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Interventional Pain Management – A Practical Guide

What is interventional pain management?

Interventional Pain Management (IPM) is a practice in which analgesic techniques (injections and infusions) are used to intervene in pain pathways. IPM can involve the use of medical procedures, medications, physiotherapy, exercise, and other non-drug therapies such as relaxation techniques and cognitive behavioral therapy which are effective for pain relief.

A clinical practice guideline to help primary care providers discuss non-drug therapies with patients was developed by the American College of Physicians (ACP) and the American Pain Society (APS). They developed recommendations for each therapy based on the available evidence. However, they stated that interventional treatments like ESI (epidural steroid injections), PNBs (peripheral nerve blocks), and neuromodulation can be used as part of a pain relief treatment plan to improve pain management.

An Interventional Pain Management practice is certainly not a novel concept to relieve pain. Interventional Pain Management has long been used as part of complementary therapies to treat chronic pain conditions such as cancer-related symptoms, backache, and osteoarthritis. Just like those using their wisdom with any kind of traditional therapy it is now time for the medical professionals to adopt interventional techniques as methodologies of their own.

Interventional pain management treatment targeting different areas of the body

What is interventional treatment?

“Interventional” pain management refers to treatments carried out to control chronic or acute pain using one or more interventional pain management techniques . Interventional pain management typically refers to medical procedures but may also include the use of medications, physiotherapy, exercise, and other non-drug therapies such as relaxation techniques and cognitive behavioral therapy.

Modern interventional treatment was born from the collaboration between physicians that were experts in pain management through injection practices. In the ’60s these physicians started injecting local anesthetics for somatic regional blocks to diagnose pathology conditions from neuromuscular-skeletal system disorders. The goal of course is to provide pain relief and diagnosis through block procedures performed on patients who were not yet having any clinical signs of major diseases. This allowed for early diagnosis and treatment of pathologies before they became apparent e.g. breast cancer or lung cancer.

Later, this type of therapy was extended to diagnose and treat other diseases such as osteoarthritis and low back pain.

What are the different interventional pain management techniques?

There are many different minimally invasive techniques that a pain management physician can perform. For example, a peripheral nerve block injection (PNB) is a technique that blocks the signals along one or more nerves in the body by injecting an anesthetic into or around that nerve. The PNB can be used to help control localized chronic pain and are usually performed under ultrasound guidance (real-time visualization on a monitor) or fluoroscopic guidance (X-ray). They may be performed for diagnostic purposes (to identify the source of certain types of pain), to determine whether surgery will fix an anatomical problem causing pain, or preemptively during surgery so post-operative pain is minimized.

Knee pain can be treated with interventional pain management

A spinal nerve block injection (SNB), also called a lumbar plexus or neuroforaminal epidural involves injecting an anesthetic into the area around one or more of the nerves that travel to the lower part of your body from your spine. This can be used to help control lower back or leg pain in many patients. A SNB might be performed when other types of analgesia are ineffective, if the patient chronic pain in multiple areas, or when surgery cannot be avoided. It does not provide immediate pain relief and it typically only controls pain for a few days at a time up to three months. These injections may be performed with or without the use of corticosteroids.

Chemical ablation is another interventional pain management technique that involves the injection of alcohol, phenol, or other irritants directly into the pain-producing structure. It has been recently found to be effective in treating interstitial cystitis and urethral syndrome by injecting irritating chemicals directly on the bladder and on the urethra respectively. Radiofrequency ablation is another technique that can be used to treat chronic pain and provide long term pain relief.

What is the difference between pain management and pain medicine?

Typically, certain Physicians will choose to specialize in Interventional Pain Management for pain relief. These pain medicine physicians focus on the prevention, diagnosis, and treatment of acute and chronic pain. The initial evaluation may include a discussion of medical history, family history, diet, medications, alcohol use, work habits (ergonomics), home situation, mental condition, and childhood experiences (abuse). Pain medicine physicians may also conduct diagnostic studies.

For pain relief, Interventional Pain Management physicians will often prescribe medication and make referrals to physical therapy (PT), psychiatry, and other disciplines as required. A pain management physician will be responsible for the ongoing care of the patient and help them get back to their preferred lifestyle.

Differentiating between interventional pain management and pain medicine:

Interventional pain physicians may be anesthesiologists, physiatrists, or other physicians who have chosen to focus their practices on the treatment of chronic intractable or acute severe pain with regional techniques or techniques that do not involve surgery.

