Level 2

If your pain does not respond to conservative approaches, a second line of therapy may be needed. The therapies offered in the second level can be used in conjunction with level 1 treatment.

Tanscutaneous Electrical Nerve Stimulation (TENS)

A TENS unit is an external stimulation device that sends electrical impulses through your skin to the painful area. Instead of feeling pain at the site, patients feel a tingling sensation. Unlike a Spinal Cord Stimulator, the TENS device does not apply energy directly to the nerve, as it must be transmitted through the skin and muscle to reach the nerves. TENS can alleviate mild to moderate pain, but is often ineffective in treating more complex conditions.


Opioids are prescription painkillers that block the ability of receptors in the brain to interpret pain signals. Physicians typically prescribe opioids for severe pain conditions that do not respond well to Level 1 treatment. Opioids can be very effective in relieving pain, but they can carry significant side effects, including drowsiness, constipation, dizziness and even potential addiction.

Nerve Blocks

A nerve block is performed by injecting a combination of local anesthetic, steroid, and/or anti-inflammatory agents into the affected area of pain. It is used to lessen the painful signals transmitted by nerves with relief ranging anywhere from a few hours to several months. Nerve blocks may need to be repeated for sustained relief, and may also be needed to give patients enough relief to successfully complete physical or rehabilitation therapy.

Thermal Procedures

Signals traveling along nerves from painful areas to the brain can be disrupted using extreme heat or cold delivered through needles or probes. Cryoanalgesia applies extreme cold to nerves, while radio-frequency lesioning uses high-frequency energy to heat or coagulate specific nerves. Both processes may temporarily relieve pain, but pain may return as the nerve tissue regenerates. Repeated applications may be necessary for continued relief.