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Interventional Pain Procedures

Pillar guide + 2 guides
Pillar GuideInterventional Pain Management Procedures: Clinical ReferenceA clinical reference to interventional pain procedures by anatomic target, with an honest evidence verdict for each and where the guidelines conflict.Read the guide →

Procedures & technique

Spinal Cord Stimulation: Why the Trial Comes FirstA 50 to 70 percent success rate is exactly why nobody is implanted without a trial — plus the selection criteria and why the patient stays awake. Intrathecal Pump TherapyWhy intrathecal delivery drops the dose so far, and how a success rate near 90 percent compares with stimulation.

Nerve Blocks

Pillar guide + 11 guides
Pillar GuideNerve Blocks in Outpatient Pain Practice: Types and SafetyHow nerve blocks are classified, what the evidence really supports for each named block, and the safety detail that matters: LAST, asepsis and steroid choice.Read the guide →

Blocks by target

Stellate Ganglion BlockWhy Horner syndrome is the sign it worked, and an honest reading of the CRPS, PTSD and perioperative evidence. Medial Branch BlockA diagnostic test rather than a treatment — false-positive rates, controlled blocks and relief thresholds. Genicular Nerve BlockThe three genicular targets, why corticosteroid adds nothing, and the durability question still open. Pudendal Nerve BlockThe Nantes criteria, the two entrapment sites, and the trial comparing pudendal with sacral blockade. Suprascapular Nerve BlockChosen for what it avoids — the complication profile against interscalene block. Intercostal Nerve BlockThe highest peak plasma anaesthetic levels of any technique, and the pleura immediately below. Saphenous Nerve BlockThe adductor canal block is a saphenous block — and the motor-sparing trade that follows. Thoracic Paravertebral BlockSomatic and sympathetic blockade in one injection, and what PROSPECT now recommends. Lumbar Sympathetic BlockThe fascial plane that makes it selective, and why skin temperature is the endpoint. Supraorbital Nerve BlockWhy the supratrochlear nerve must be blocked too, and what can honestly be claimed. Superficial Cervical Plexus BlockFour nerves at one point, and the fascial plane that separates it from the deep block.

Spine Injections

Pillar guide + 6 guides
Pillar GuideEpidural Steroid Injections: Approaches, Steroid Choice and ComplicationsWhat the injection treats, how the three approaches are chosen from the symptom pattern, why particulate and non-particulate steroid matter, and the complications that need urgent action.Read the guide →

Technique & patient guidance

Cervical Epidural Steroid InjectionWhich levels herniate and which rarely does, the contrast rule when uptake goes intravascular, and the longer contraindication list. Transforaminal vs Interlaminar vs CaudalWhich symptom pattern points to each approach, how previous surgery redirects the choice, and why the steroid changes with the route. Epidural Steroid Injection Side Effects and RisksWhat is expected, what is an emergency, and the anticoagulation rules behind the medication history. What Not to Do After an Epidural Steroid InjectionAftercare, the recovery timeline, and why the pain often worsens before the steroid takes effect. How Often Can You Have Epidural Steroid Injections?What sets the limit, how far apart to space them, and what to do when they stop working. How Painful Is a Lumbar Epidural Steroid Injection?What each step feels like in order, how long it takes, and why feeling faint is common.

Musculoskeletal Ultrasound

Pillar guide + 5 guides
Pillar GuideMusculoskeletal Ultrasound for Pain PracticeWhat ultrasound guidance actually improves — accuracy and safety rather than pain scores — plus diagnostic limits, the learning curve, credentialing and the bundling rule that decides most denials.Read the guide →

Technique & targets

Probe Selection and Machine SettingsWhich probe for which depth, what echogenicity and gain mean, and the two-fingers-down scanning rule. In-Plane vs Out-of-Plane Needle GuidanceWhy in-plane is strongly advised — and the bright-white-dot trap that hides the needle tip. When Does the Probe Need a Sterile Cover?The rule that decides it, and why hand and foot injections are a deliberate exception. Greater Trochanteric PainThe anatomical correction that reorganises the lateral hip, and why the injection keeps wearing off. Plantar Fasciitis InjectionWhy you cannot exercise the plantar fascia — and what to strengthen instead.

Joint & Extremity Injection

Pillar guide + 11 guides
Pillar GuideJoint and Extremity Injection: Technique, Steroid Choice and SafetyThe non-spinal targets performed on palpation and anatomical landmarks — patient selection, steroid pharmacology, the local anaesthetic rule that has no exceptions, and coding.Read the guide →