Some pain medicine physicians, including anesthesiologists, might perform regional anesthesia and interventional procedures such as epidural injections and facet blocks to treat chronic back pain and other chronic nerve-related pain conditions. Interventional pain management physicians are often board-certified anesthesiologists who have chosen to focus their practices on the treatment of chronic intractable pain or acute severe pain with a regional technique or technique that does not involve surgery. For example, a traditional anesthesiologist might put a patient under general anesthesia before performing surgery. An interventional pain management physician might perform a local anesthetic block to treat acute or chronic back pain.

Interventional pain management treatment for pinched nerve

What are the benefits of using an interventional approach?

This type of interventional pain medicine can provide pain relief for people who do not respond well to medications, such as opioids. Interventional techniques can be used to treat the pain itself, and differ from traditional approaches to chronic pain because Interventional Pain Management does not involve surgery or medications to relieve pain.

They combine the current understanding of the neuromatrix with recent advances in neurobiology and molecular biology to provide new insights into how pain is produced and what can be done to change it.

In addition, interventional methods are typically used for definitive treatment

What does an interventional spine doctor do?

An interventional spine doctor is a specialized pain physician who uses minimally invasive procedures to diagnose and treat conditions and manage pain that affects the bones, joints, ligaments, discs, or nerves of the spine.

Dagram of the spine on a 3d image showing relationship with nterventional pain management

Spinal cord stimulation

Spinal cord stimulation uses an implanted device that sends low levels of electricity directly into the spinal cord to block pain signals and thus relieve pain. “A spinal cord stimulator (SCS) device is surgically placed under your skin and sends a mild electric current to your spinal cord (Fig. 1). Thin wires carry current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the SCS stimulates the nerves in the area where your pain is felt. Pain is reduced because the electrical pulses modify and mask the pain signal from reaching your brain.”

A transversus abdominis plane (TAP) block is a regional technique that provides analgesia for visceral structures, the muscles, and skin of the anterior abdominal wall, as well as dermatomes T7 to T11, which are served by the intercostal nerves. Anesthesia of this area is not only beneficial in general surgical procedures but also is an effective adjunct to interventional techniques such as radiofrequency ablation.

Radiofrequency ablation is used to treat chronic pain, cancer pain, and pain associated with spinal cord injury. It can provide relief for many types of acute and chronic pain, including back pain, arthritis pain, degenerative disc disease, low back pain, neck pain, hip pain, and post-surgical pain. The procedure blocks the nerve cells from generating and transmitting pain signals and can be used to treat several conditions, including herpes zoster ophthalmicus, postherpetic neuralgia, neoplasm pain, postlaminectomy syndrome, phantom limb pain, and stump pain.

In Radiofrequency ablation, a local anesthetic is applied to numb the skin, and then a needle is inserted into the area where the nerve is located. The doctor then guides a small probe through this needle to the target nerve and delivers controlled radiofrequency energy to the nerve.A wire loop may be used during some procedures to destroy small areas of tissue, such as in neoplasm cases. Radiofrequency ablation is a relatively simple procedure that can be performed in an outpatient setting.

A paravertebral block is an injection of anesthetic or steroid medication into the space around the spinal cord. It can provide relief for many types of pain, including back pain, arthritis pain, degenerative disc disease, low back pain, neck pain, hip pain, and post-surgical pain. The procedure blocks the nerve cells from generating and transmitting pain signals.

In a paravertebral block, a local anesthetic is applied to numb the skin, and then a needle is inserted between the spinous processes, at level L1-L2 for upper back pain and level T10-T11 for lower back pain. The doctor then guides a small probe through this needle to the target nerve and delivers controlled radiofrequency energy to the nerve.

Instead of performing open surgery through large incisions on your back—a technique that requires long recovery times and scarring—an interventional spine doctor might use a minimally invasive technique that creates small incisions instead to provide pain relief.

What is the nursing intervention for pain?

Nurse and doctor involved in treating a patient using interventional pain management treatment

1. Pain management

Nursing interventions for pain focus on managing the patient’s pain through medication, physical therapy, relaxation techniques, and other noninvasive means.

2. Complementary Care

Nurses use complementary care to help patients manage their pain, including therapies such as acupuncture, biofeedback, hypnosis, and transcutaneous electrical nerve stimulation.

3. Disease Management

In multidisciplinary settings, nurses work with other health care professionals to manage chronic and complex conditions such as pain.

4. Assess Pain

Nurses routinely assess and monitor pain in patients and record their findings in the medical record to track patient progress and maintain an accurate chart.

What are the most common types of pain?

The most common types of pain are low back pain, neck pain, and headaches.

