Services

The Washington Pain Center specializes in expert pain medicine care from general physical examination and medication management, injections, neuromodulation, opioid detoxification, cancer pain management, procedural headache management, and complementary medicine. A listing of common procedures follows:

  • Cancer Pain
  • Celiac Plexus Block
  • Cervical Steroid Injections
  • Detoxification
  • Epidural lysis of adhesions and Epiduraloscopy
  • Facet Joint Injection
  • Hydrodiscectomy
  • Kyphoplasty
  • Lumbar Epidural Steroid Injections
  • Medical acupuncture
  • Medication management
  • Myofascial injection
  • Neuromodulation
  • Post herpetic neuralgia
  • Selective nerve root block
  • Spinal/intrathecal opioid treatment

Kyphoplasty

Dr. Dombrowski recently trained to perform kyphoplasties in his office.


Hydrodiscectomy

Dr. Dombrowski has recently been trained in hydrodiscetomies. For more information about this new procedure please contact Dr. Dombrowski, or go to: washawaybackpain.com.

A revolutionary way to treat herniated discs using the power of water to wash away back pain. Hydro Discectomy is a minimally invasive procedure that uses a high speed water stream to remove herniated disc tissue, relieving the nerve pressure that causes back and leg pain.

Spinal discs are the cushioning tissue between two adjacent vertebrae or spinal bones. When the outer wall of the disc (annulus) becomes damaged or weakened due to age or injury, the inner part of the disc (nucleus) may bulge out. This is called disc herniation, disc prolapsed or a slipped disc. Procedures or surgeries that remove this protruding tissue, relieving the pressure from the nerves, are known as discectomy.

Hydro Discectomy uses a high velocity fluid jet instrument called Spinejet to cut and remove degenerated disc tissue, relieving the herniation. It does not involve cutting of any bone tissue, i.e. laminectomy or laminotomy, as is done in traditional (open) or endoscopic surgeries. It is performed as an outpatient procedure – and patient is able to go home the same day within one to two hours.

Hydro Discectomy is performed using a fluoroscope, which is a machine that projects live x-ray pictures onto a monitor. This guides the physician to navigate the Spinejet device within the spinal disc accurately without using a large incision. The procedure is usually performed using local anesthesia. Once the device is in place, the water jet action works to quickly remove the herniated disc tissue. Being able to do in awake state, this procedure can be done safely even on the elderly and more sick patients who cannot tolerate general anesthesia. Moreover, the complication rates with Hydro Discectomy are negligible as compared to open or endoscopic surgeries where lots of scarring can occur post operatively that leads to ‘Failed Back Surgery Syndrome’.

What Are the Benefits of the SpineJet HydroDiscectomy Treatment?
• It’s an outpatient procedure that requires no hospitalization
• It offers fast recovery so you can return to work quickly
• There is less pain
• No bone is removed
• There is no trauma to your back muscles or surrounding tissue
• No general anesthesia is needed
• It’s a clinically proven procedure


Lumbar epidural steroid injection

This is an injection for patient that suffer with low back pain. This pain can come from several causes: degenerative disc disease, lumbar canal stenosis, a herniated disc or post lumbar laminectomy syndrome. The lumbar epidural steroid injections have been done since 1952. Hundred of thousands of lumbar epidural steroid injection have been done safely, providing relief.

This injection can be done either in a classic (non x-ray ) or a fluoroscopy approach.

The risk of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the low back/leg pain, headache, and nerve damage. All of these risks are less that 1% in the majority of patients.


 

Caudal epidural steroid injection

Is another way to get steroids into and near the spinal cord/nerve root to assist in pain relief. The caudal injection will help the same pain problems that were discussed for the lumbar epidural steroid injection. The caudal injection has been used for many years in operating rooms for regional anesthesia in operating rooms.

The caudal injection with steroids was first described in 1953. Depending on your needs Dr. Dombrowski will suggest which procedure will give you the best chance to alleviate your pain.

The risks are the same as for the other described injections. The caudal approach is now used for other procedures to “access” the epidural space. This “access” is very important in patient with low back pain, that have failed traditional treatments. The specialized procedure is epidural lysis of adhesions and epiduraloscopy.


Cancer Pain

Cancer pain treatment has always held a special place in Dr. Dombrowskis practice. Cancer pain is often under treated. Many studies have now shown that aggressive pain management in patient that suffer with cancer will have a better quality of life and may even live longer.

Injections that are done for cancer pain are: celiac, hypogastric, and impar anesthetic blocks. These injections were done as the standard of care in the 50s and 60s. Unfortunately, these techniques were rarely taught, and therefore patients were no longer offered this form of pain alleviation. Many cancer patients take opioids with significant side effects of constipation, sedation, and poor pain control. These injections have been able to turn these patients lives around. We are pleased to be a part of this “life changing” event.

