Interventional Pain Management

Board-certified pain management physicians — Downey & Los Angeles.

Downey Outpatient Surgery Center hosts fellowship-trained, board-certified interventional pain physicians performing image-guided injections, nerve blocks, radiofrequency ablation, and minimally-invasive spine procedures in an accredited ambulatory surgery setting. Insurance, Medicare, workers’ compensation, self-pay, and personal-injury lien cases accepted.

Call to Schedule — (562) 555-0100 Email Scheduling

Board-certified, fellowship-trained physicians

Every pain management physician credentialed at DOSC is board-certified — most commonly in Physical Medicine and Rehabilitation (physiatry) or in Anesthesiology — with additional fellowship training in Pain Medicine and subspecialty board certification from the American Board of Anesthesiology, the American Board of Physical Medicine and Rehabilitation, or the American Board of Pain Medicine. Credentials are verified at initial privileging, re-verified every two years, and cross-checked against the National Practitioner Data Bank and state medical-board disciplinary records.

What this means practically: the physician performing your injection has completed a residency in their primary specialty, a dedicated pain medicine fellowship at an ACGME-accredited program, and has passed the subspecialty board examination. In deposition, IME, or peer-review contexts, those credentials hold up.

Interventional procedures performed at DOSC

All procedures are performed in a fluoroscopy-equipped procedure room under sterile technique, with continuous anesthesia monitoring (pulse oximetry, capnography, blood pressure, ECG) and experienced perioperative nursing. Sedation is individualized — most patients receive light IV sedation; some procedures can be performed with local anesthetic only for patients who must drive themselves home.

Epidural steroid injections (ESI)

Image-guided injection of a local anesthetic and corticosteroid into the epidural space to reduce inflammation around irritated spinal nerve roots. Performed at the cervical, thoracic, or lumbar level depending on the pain generator, and by the interlaminar, transforaminal, or caudal approach depending on the anatomy and the clinical question. Most commonly used for radicular pain from disc herniation, foraminal stenosis, or post-surgical fibrosis.

Medial branch blocks & facet joint injections

Diagnostic and therapeutic injections targeting the medial branch of the dorsal ramus nerves that innervate the facet joints. A positive diagnostic block — typically two, on separate dates — confirms facet-mediated pain and establishes the medical-necessity basis for subsequent radiofrequency ablation. Common indications include axial low back pain, axial neck pain, and whiplash-associated facet injury.

Radiofrequency ablation / rhizotomy (RFA)

After a positive diagnostic block, a radiofrequency probe is positioned at the medial branch nerve under fluoroscopic guidance and a controlled thermal lesion is created. Pain relief typically lasts 6 to 18 months; the procedure can be repeated when symptoms recur. RFA is performed at cervical, thoracic, and lumbar levels; related techniques include cooled RFA for sacroiliac and genicular applications.

Sacroiliac (SI) joint injections

Fluoroscopically-guided injection of local anesthetic and corticosteroid into the SI joint, a common and often-missed generator of lower back and buttock pain. Diagnostic value is high: a positive response localizes the pain source and opens the door to longer-term interventions including sacroiliac RFA and, for appropriate candidates, surgical SI joint fusion.

Occipital nerve blocks

Injection of local anesthetic, sometimes with corticosteroid, at the greater and lesser occipital nerves for post-traumatic headache, cervicogenic headache, and occipital neuralgia. Frequently used in whiplash and concussion patients whose headaches have not responded to medication and physical therapy alone.

Genicular nerve radiofrequency ablation

Targeted RFA of the superior medial, superior lateral, and inferior medial genicular nerves for chronic knee pain, including osteoarthritis pain in patients who are not surgical candidates, persistent pain after knee replacement, and post-traumatic knee pain. Performed after a confirmatory diagnostic genicular block.

Kyphoplasty

Minimally-invasive percutaneous treatment for painful vertebral compression fractures, most often from osteoporosis or trauma. Under fluoroscopic guidance, a balloon is advanced into the collapsed vertebral body to partially restore height, then polymethylmethacrylate (PMMA) cement is injected to stabilize the fracture. Most patients experience meaningful pain relief within 24 to 48 hours.

