, material that cushions (shock absorbs) the bones of the spine (vertebrae) slips out of place, breaks open or becomes damaged. It’s also called a slipped or ruptured disc. You can have a herniated disc in any part of your spine. The most common place for a herniated disc is the lumbar spine (the lower back).
  • Degenerative disc disease (DDD). Spinal discs act as shock absorbers for the spinal vertebrae. They separate the vertebrae bones and allow the spine to bend, move, and twist. DDD can happen through injury or through aging. DDD isn’t really a disease—it’s a change in the condition of your discs. The most common pain areas are the lower back and the neck. DDD can impinge on the nerves.
  • Vertebra compression fractures
  • Facet joint or nerve root cysts
  • A torn disc also called an annular tear.

When a Lumbar Steroid Injection is Not a Good Idea

Injections for back pain or sciatica pain should be posted if the patient:

  • Has a current infection
  • Is pregnant
  • Has bleeding problems. Patients who are on the Coumadin medication may need to go off the medication until the bleeding is under better control
  • Might have a tumor of the spine

For help with any pain issues, please call our Langhorne, Pennsylvania office at 215.741.4410. We help patients throughout Bucks County, Mercer, Philadelphia, and Montgomery Counties. We see many patients from Langhorne, Newtown, Fairless Hills, Levittown, Bristol, Richboro, and Doylestown.


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Wintertime Pain Management

How to Manage Wintertime Pain

Winter weather can increase the likelihood of pain in several respects. Good preparation can help avoid some common wintertime pain issues.

Shoveling snow

Getting rid of the snow can put a lot of pressure on the back. The wetter the snow and the deeper the snowfall, the more difficult it is to get clear the snow from driveways and sidewalks. If you have pain already, then the best course of action is to get someone else to shovel the snow or you. Ten-Fifteen dollars may seem like a lot but it can be a lot cheaper than paying for high deductibles if you need to see a pain management doctor.

If you have to shovel the snow, consider investing in a snow clearing machine. Otherwise, use common sense strategies such using proper techniques, splitting the shoveling over several different stretches, and salting the icy areas as soon as possible.

Improper shoveling can cause disc damage, muscle injuries, sore backs, and more. The cold weather also makes injuries more likely because the muscles are tighter – so dress warmly.

Slip and falls

Snow and ice make it much easier to fall. Any fall can cause serious neck and back injuries that may require surgery or long-term physical therapy. Many patients develop sciatica after a fall. To avoid slips and falls consider:

· Having someone else clear the sidewalks

· Wear boots or footwear that has some traction to the soles

· Wait until the ice melts before you travel about

Car accidents

Wintertime is the time when more auto crashes happen than other seasons. Poor visibility and bad roads make it difficult for drivers to see and to handle the roadways. Any accident cause many types of injuries including damage to the spine. Muscle aches and pains and whiplash are common medical problems when cars collide.

For help with pain issues of any kind, please call us at 215.741.4410. Our offices, Oxford Valley Pain and Spine  Center, are located  in Langhorne, PA. We see patients from Newtown, Levittown, Bristol, Doylestown, Richboro, and other towns in Bucks  County. We also see patients from Philadelphia, Mercer, Montgomery, and Chester counties.


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The Benefits of Yoga for Pain Management

The many benefits  of Yoga

Many of the treatments we recommend do not involve medications. A perfect example is yoga – a way of getting exercise but with minimal risk of pain and plenty to be gained.

What is Yoga?

Yoga is a mix of physical positions, breathing techniques, and elements of meditation. There are different levels of yoga for people in different levels of activity. There is even chair yoga for seniors and those with a fair amount of pain. The physical part of yoga helps with flexibility and strength. The breathing and meditation parts help lessen stress. The combination of elements is meant to create a happier healthier life.

Yoga is one of the leading ways to help relieve pain. The number of people using yoga for pain and for exercise is growing – especially as men realize it is a great form of exercise too. Younger adults are also trying yoga on a regular basis.

We have regular classes that our available at our Summit Square Kaaya location. Our teacher, Pat, is a long-time yoga instructor who has extensive experience working with patients who are in pain.

Yoga helps with back pain, migraines, arthritis, and other health issues. One main benefit of yoga is that it just gets people to start exercising again. N to It can even help with weight loss

Yoga does require active participation. As with most forms of exercise, when you stop doing yoga, your health can return to the state it was in before you began. That’s why it’s important to make yoga part of your regular living routine.

To learn more about yoga and our yoga programs, please call us at 215.7414410. We have. Patients from Langhorne, Newtown, Levittown, Fairless Hills, Richboro, Doylestown, and anywhere in Bucks County or neighboring counties are welcome.


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What is Firbromyaglia?

What is Fibromyalgia

Fibromyalgia is a painful condition that affects the musculoskeletal system. The pain usually affects both sides of the body and the anatomy above and below the waist. Scientists believe some of the pain is due the way the brain processes signals from the brain.