The celiac plexus block was first described in 1914. This injection will help with pain coming from the pancreas, stomach, small intestine, gall bladder, and to the transverse colon.

The hypogastric plexus block was first described in 1921. This injection was used for pain in the pelvic area. This injection will help with pain coming from the descending colon to the anus. The injection will also help with pain in the pelvic area. This block has been used for cancer pain for the past twenty years.

The ganglion of impar block was described in 1990. This injection is helpful in pain in the anal, vaginal, labia/scrotum area.

The risks of any procedure involving a needle are, but not limited to: bleeding, infection, worsening pain, puncture of an organ, nerve damage. All of these risks are less than 1% in the majority of patients.


Detoxification

Dr. Dombrowski has special training in addiction medicine. He has a special DEA number that allow him to prescribe Suboxone. This is a new medication that assists patient withdrawal from opioids (MS Contin, Oxycontin, Percocet and Vicodin). This program must be in concert with a psychiatrist and or an addiction specialist.


Epidural lysis of adhesions and Epiduraloscopy

These are techniques that can help patient that have failed most conventional treatments. This is a new procedure that has not been until now offered in the Washington DC metropolitan area until today. Dr. Dombrowski can perform a procedure to determine if the cause of your pain is secondary to adhesions in the epidural space. The presence of adhesions may prevent traditional therapies from working. Once a diagnosis is made then the adhesion can be gentle removed using a small plastic tube. The results through the country have been extremely positive for these patients who have given up hope.

Once the adhesions have been broken down then the patient can do focused physical therapy. Dr. Dombrowski considers this physical therapy, as “dental floss” for the spinal cord and nerves. These exercises will help prevent further accumulation of this scar tissue.


Lumbar facet injection

These are injections for low back pain that is not caused by a herniated disc or other spinal pathology. These injections are usually done in patients with a diagnosis of: post lumbar laminectomy syndrome (multiple back surgeries with little/no improvement), arthritis of the facet joints, lumbar canal stenosis, or low back pain with localized pain only in the low back.

If pain is greater than three months, has not responded to conservative treatment ( Nsaids, physical therapy and chiropractor manipulations) and the pain is either continuous or intermittent that will cause a functional disability.

The lumbar facet injection has been done since 1971. Because the lumbar facet injection is a very specific area in the body, fluoroscopy must be used to ensure proper needle placement.

The usual course of treatment is a series of three injections 2-3 weeks apart. As the patient responds in a positive fashion, Dr. Dombrowski will start a program in physical therapy to keep the patient active and healthy, thereby, decreasing the need for further procedural management.

Once the series of injections have concluded the relief should be for one to two years. If the pain relief does not reach that length of time Dr. Dombrowski can then do more specialized treatment to the pain relief. Dr. Dombrowski has the skill and specialized equipment to “burn” the nerves that give feeling to the lumbar facet nerves . This procedure is called “radio frequency ablation”. The “radio frequency ablation” should provide relief from pain for one year.

The risks of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the low back/leg pain, headache, nerve damage. All of these risks are less than 1% in the majority of patients.


Cervical facet injection

This procedure is again similar to the lumbar facet injection. Patients that are helped by these injections are those that suffer with chronic localized neck pain. The pain is usually made worse with moving the neck backwards and from side to side.

The pain is greater than three months, has not responded to conservative treatment ( Nsaids, physical therapy and chiropractor manipulations) and the pain is either continuous or intermittent that will cause a functional disability.

The usual course of treatment is a series of three injections 2-3 weeks apart. As the patient responds in a positive fashion, Dr. Dombrowski will start a program in physical therapy to keep the patient active and healthy, thereby, decreasing the need for further procedural management.

Once the series of injections have concluded the relief should be for one to two years. If the pain relief does not reach that length of time Dr. Dombrowski can then do more specialized treatment to length the pain relief. Dr. Dombrowski has the skill and specialized equipment to “burn” the nerves that give feeling to the cervical facet nerves . This procedure is called “radio frequency ablation” The “radio frequency ablation” should provide relief from pain for one year.

The risks of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the neck / extremity pain, headache, nerve damage. All of these risks are less than 1% in the majority of patients.


Medical acupuncture

Dr. Dombrowski was trained in the field of medical acupuncture in 1999. He received his education at UCLA. The office is proud to offer this holistic approach. Dr. Dombrowski understands that not every ailment can be helped with traditional medical therapy. Patients are tired of taking multiple medications. These medications have side effects and are cost prohibitive. Many patients believe that there IS another way to get better. Dr. Dombrowski is a licensed acupuncturist in the District of Columbia.


Medication management

At times, patient with chronic pain will need to be treated with opioid medication. This is a very limited practice for Dr. Dombrowski. The patients that are in this limited practice are seen every month. These patients will also be a part of a multidisciplinary program of psychological support, exercise, and other means of physical/emotional treatment or care. The office will determine that the patient function has increased and that the disability has decreased on these medications. The overall goal is alleviation of pain and improvement of function.