Conditions treated

  • Lumbar and cervical radiculopathy — sciatica, pinched nerve, herniated disc pain
  • Axial low back pain and axial neck pain (facet-mediated)
  • Whiplash-associated disorders and post-traumatic cervical pain
  • Sacroiliac joint dysfunction
  • Post-surgical spine pain (“failed back surgery syndrome”)
  • Post-traumatic and cervicogenic headache; occipital neuralgia
  • Vertebral compression fractures (osteoporotic and traumatic)
  • Chronic knee osteoarthritis pain; persistent pain after knee arthroplasty
  • Complex regional pain syndrome (CRPS) — sympathetic blocks where indicated
  • Neuropathic pain syndromes amenable to peripheral nerve blocks

What to expect on procedure day

  1. Arrival & check-in — typically 60 to 90 minutes before the procedure. Photo ID, insurance cards, and surgeon/physician paperwork reviewed at registration.
  2. Pre-procedure evaluation — the pre-op nurse confirms NPO status, reviews medications (especially anticoagulants and blood thinners), starts an IV if sedation is planned, and positions you for the procedure.
  3. Anesthesia discussion — for sedation cases, the anesthesia provider meets with you to review options, allergies, and airway. For local-only cases, this step is abbreviated.
  4. The procedure itself — most interventional pain procedures take 15 to 45 minutes of procedural time. You will be positioned (prone, supine, or lateral), the skin prepped with antiseptic, and the target anatomy localized under live fluoroscopy. Injections are performed with real-time imaging.
  5. Recovery — 30 to 60 minutes in our PACU with nursing and anesthesia monitoring. Vital signs, pain scores, and neurological status checked before discharge.
  6. Discharge & home instructions — written activity, medication, and follow-up instructions. A responsible adult driver is required if any sedation was used. Most patients resume normal activities the following day.

Safety & monitoring

DOSC meets the same safety standards for pain management procedures that we hold for general surgical cases:

  • Continuous monitoring during all cases: pulse oximetry, capnography for sedation cases, three-lead ECG, and non-invasive blood pressure.
  • Perioperative nursing staffed by ACLS-certified RNs with dedicated ASC experience.
  • Anesthesia services available for any case that requires them; all anesthesia providers are board-certified.
  • Emergency equipment on-site: difficult airway cart, defibrillator, reversal agents (naloxone, flumazenil), resuscitation medications.
  • Transfer agreements with nearby hospitals for the rare case requiring higher level of care.
  • Infection control aligned with CMS Conditions for Coverage and our accrediting body — single-use sterile trays, terminal cleaning between cases, tracked instrument processing.
  • Medication reconciliation at pre-op, with explicit screening for anticoagulants that contraindicate neuraxial procedures without a hold.

Who refers patients to DOSC for pain management

  • Primary care physicians managing patients whose pain has not responded to conservative care.
  • Orthopedic surgeons and spine surgeons co-managing pre-surgical and post-surgical patients.
  • Neurologists and physiatrists managing chronic pain, neuropathic pain, and post-traumatic syndromes.
  • Physical medicine and rehabilitation offices integrating interventional procedures into a broader rehab plan.
  • Workers’ compensation case managers coordinating authorized pain care for MPN and non-MPN cases.
  • Personal-injury attorneys referring clients with auto-accident and PI injuries for evaluation on medical lien.
  • Established pain patients requesting that their treating physician schedule at an accredited facility.

Insurance & payment

Pain management procedures at DOSC are covered by most commercial PPO and HMO plans, Medicare and Medicare Advantage, and select workers’ compensation panels — subject to medical-necessity documentation and prior authorization where required. See our full Insurance & Payment page for accepted plans, verification-of-benefits workflow, Good Faith Estimates, self-pay rates, and medical-lien acceptance for personal-injury cases.

Phone — Scheduling
(562) 555-0100
Email — Scheduling & referrals
[email protected]
Hours
Mon–Fri · 7:00 AM – 5:00 PM

Information on this page is for patients, referring physicians, case managers, and attorneys. It is not medical advice and does not establish a physician-patient relationship. Procedure availability depends on the credentialed physician’s schedule and on case-by-case medical appropriateness.

Ready to schedule your procedure?

Our scheduling team coordinates with your referring physician and confirms your benefits before the date.

Call (562) 555-0100 Email Scheduling

What patients can do the week before an interventional pain procedure to support a smooth visit

What patients can do the week before an interventional pain procedure to support a smooth visit

The seven days leading up to an outpatient pain procedure shape how the visit itself unfolds. Most of the preparation is unremarkable, a sequence of small adjustments to medication, food, transportation, and clothing, but each step removes a variable that could otherwise delay or complicate the appointment.