Symptoms include tiredness even when the patient has had a full night of sleep. Mood and memory issues are also common. Sometimes the symptoms can arise over time. Other symptoms can include anxiety, an irritable bowel, and tension headaches. Sometimes fibromyalgia can develop over time. But fibromyalgia can also caused by a triggering event such as an infection, surgery, or some type of trauma.

Women seem more prone to fibromyalgia then men. Fibromyalgia tends to run in families.

Treatment for fibromyalgia generally incudes medications, exercise, and methods to reduce stress and help you relax.

Treatment for fibromyalgia generally incudes medications, exercise, and methods to reduce stress and help you relax.

For help with Fibromyalgia and any pain issues, please  do not hesitate to call us at 215-741-4410. We see patients throughout Bucks County and from Montgomery County, Mercer County, and Philadelphia.

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Common workplace injuries

We treat a lot of people who have suffered a workplace accident. Each case is different but there are some common reasons why workers get injured. It helps to know these reasons so workers and employers can prepare for these types of injuries. It also helps us to know so we can properly treat our patients.

Here are some of the main reasons employees get injured at work:

· Overexertion. Pulling a muscle or pushing a joint too far when the worker lifts, pushes, pulls, or carries something – especially heavier items.

· Slips and Falls. Many workers trip over electrical cords, fall over equipment that wasn’t picked up or get hurt when they slip on a wet surface. Any fall can hurt the back, neck and spine.

· Falling to a lower level. Workers who fall off a ladder, from a stairwell, or off a roof are going to be in a lot of pain.

· Being struck by an object. Loose merchandise or poorly placed tools can fall directly on a person’s head, back or neck requiring medical help

· Striking an object. Some workers are pushed into slip into an object such as a barricade or equipment.

· Motor vehicle accidents. Many workers have to drive as part of their job. Any car or truck accident can cause injuries to the neck, back, and spine – as well as other parts of the body

· Equipment accidents. Many workers get hurt while they are operating heavy machinery such as a forklift. Equipment injuries can crush parts of the body causing severe pain.

If you or someone you know if suffering with any type of pain, please contact use. We are experienced pain management doctors. Our office is located in Langhorne, PA. We see patients from Levittown, Norristown, Newtown, Trenton, Doylestown, Philadelphia, and the surrounding areas.

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Surgical Pain Management


By Dr. Nirav K. Shah (left) and

Dr. Nazer H. Qureshi (right)

Princeton Brain and Spine


Board Certified Neurosurgeons

215-741-3141    1-609-921-9001

Princeton, Langhorne, Freehold, Flemington, and New Brunswick


Pain can be debilitating. Chronic pain can affect your ability to do the things you love most such as playing golf on a sunny day, travelling with your family, or even watching the next Phillies game.

Sometimes conventional surgery fails to completely relieve pain and a patient will continue to have pain related to the spine such as pain in one’s back/neck and/or extremities. This is known as failed back syndrome. Patients often ask, “I have had spine surgery or I have had spinal fusion and I am still having quite a bit of discomfort. What are my options?”

Options after Failed Spine Surgery

One option is surgical pain management such as spinal cord stimulation. This is an option for patients who have tried conservative care such as physical therapy and medications. The patients have also had multiple spine surgeries including spinal fusion without resolution of his/her symptoms. Symptoms could include pain as well as associated numbness and tingling in the extremities. After these failed surgeries, an orthopedic surgeon or spine surgeon may be reluctant to perform additional surgery due to scar tissue formation. Therefor there are no surgical cures at the site of the previous spine surgeries. This is when a patient can be considered for spinal cord stimulation. Spinal cord stimulation studies have proven to reduce pain levels by at least fifty percent or greater.

What Is Spinal Cord Stimulation?

Simply put, an electrode is placed on the spinal cord to block the pain. There are a few steps that must occur prior to taking the patient to the operating room.

Steps for Placement of Spinal Cord Stimulator

  1. A neuropsychological evaluation is performed to see if the patient understands what the procedure entails and whether he/she will be able to tolerate the operation.
  2. A pain management physician will perform a spinal cord stimulator trial. For this, the physician will place a percutaneous lead placement. In other words, a stimulator placed in the spinal canal. The wires are then attached to a battery (pulse generator) which is then taped to the patient’s body. For the next three to five days, the patient must keep an active diary of how the pain is controlled with the spinal cord stimulator.  After three to five days have passed, the patient will return to the pain management physician to discuss the next steps.
  3. If the trial is deemed successful by the pain management physician and patient, then the patient is referred to a neurosurgeon for further consultation regarding permanent implementation of the spinal cord stimulator. The neurosurgeon will make the final decision as to what the best course of action if for the patient.

The surgical procedure requires two incisions in the back. One is for the placement of the paddle lead and the other is on the patient’s side for placement of the implantable pulse generator. This procedure is done by a neurosurgeon and then the pain management physician will manage the device stimulation on a long-term basis.

