Interventional Pain Management

What is interventional pain management?

Interventional pain management is a branch of medicine that focuses on the diagnosis and treatment of pain using minimally invasive procedures. There are many different types of interventional pain management procedures, but they all share one common goal: to diagnose and relieve pain without the need for medication or surgery.

Spinal injections are performed under X-ray guidance, called fluoroscopy, to ensure correct placement and deposit of the medications.  Sometimes a contrast dye may be used to provide visual confirmation that the medication is deposited in the correct location. Injections usually contain a mixture of local anesthetic and a steroid. Local anesthesia provides immediate pain relief, but the steroid can take several days to weeks to begin working to relieve inflammation and swelling of the nerve.

Spinal injections are safe, and risks are rare, but can include bleeding, infection, nerve injury, and headaches. Patients with a skin infection near the injection site, bleeding disorders, uncontrolled blood pressure and diabetes are not good candidates for spinal injections.

What are some common interventional procedures?

• Trigger point injections – Trigger point injections are used to treat condition such as fibromyalgia, tension headaches and myofascial pain syndrome. Myofascial pain syndrome is a condition that causes chronic pain in the muscles. Pressure on the trigger points cause muscle pain and referred pain, pain in another area of the body.
• Epidural steroid injections – They are the most common intervention to treat low back and neck pain caused by lumbar or cervical disc herniation, lumbar or cervical spinal stenosis, and degenerative disc disease in the cervical and lumbar spine. The medication is injected into the epidural space which is just outside of the membrane that encases the spinal cord.

  An epidural is beneficial to allow the patient to participate in physical therapy and can reduce pain for months or years. These injections can be repeated when pain returns.

• Selective nerve root blocks – A nerve block is injection of a local anesthetic and a steroid where the nerve exists the spinal cord. It treats pain from a single nerve in the arm or leg. It can also be used to diagnose the source of your pain. They are offered when oral pain medications are ineffective and to delay or avoid surgery. They can treat spinal stenosis, herniated discs, degenerative disc disease, arthritis of the spine. and slippage of vertebra over each other called spondylolisthesis.
• Facet joint injections – They are used to identify the source of your pain caused by compressed nerve roots, and to treat the pain. Facet joints are the bones that connect each vertebra to the next. Injections are limited to the facet joints and not the entire spinal column. They treat pain caused by injury, spinal stenosis, sciatica and arthritis in the neck, arm, low back, or leg. When the injection identifies the source of pain, it may be permanently treated with radiofrequency nerve ablation.
• Sacroiliac (SI) joint injections are used to identify and treat the source of your pain in the sacroiliac joint and to treat low back, buttocks, and leg pain. SI joint pain is usually confined to one side of the body.
• Radiofrequency ablation (also called a rhizotomy) – This minimally invasive procedure uses radiofrequency energy to temporarily interrupt the transmission of pain signals by creating lesions in the sensory nerves that are causing your difficult to treat chronic pain including sciatica and the pain of knee arthritis. It is also used to treat neck, back and pelvic pain and peripheral nerve pain. Pain relief can last months to more than two years. Eventually the nerves grow back, and the procedure must be repeated. 

It is performed while you are awake.  Local anesthetic injections are placed where the radiofrequency electrode (a thin hollow needle) is inserted under fluoroscopy to numb the area.  When the needle is in place, local anesthesia is injected, and a radiofrequency current is passed through the hollow needle to create lesions that interfere with the sensory portion of the nerve. Often an oral or IV sedative is provided for your comfort. It can take 10 days to two weeks to being to experience relief. In the interim you may feel pain from the ablation or muscle spasms.

What is the difference between traditional pain management and interventional pain management?

These procedures are usually performed using local anesthesia, meaning that you will be awake during the procedure but will not feel any pain.

Traditional pain management involves the use of pain medications, physical therapy, psychological therapy, mind body techniques like hypnosis and neurostimulation.

Unlike traditional pain management, interventional pain management relies on minimally invasive procedures to intervene to disrupt pain signals.

What does interventional pain management treat?

Interventional pain management can be used to treat a wide variety of conditions, including:

• Arthritis pain
• Back pain
• Cancer pain
• Fibromyalgia
• Headaches
• Neuropathic pain
• Radiculopathy

Ultimately, the goal of interventional pain management is to help you live a pain-free life.