Targets & drug selection

Occipital Nerve BlockWhy both nerves are blocked, the artery that governs the technique, and the post-traumatic mechanism faculty see most. Trigger Point InjectionsThe injection that usually contains no steroid — and why dry needling works at all. Shoulder InjectionTwo joints plus the cuff, and which examination findings select the target. Corticosteroid Injections: Which and How OftenGlucocorticoid versus mineralocorticoid, the cloudy-or-clear test, steroid flare and the diabetic patient. Local Anaesthetic Allergy, or Epinephrine?Most reported allergy describes an epinephrine reaction at the dentist — and the label costs patients years of care. Tennis Elbow and Golfer’s ElbowWhy the condition is a tendinopathy rather than an inflammation, and what that changes about the steroid decision. Piriformis SyndromeButtock pain that mimics sciatica — the anatomy, how common it really is, and the differential that matters. Morton’s NeuromaThe forefoot diagnosis and the injection approach, including the web space landmarks the technique depends on. Tarsal Tunnel SyndromeThe posterior tibial nerve at the ankle, and why results here are less reliable than at the wrist. Meralgia ParestheticaLateral femoral cutaneous nerve entrapment — a purely sensory nerve, and the block that confirms it. The Ankle Block for Diabetic NeuropathyFive nerves, one sitting — the pain-practice volumes, and what the block can and cannot achieve.

Regenerative Pain Medicine

Pillar guide + 6 guides
Pillar GuideRegenerative Pain Medicine: PRP, Prolotherapy and Perineural InjectionHow the three modalities relate, the healing phases that explain the timeline, the platelet concentration ceiling the evidence actually supports, and where the FDA line now sits.Read the guide →

Evidence & technique

Why More Platelets Is Not Better PRPAbove 750,000 per microlitre the evidence shows no added benefit — and in bone, high concentrations performed worse than no treatment at all. Is Prolotherapy a Hoax?Why the scepticism is reasonable, why the trials genuinely disagree, and which claims the evidence supports. What Is Prolotherapy?What is in the injection, the three healing phases, and the aftercare instruction that protects the result. PRP for Knee OsteoarthritisWhich formulation is used for knees, how it compares with steroid and hyaluronic acid, and what A2M did not achieve. Perineural Injection TherapyThe one regenerative technique that needs no inflammation — and produces analgesia without anaesthesia. De Quervain’s TenosynovitisThe first dorsal compartment, and the perineural approach as an alternative to steroid.

Electrodiagnostic Testing — EMG and Nerve Conduction

Pillar guide + 7 guides
Pillar GuideElectrodiagnostic Testing: EMG and Nerve Conduction StudiesWhat the tests measure, what the numbers on the report mean, what the study can and cannot diagnose, and the technical factors that decide whether a result can be trusted.Read the guide →

Understanding the test

What a Nerve Conduction Test DiagnosesCompression neuropathies, peripheral neuropathy, radiculopathy, plexopathy and myopathy — and the conditions the study is poor at detecting. How to Read a Nerve Conduction ReportWhat latency, amplitude and recruitment mean, and how the pattern across them separates a demyelinating problem from axon loss. Carpal Tunnel: What Electrodiagnostic Testing AddsHow the study confirms and grades carpal tunnel, the comparison technique that catches mild cases, and the AANEM study limits. Can You Fail a Nerve Conduction Test?Why the measurements are not under your control, what effort does and does not change, and what actually produces a misleading result. Does a Nerve Conduction Study Hurt?An honest account of what each part feels like, how long the study takes, and why they warm your hands first. Cubital Tunnel SyndromeUlnar nerve entrapment at the elbow, and the across-elbow study that localises it. Foot DropPeroneal nerve, sciatic or the L5 root — how nerve conduction separates them.

Spinal Manipulation

Pillar guide + 3 guides
Pillar GuideSpinal Manipulation: Indications, Contraindications and Who May Perform ItWhat a high velocity low amplitude thrust actually does, which patients it suits, the red flags that stop it, who may legally perform it, and how it is coded.Read the guide →

Screening & scope

Contraindications and Red FlagsCauda equina, motor weakness, electric radicular pain, osteoporosis — and the pathology that presents as back pain. Who Can Perform Spinal Manipulation?Scope of practice, the training clause that governs it, and how the procedure is coded and reimbursed. Manipulation for SciaticaWhy sciatica is no more specific than a cough — and the threshold at which the patient should be referred.

More on pain practice

From the blog

Compliance & credentials

MATE Act Compliance for Pain PhysiciansWhat the eight hours have to cover, who must attest, and why training you already completed probably counts. Pain Management CME Requirements by StateHow to find your state's requirement, the four structural categories, and the traps worth knowing before you buy CME. CME Pain Training vs a Pain Medicine FellowshipWhat each path is for, and how credentialing committees and carriers evaluate a new procedure. Can PAs Perform Pain Management Injections?The four gates that decide scope, four states with four different mechanisms, and who to ask.

Practice revenue

NCV and EMG Testing as In-House RevenueWhat bringing nerve conduction and electromyography in house actually involves.

Train with Empire

These guides are written from what Empire faculty teach in the room. Hands-on pain management training, including ultrasound-guided technique, runs throughout the year.

CoursesPain Management Training CoursesInterventional and conservative pain management training for physicians, physician assistants and nurse practitioners, with AMA PRA Category 1 Credits™.See the courses →