Myofascial injection

These are (trigger point) injection to help with patients who suffer with chronic muscle spasm. Once the diagnosis of a myofascial pain syndrome is made then injection can help limit and improve the condition. Dr. Dombrowski will be sure to have the patient start physical therapy/yoga/pilates. These modalities will help continue to reduce muscle tension.


Neuromodulation

This has been an exciting addition to Dr. Dombrowski’s practice. This procedure has helped hundreds of patients in the country. To date Dr. Dombrowski has the most experience in this technique of pain management in Washington, DC. This procedure is done for patients that suffer from chronic neck, arm, low back and leg pain. The technology has been used since the 1970’s. Over the past thirty years, the technology has improved to the point that will ensure better patient outcomes in pain control.

The patients that are candidates for this procedure are: post lumbar laminectomy syndrome (patient that had multiple spine surgeries with little/no improvement), patient that do not wish surgery or are not surgical candidates for medical or personal reasons. Finally, patients that suffer with RSD (reflex sympathic dystrophy or Complex regional pain syndrome) are also a candidates for this procedure.

Other pain syndromes that can be helped are: headaches from post occipital neuralgia, chronic pelvic pain, (interstitial cystitis, vulvodynia, and pudendal neuralgia), cancer pain that fails opioid treatment, and pancreatitis.

Dr. Dombrowskis office can provide the patients with all needed medical literature/DVD to make a necessary medical informed decision. To date, Dr. Dombrowski performs one neuro-modulation once a week. Please refer to the linked web site to obtain further information: www.controlyourpain.com  (Boston scientific), www.tamethepain.com  (Medtronic), www.ans-medical.com  (ANS).


Post herpetic neuralgia

This is a diagnosis that can affect many patients. This is nerve pain produced by the reactivation of the herpes zoster (chicken pox) virus. This pain can be very debilitating and sometime fails traditional medical therapy. Dr. Dombrowski can place certain medications near the affected nerve root that is transmitting pain. As the treatments progress the patient will notice a relief of the pain from this common illness.


Selective nerve root block

This is a more specialized injection for low back pain with leg pain. The procedure is similar to a lumbar epidural steroid injection, but the injection is made very near the affected nerve root. Because of the highly technical component, this procedure must be done with fluoroscopy. The diagnostic value of this procedure was recognized in 1971.

The risk of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the low back/leg pain, headache, and nerve damage. All of these risks are less that 1% in the majority of patients.


Cervical epidural steroid injection

This injection is done for patients who suffer with chronic neck and extremity (arm and/or hand pain). The diagnosis for this injection is usually a cervical herniated disc causing specific nerve root pain.

Patients who have failed conservative treatment for neck pain are excellent candidates for a cervical epidural steroid injection.

The procedure is similar to the lumbar epidural steroid injection. This injection can be done either in a classic (non x-ray) or a fluoroscopy approach.

The risks of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the neck /extremity pain, headache, nerve/spinal cord damage. All of these risks are less than 1% in the majority of patients.


Sacroiliac joint injection

This diagnosis remains relatively illusive for most patient and physicians. The pain of the sacroiliac joint is sacral (very low back) and will radiate into the same side hip and even groin. The diagnosis is usually made by a history and physical exam. Finally an injection will usually confirm the pain generator as the sacroiliac joint.

The sacroiliac joint was known as a source for low back pain since 1905. The injection can be done either as a classic (non x-ray) vs. fluoroscopy approach. The usual course of treatment is a series of three injections 2-3 weeks apart. As the patient responds in a positive fashion, Dr. Dombrowski will start a program in physical therapy to keep the patient active and healthy, thereby, decreasing the need for further procedural management.

Once the series of injections have concluded, the relief should be for one to two years. If the pain relief does not reach that length of time, Dr. Dombrowski can then do more specialized treatment for the pain relief. Dr. Dombrowski has the skill and specialized equipment to “burn” the nerves that give feeling to the sacroiliac joint. This procedure is called “radio frequency ablation”. The “radio frequency ablation” should provide relief from pain for one year.

The risks of any procedure involving a needle are, but not limited to: bleeding, infection, worsening the pain and localized tenderness. All of these risks are less than 1% in the majority of patients.


Spinal/intrathecal opioid treatment

If the injections are not entirely helpful Dr. Dombrowski can still offer help. Many times patient cannot tolerate “high” doses opioids (narcotics) secondary to sedation, constipation, or the patient just cannot take enough pills to control the pain.

When this occurs, Dr. Dombrowski can then place the medication near the epidural or spinal space. The effectiveness of this form of drug delivery system (intrathecal drug therapy) is significant. Most patients can get marked pain relief with a reduction of the opioids by 80-90%. Please look at the web site of Medtronic to get further information.