The need for Interventional Pain Management

Pain that persists despite routine medical management poses a difficult problem for patients and their treating physicians. When pain continues despite medical care, there is an increasing probability of physical disability, psychosocial dysfunction, drug dependence, and development of chronic pain. These procedures are very safe and effective.

Recent advances in technology along with new understanding of the anatomy and physiology of pain make it possible to accurately diagnose and effectively treat many types of persistent pain previously thought untreatable. In the area of spinal pain for instance, advances in the art and science of fluroscopy combined with new knowledge of spinal pathophysiology have allowed for a variety of new diagnostic and therapeutic interventions into low back pain, radiculopathy, neck pain, and cervicogenic headache.

Fluroscopy adds the following compelling advantages:

• Specific spinal pain source can be precisely targeted for diagnosis and therapy
• A variety of refined techniques can be employed including routine posterior interlaminar epidural injection, transforaminal epidural injection, selective nerve root block, intervertebral disc injection, and facet joint block depending on pain source
• Radiologic documentation of medication delivery is routine
• Patients with difficult anatomy can accurately injected with minimal risk
• Fine needles can be used, imposing less risk and improving patient comfort

Radiofrequency Neuroablation

Radiofrequency lesioning has recently been used successfully as a treatment for chronic, refractory neck pain from whiplash injury, a condition in which recent scientific research has identified spinal facet joints as commonly responsible for persistent pain. Facet joints may also be the source for pain in certain types of cervicogenic headache and in non radicular low back pain. Facet pain can be identified by its characteristic pattern of radiation, and the diagnosis is confirmed when pain is relieved transiently with precise fluroscopic nerve block of the facet joint nerves. Once facet joint pain is precisely localized, radiofrequency denervation of the denervation is gaining acceptance as an effective treatment option when more conservative approaches fail to relieve symptomatic relief with minimal risk and low morbidity. Facet denervation is gaining acceptance as an effective treatment option when more conservative approaches fail to relieve symptoms. It is also successfully used for neuroablalism of sympathetic ganglia in sympathetically maintained pain syndromes.

Implantable Devices for pain Control
There are two types of implantable systems that may provide effective relief of chronic refractory pain:

Spinal Cord Stimulation With this technique, an electrode is implanted percutaneously into the epidural space using floroscopic guidance. This electrode is then connected to an electrical generator which is also implanted under the skin. Current is transmitted through the electrode into the spinal cord at the same level as pain impulses are entering the cord from the pain source. Electrical stimulation of the spinal cord causes the pain sensation to be blocked and replaced by a benign vibratory sensation. This system has proven very useful in the treatment of pain in an extremity from chronic radiculopathy and has the advantages of requiring no medication and being nondestructive.

Intrathecal Opiate Infusion Pump Opiates placed directly onto spinal cord receptors have provided powerful analgesia for a number of difficult chronic pain conditions. Technology has now progressed to the point whereby a pump and intrathecal catheter system may be implanted entirely within the body and set to deliver a continuous flow of intrathecal opiate with or without added local anesthetic. The system resevoir is refilled through the skin and, depending on rate, may run continuously for weeks or months without refilling. The intrathecal pump system is usually reserved for patients who have failed all other means of pain control and is especially effective for generalized pain in multiple areas of the body.