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Spinal Cord Stimulation Implants

What is Electronic Spine Stimulation?

Electrical nerve stimulation uses electrical pulses that interfere with the nerve impulses. The nerve pulses create the sensation of pain. The electrical pulses help to ease the pain. There are two types of nerve stimulations: Peripheral Nerve Stimulation (PNS) and Spinal Cord Stimulation (SCS).

The procedure is a two step process.

1. The first step is a trial run. In this first step, the doctor will insert a temporary electrode through the skin. The patient will be able to control the electrode to see if the stimulation works to ease the pain to a manageable level.

2. If the trial run succeeds, then your doctor will do the second step which is to implant the a stimulator permanently under your skin. The second step procedure implants the thin electrical wires with electrical leads near the spinal column. No incision is needed to implant the leads. There is a small incision to implant a tiny generator that is inserted into the buttock or the abdomen. The generator is programmable which means the patient can mange the currents to the spinal column. This procedure is done with the help of a local anesthetic and a sedative.

Once the procedure is done, the doctor and you will determine the best pulse setting. At home, most patients use the stimulator several times a day for an hour or two.

Our office does the trial part. We refer patients to other professionals to implant the stimulator permanently. To learn more about the actual implant of the spinal cord stimulator, please see our next blog which will be a guest blog by doctors who do the permanent stimulation.

Why Electronic Stimulation May be an Option

This procedure may be an option for people with severe chronic pain. It is done to treat existing pain (including low back pain, leg pain, and complex regional pain syndrome ) and also a diagnostic tool to determine if other problems exist including paraplegia, multiple sclerosis and intractable angina. Treatment success varies from patient to patient.

What Are the Risks?

As with most procedures there are risks. The risks associated with this procedure include scar tissue (fibrosis) around the electrode, pain, hardware failure, infection, spinal fluid leakage, headaches, bladder issues, and getting used to the stimulator. If you have an implanted stimulator, you can not have an MRI (magnetic resonance imaging) test.

Please Contact Us

If you have questions about Spinal Cord Stimulation Implants or any pain issues, please contact us at 215.741.4410. Our office is located near the Oxford Valley Mall.


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Cupping – the “hot” Olympic treatment

ABC Olympic Photo

Anyone who has watched the Rio Olympics has noticed that a fair number of the athletes have red circles on their skin.  The red marks come from an ancient form of medicine known as cupping. The Egyptians used cupping as far back as 1,550 B.C.

In cupping, the doctor or health provider places unique cups on your skin for several minutes. The cups can be made out of glass, bamboo, silicone, or earthenware.

Cupping IS used for pain management, stress, better flow of blood, and for deep level massages. Cupping can be dry or moist.

The main steps of cupping are these:

  • The use of fire. The health provider uses alcohol, paper, herbs, or some flammable substance which is placed in the cup and seat afire. As the fire subsides, the therapist places the cup upside down on the patient’s skin.
  • When the air in the cup cools, a vacuum is created which causes the blood vessels to expand. The blood vessel expansion is what creates the red marks. The cup stays on your skin for about three minutes. Today, a rubber pump is sometimes used to create the vacuum instead of fire.

The vacuum is supposed to draw up non-circulating blood and sticky fluids so the healthier blood, cells, nutrient, and oxygen can circulation underneath. This shift in circulation helps people who have muscle pain and bruises.

In wet cupping, the doctor or therapist makes small cuts in the skin with a scalpel – after the cup is removed. A second cup is then used to draw out some of the blood.

Patients normally get 3-5 cup treatments per session. The treated areas are also treated with an antibiotic salve and/or a bandage to prevent infection.

For questions about cupping, please all our Oxford Valley Pain and Spine office in Langhorne, PA. We do cupping treatments. We can be reached at 215.741.4410.

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Lumbar Steroid Injections – Results and Side Effects

Lumbar Steroid Injections – Results

Injections can help relieve pain for a short period of time. They are not a long-term solution.


As with all medical procedures, there can be side effects. Side effects can include infection, bleeding, nerve damage, and tearing of fluid that surrounds the spinal cord.

Because steroid injections can cause soft tissue damage, they are usually only given 3-4 times in the same spot in any given year.

The procedure is an out-patient procedure that takes about 30 minutes. You will be monitored for an additional 15-20 minutes after the procedure and then told to rest at home. We perform the procedure at our own ambulatory surgery center.

Women who are pregnant should be sure to inform their doctor before considering this procedure.

If your back is hurting, a lumbar steroid injection procedure may help manage the pain. Please call the Oxford Valley Pain and Spine Center at 215.741.4410 to schedule an appointment. We are located in Langhorne, PA. We treat patients from Levittown, Newtown, Doylestown, Norristown, Philadelphia, Trenton, and the surrounding regions.

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