As a skilled pain management practitioner, Dr. Ruben uses the most advanced treatments available to help control his patients’ pain. Some of these treatments are, at present, not generally done here in Citrus County but are offered by Dr. Ruben. They include:

Spinal Cord Neurostimulation
Neurostimulation is a proven, effective alternative to repeated back surgery, medication or other therapies for chronic pain. Neurostimulation uses a small system that is surgically placed under the skin to send mild electrical impulses to the spinal cord or to a peripheral nerve. The electrical impulses block the pain signal from reaching the brain. Clinical studies have shown that neurostimulation improves pain relief and improves the ability to pursue daily activities among people whose pain treatment is no longer effective.

Intrathecal Pump
Intrathecal drug delivery has been shown to improve pain relief and improve the quality of life for people with severe chronic pain. It may also cause fewer side effects than oral medications. This therapy uses a small pump that is surgically placed under the skin of the abdomen to deliver medication directly into the intrathecal space (the area surrounding the spinal cord). The medication is delivered through a small, soft tube called a catheter that is also surgically placed.

Because the drug is delivered directly to where pain signals travel (the spinal cord), intrathecal drug delivery offers significant pain control, with a small fraction of the dose that would be required with pills. It also serves to minimize side effects.

Radio Frequency Neuroablation
Radiofrequency (RF) lesioning is a safe, proven means of interrupting pain signals. A small, thin, fine electrode is placed on the nerves that cause pain in the back. A stimulation process used during the procedure properly identifies the nerve. Radiofrequency current is then passed through a microelectrode and heats the nerve, thereby destroying the targeted nerve and interrupting pain signals from that specific area. Clinical data shows that radiofrequency lesioning can effectively provide lasting pain relief.

Other, more commonly performed treatments available include:

Epidural Steroid Injections (Cervical, Caudal, Lumbar Epidurals)
Epidural steroid injection has been found to be an effective treatment for some patients who are suffering from neck pain, back pain or leg pain due to nerve impingement. Commonly, nerves that supply the back and legs are compressed near the spine either by a bulging disk, a bone spur or scar tissue. This causes the nerve to become irritated, inflamed and swollen. The more swollen it becomes, the bigger target it is for whatever is pushing against it.

Cortisone is a powerful anti-inflammatory and its action therefore is to decrease the swelling and inflammation in these nerves, thereby breaking this cycle of swelling and irritation. The cortisone is commonly injected along with a local anesthetic. The entire procedure usually takes only five to 10 minutes.

Dr. Ruben performs epidural steroid injections under fluoroscopy, or live x-ray, to ensure precise placement of the epidural needle. By using fluoroscopy for guidance, a physician can direct the needle toward the epidural space with increased safety. Fluoroscopy is considered important in guiding the needle into the epidural space.

Sympathetic Blocks
A Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of spine, in the back. The injection blocks the Sympathetic Nerves and may reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving lower extremities. Sympathetic Blocks are also performed under fluoroscopy.

Other nerve blocks performed by Dr. Ruben are:

Peripheral Nerve Blocks
Intercostal Nerve Blocks

Facet Joint Injections
Arthritis can occur in facet joints, the joints that connect two vertebrae. Back pain, pain that occurs in your side when bending and twisting or pain that spreads to your thigh can be caused by arthritis in facet joints.

A facet joint injection, or facet block, is used when a person has back pain that has clinical and radiological evidence of a disease or abnormal condition affecting the facet joint. Under fluoroscope, or live x-ray, for optimum safety, an anesthetic and a steroid are injected into the facet joint to decrease pain and inflammation. Pain relief can occur immediately, although some discomfort may be felt for 24 hours as a result of the injection.

Sacroiliac Joint Injections
SacroIliac Joint Injection is an injection of long lasting steroid ("cortisone") in the SacroIliac joints – which are located in the low back area. The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.

Trigger Point Injections
Botox Injections/EMG