Interventional pain management treatments for chronic pain  

There are many types of Interventional Pain Management treatments for chronic pain that do not involve the use of prescription medications. Examples include:

  • Radiofrequency ablation of nerves
  • Intrathecal pump implantation.
  • Intradiscal electrothermal therapy
  • Lumbar medial branch neurotomy
  • Percutaneous diskectomy
  • Balloon kyphoplasty or vertebroplasty
  • Sacroplasty
  • Intradiscal electrothermal therapy
  • Platelet rich plasma injection
  • Trigger point injection
  • Peripheral Joint Injections
  • Bursa Injections
  • Percutaneous intradiscal radiofrequency thermocoagulation
  • Facet Joint Injections
  • Radiofrequency ablation (Neurotomy)
  • Paravertebral block
  • Botulinum toxin type A injection
  • Intramuscular stimulation
  • Spinal cord stimulation
  • Peripheral nerve stimulation
  • Peripheral nerve blocks
  • Ultrasound-guided needle electrode
  • Implantable drug delivery systems

What is the goal of Interventional pain management for chronic pain?  

The goal of this type of pain management for acute or chronic pain is to help with the control of acute and often persistent, debilitating pain. The pain management specialist performs the procedure to treat the source of acute or chronic pain by blocking nerve signals, minimizing tissue damage, or destroying tissue.

Who is a good candidate for interventional pain management for chronic pain?  

A good candidate for interventional pain management would be someone who has found no relief from prescription medications and who has exhausted other treatments such as physical therapy and chiropractic. The pain management specialist will then perform a thorough medical history, patient interview, and physical examination to determine the best treatment option for each individual. Diagnostic tests may include x-rays, MRI scanning, CT scanning, nerve conduction studies, and bone scans.

What types of conditions can interventional pain management for pain treat?  

Interventional pain management for chronic pain can treat many conditions such as lumbar radiculopathy, herniated discs, degenerative disc disease, sciatica, failed back surgery, post-laminectomy syndrome, sports injuries, neurogenic claudication, Parsonage Turner Syndrome, complex regional pain syndrome (reflex sympathetic dystrophy), carpal tunnel syndrome, thoracic outlet syndrome, angina pectoris, mammary neuralgia/mastitis

What are the benefits of interventional pain management treatments for pain relief?  

The benefits of interventional pain management are that surgery and its accompanying risks may be avoided, symptoms are managed, and recovery can happen quickly.

3d diagram refering to interventional pain management

What are the symptoms that suggest Interventional Pain Management may be effective in treating pain?  

Symptoms associated with interventional pain management for chronic pain include sharp back or neck pain, weakness in the arms or legs, sudden numbness of the arms or legs, chest pains (heart attack), pain spreading to other parts of the body.

Why interventional pain medicine can work for pain management?  

There are times when medications, physical therapy, chiropractic medicine and other, similar treatments simply do not provide long-term relief from chronic or acute pain. Interventional pain management proves to be a great alternative for patients who have exhausted those standard options such as medication and other therapeutic procedures but look to avoid traditional surgeries.

What is the difference between interventional pain management treatments for pain and pain management?  

Interventional pain management treatments for chronic or acute pain are conducted by a specially trained interventional pain management specialist. Pain management refers to the overall treatment of an individual with severe, long-term aches and pains.

How many times can interventional pain medicine be done for patients with pain?  

Interventional pain management treatments for chronic or acute pain can be performed multiple times per year. Some procedures may be performed only one to two times a year while others may be performed every three to four months.

What is the prognosis of interventional pain management post-op procedures for patients with acute pain?  

After undergoing an interventional treatment, the patient’s prognosis depends on the diagnosis, severity of their condition, and the extent of damage or injury to tissue/nerves.

What is the purpose of interventional pain management?  

The main purpose of interventional pain management is to diagnose and relieve acute or chronic pain that has not responded well to other therapies such as medication and physical therapy, or that has continued despite surgery to treat the underlying condition.

How is interventional pain management different from traditional pain management?  

Traditional pain treatment for chronic or acute pain include medications, physical therapy, and other medical procedures like injections/epidurals or surgery. Interventional pain management for chronic or acute pain focuses on diagnosing the source of an individual’s pain and if possible, treating the problem without surgical intervention. Note though that certain Interventional pain management techniques do include the use of injections and implantation of certain devices.

For more information visit:

http://www.webmd.com/pain-management/guide/interventional-pain-management

http://www.webmd.com/chronic-pain/what-is-interventional-pain-management

For Arizona patients, more information can be found on our Tucson pain management page, as well as information on our Tucson pain management physicians.

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