Patients are typically asked to review their full medication list with the clinical team well before the procedure date. Anticoagulant and antiplatelet medications often require a structured pause, and the timing depends on the specific agent and the patient's underlying conditions. This is not a decision to make independently; the prescribing physician and the proceduralist coordinate the schedule together. Over-the-counter anti-inflammatories, certain supplements, and herbal products may also need to be held, so patients should bring an inclusive list that captures everything taken on a regular or as-needed basis.

Food and fluid instructions vary based on whether sedation is planned. When sedation is involved, a fasting window is standard, usually from midnight the night before. Patients on diabetes medications should ask specifically how to adjust dosing on the morning of the procedure, since fasting alters normal regimens. Hydration in the days leading up to the visit, paused only during the fasting window itself, helps with intravenous access and post-procedure recovery.

Logistics that prevent same-day cancellations

Transportation is the single most common reason a procedure is postponed at check-in. If sedation is part of the plan, a responsible adult must accompany the patient and remain available for the drive home. Rideshare services do not satisfy this requirement at most facilities. Patients are encouraged to confirm their driver several days ahead and again the night before.

Clothing should be loose and easy to change. Two-piece outfits work well for procedures targeting the spine, hips, or shoulders. Jewelry and metal accessories are best left at home. Patients who use CPAP, hearing aids, glasses, or mobility devices should plan to bring them; the clinical team will store items safely during the procedure itself.

A brief written summary of current symptoms, including pain location, intensity patterns, and any recent changes, helps the proceduralist confirm the treatment plan on arrival. Patients who have had imaging at outside facilities should verify that records have been received, ideally a few days in advance rather than the morning of the visit. Insurance authorizations, when required, are typically handled by the office, but patients can call to confirm status if they have not received notification.

Sleep, light activity, and a normal diet in the days before the procedure all contribute to a steadier baseline. Patients who develop a fever, active infection, or significant new symptoms in the days leading up to their appointment should contact the office promptly, as these may require rescheduling for safety reasons.

This page is informational and is not medical advice. Treatment options and procedure preparation should always be made in consultation with a qualified physician.

What patients should know about anesthesia and sedation choices for interventional pain procedures at DOSC

Interventional pain procedures at Downey Outpatient Surgical Center are performed with anesthesia plans tailored to the procedure, the patient's medical history, and the level of comfort required. The clinical team selects from several well-established options, each with a defined role in outpatient interventional pain care.

Most diagnostic and therapeutic injections, including facet joint injections, medial branch blocks, and many epidural steroid injections, are performed under local anesthesia alone. A small amount of numbing medication is placed at the skin entry site, and patients remain awake and conversational throughout. This approach is often preferred when the clinical team needs patient feedback during the procedure, such as confirming the location of referred sensations.

For procedures that are longer, more involved, or anxiety-provoking, monitored anesthesia care is commonly used. Under this approach, an anesthesia provider administers sedating medication through an IV while continuously monitoring vital signs. Patients are typically drowsy and relaxed, with reduced awareness of the procedure, but breathe on their own without an airway device. Radiofrequency ablations, spinal cord stimulator trials, and certain epidural procedures are frequently performed this way.

General anesthesia is used less often for interventional pain work and is reserved for cases where deeper anesthesia is clinically indicated, such as some implantable device placements or when patient factors make lighter sedation impractical. When general anesthesia is appropriate, the anesthesia team reviews airway, cardiac, and pulmonary history in detail during the pre-operative evaluation.

How the pre-operative evaluation shapes the sedation plan for each outpatient pain procedure

Before any interventional pain procedure, patients complete a pre-operative review that covers current medications, prior anesthesia experiences, sleep apnea screening, and relevant cardiac, pulmonary, and metabolic history. Anticoagulant and antiplatelet medications receive specific attention, since some interventional procedures require a hold period coordinated between the referring physician and the proceduralist. Patients should arrive with an accurate medication list and disclose any over-the-counter supplements that affect bleeding or sedation.

Fasting instructions are provided in advance and depend on the planned sedation level. Local-only procedures generally allow a light meal, while monitored anesthesia care and general anesthesia require longer fasting windows. Patients who use CPAP for sleep apnea are asked to bring their device on the day of surgery when sedation beyond local anesthesia is planned. A responsible adult driver is required for any patient receiving sedation; rideshare services are not accepted as a substitute. Recovery times vary from roughly thirty minutes for straightforward local cases to several hours for procedures involving deeper sedation.

