Interventional Procedures for Pain Management

Pain is a multidimensional problem ranging from discomfort to agony and affecting physical, emotional, and cognitive function as well as interpersonal relationships and social roles. Effective pain management, particularly for chronic pain, is best achieved using a patient-centered, multidisciplinary, multimodal, integrated approach that may include pharmacotherapy and restorative therapies.

In this section you will learn more about pain, its causes, evaluation and treatment utilizing Interventional Procedures. Interventional pain management is part of the pain specialty that applies image-guided and minimally invasive procedures toward the diagnosis and treatment of pain conditions. Many interventional procedures for pain have been around for decades, and they vary in their invasiveness. Image-guided interventional procedures (using ultrasound, fluoroscopy, and computed tomography) can greatly benefit comprehensive assessment and treatment plans by identifying the sources and generators of pain. that are provided as a component of interdisciplinary, multimodal pain care.

Epidural steroid injections (ESIs) deliver anti-inflammatory medication directly into the epidural space — the region outside the sac of fluid surrounding the spinal cord. Lumbar epidural injections treat back pain and radicular pain resulting from chemical irritation of nervous tissues by eliminating the inflammatory compounds mediating nervous tissue irritation in the epidural space.

Facet joint nerve block and denervation injection are common fluoroscopy-guided procedures for facet-related spinal pain of the low back and neck area in which local anesthesia with or without steroids is injected onto the medial branch nerves that supply these joints (medial branch blocks or less commonly directly into the facet joint).

Cryoneuroablation is a specialized interventional pain management technique that uses a cryoprobe to freeze sensory nerves at the source of pain to provide long-term pain relief.

RF Ablation. Conventional RF lesioning and pulse RF (PRF) are both means to ablate certain nerves that have been identified as contributing to chronic pain syndromes, and they continue to have great value as a treatment modality in the management of a variety of pain syndromes.

Peripheral nerve injections, commonly referred to as peripheral nerve blocks (PNBs), are injections of local anesthesia frequently mixed with anti-inflammatory steroid medication or clonidine for both diagnostic and therapeutic pain relief purposes.

Neuromodulation techniques use device-based electrical or magnetic stimulation to activate central or peripheral nervous system tissue associated with pain pathways to produce analgesia or reduce sensitivity to pain.

Intrathecal Pain Pumps. Because there are opioid receptors on the spinal cord and at specific areas of the brain, small doses of opioids in the spinal fluid can provide significant analgesia at much lower doses than oral opioids. Implanted intrathecal pumps with catheters in the spinal fluid can supply medication continuously, and they have been used for cancer as well as noncancer pain.

Vertebral augmentation stabilizes the spine through the application of cement to vertebral compression fractures that are painful and refractory to medical treatment ; this approach can include vertebroplasty (injecting cement into a fractured vertebra) or balloon kyphoplasty (using an inflatable balloon to create injection space).

Trigger points are palpable, tense bands of skeletal muscle fibers that, upon compression, are capable of producing both local and referred pain.Using either dry needling or injections of local anesthesia, trigger points can be disrupted, resulting in relaxation and lengthening of the muscle fiber, thereby providing pain relief.

Joint Injections. In addition to the facet joints, corticosteroid injections into other joints (e.g., shoulder, elbow, wrist, knee, ankle) are common interventional procedures, particularly in the treatment of inflammatory arthritis and basal joint arthritis. When local anesthesia is combined with corticosteroids, the joint injection can also be used therapeutically to treat joint pain resulting from injury or disease or diagnostically to identify the source of joint pain.

Interspinous Process Spacer Devices. Research has shown that interspinous process spacer devices can provide relief for patients with lumbar spinal stenosis with neuroclaudication.

Regenerative/adult autologous stem cell therapy may show promise in the treatment of multiple painful conditions.Further research is needed and encouraged to investigate the potential of these therapies.