This page is informational and is not medical advice. Specific anesthesia and sedation choices should always be made in consultation with a qualified physician and the anesthesia team during the pre-operative visit.

How DOSC coordinates with referring physicians before and after your interventional pain procedure

Most patients arriving at Downey Outpatient Surgery Center for an interventional pain procedure have already worked with a referring pain specialist, orthopedist, or primary care physician. The handoff between that office and our facility is structured so nothing about your case has to be re-explained at the door, and so your follow-up returns to the physician who knows your history.

Before your scheduled date, the referring physician's office sends procedure orders, imaging, and the relevant clinic notes directly to our pre-op team. A nurse reviews these against your intake forms and flags anything that needs clarification, including anticoagulant use, prior reactions to contrast or sedation, and any changes in symptoms since the referral was written. If a discrepancy appears, we contact the referring office before the procedure date rather than on the morning of surgery.

On the day of the procedure, our anesthesia and proceduralist teams work from the referring physician's plan. The interventional pain physician performing the injection, ablation, or stimulator trial is typically the same provider who saw you in clinic, which keeps the clinical reasoning continuous. For patients referred from outside practices, our team confirms the targeted level, laterality, and approach against the written order before you enter the procedure room.

What happens after you leave the outpatient center

Once you are cleared from recovery, a procedure note is generated and sent to the referring office, usually the same business day. The note documents the technique used, fluoroscopic guidance details when applicable, any medications administered, and post-procedure observations. This means your follow-up visit at the referring clinic begins with the full record already in hand.

Patients receive written discharge instructions covering activity restrictions, expected soreness at the injection site, and the timeline for symptom changes. For diagnostic blocks, you will be asked to track pain levels over a defined window so the referring physician can interpret the response at follow-up. For therapeutic procedures, the instructions outline when to resume physical therapy, anticoagulants, and routine medications. If symptoms outside the expected range develop, the discharge sheet lists who to call, and after-hours guidance routes to the appropriate on-call provider.

This page is informational and is not medical advice. Treatment options should always be made in consultation with a qualified physician.

How to prepare for an interventional pain procedure at an outpatient surgery center

Interventional pain procedures performed at an outpatient surgery center, including epidural steroid injections, facet joint injections, medial branch blocks, and radiofrequency ablation, are designed as same-day visits. Patients arrive, undergo the procedure, spend a short observation period in recovery, and return home the same day. Thoughtful preparation in the days leading up to the visit helps the clinical team work efficiently and keeps the patient comfortable throughout.

The most important early step is a complete medication review. Patients should bring a written list of every prescription medication, over-the-counter product, herbal supplement, and vitamin currently in use. Blood-thinning medications, including anticoagulants and certain anti-inflammatory drugs, often need to be paused for a specified window before an injection-based procedure to reduce the risk of bleeding at the needle site. The clinical team will provide individualized timing instructions based on the medication, the procedure, and the patient's overall health profile. Patients should never stop a prescribed medication without confirmation from the ordering provider.

Most procedures involving sedation require fasting beforehand. The surgery center provides specific NPO (nothing by mouth) instructions during the pre-procedure call, usually including the times after which solid foods, then clear liquids, must stop. Small sips of water with essential morning medications may be permitted when confirmed by the team. Patients receiving any form of sedation must arrange for a responsible adult to drive them home; rideshare services without a designated companion are generally not accepted as a discharge plan. The driver should be available for the full appointment window, which typically runs longer than the procedure itself once intake, the procedure, and the recovery observation period are combined.

On the day of the visit, patients should wear loose, comfortable clothing that allows access to the treatment area. A two-piece outfit is often easier than a one-piece. Items to bring include:

Patients managing diabetes, hypertension, sleep apnea, or other chronic conditions should confirm their morning routine with the clinical team in advance. Continuous positive airway pressure equipment, glucose monitors, and home blood pressure logs may all be relevant to the anesthesia plan. Any recent change in symptoms, including a new infection, fever, or unexplained pain, should be reported before the appointment, as it may affect timing or readiness for sedation.

This page is informational and is not medical advice. Treatment options should always be made in consultation with a qualified physician.

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