Pain is the feeling none of us would love to feel and experience, but it is inevitable. There are two major types of pain we physically experience, the acute and the chronic pain. Acute pain is caused by a specific incident and is suddenly felt. It is commonly sharp and the pain will not last longer than six months. Pain is relieved once the source of the pain is treated. Acute pain can be due to surgery, broken bones, dental work, burns or cuts, and labor and giving birth. On the other hand, chronic pain is continuous felt and can last longer than six months. People with chronic pain seek interventional pain management to relieve their pain.
Chronic pain may continue even if the illness or injury is already treated or healed. This condition exists because the pain signals persist in the person’s nervous system even after week, months, or worse years the pain began. Some chronic pain causes may remain a mystery and untraceable. Some underlying causes of chronic pain are:
People with chronic pain face double jeopardy. Aside from the continuous pain, they also get stressed on where to go for treatment and how to cure their pain. Chronic pain causes tensed muscles, limited movement, and lack of appetite. Emotional stress also comes along with chronic pain. Patients get irritated, depressed, angry, anxious, and fearful of feeling more pain. Pain relief is also time and money consuming because they jump from one pain treatment to another such as pain relievers, exercises, and therapy sessions. But with interventional pain management, chronic pain patients may find help to cope with their pain.
It is believed that interventional pain management started in the late 1800s when physicians studied regional anesthesiology and nerve blockage. Through regional anesthesiology and nerve blockage, only the targeted area of the body will be numb from pain. Dr. Carl Koller said that cocaine could numb the tongue and doctors started using cocaine to numb regions of the body in surgeries. It was in 1889 that the first nerve block spinal cocaine was described, and since then interventional pain management started to evolved and advanced until today.
Interventional pain management is simply defined by American Society of Interventional Pain Physicians (ASIPP) as “discipline of medicine devoted to the diagnosis and treatment of pain related disorders.” It is a multidisciplinary approach to chronic pain management. An interventional pain management team is composed of several medical specialists like physiatrists, anesthesiologists, internists, physical therapists, occupational therapists, nurses, psychologists, and psychiatrists.
These interventional pain specialists come together for one ultimate goal: to reduce, relieve, and manage the pain the patient is currently enduring. This way the patient can improve quality of life or better, he will be able to regain his body’s normal function as soon as possible. Interventional pain management uses invasive techniques that go beyond reliance on medication to help the patient get back on their feet.
Below are the best interventional pain management treatments which help patients with chronic pain get healed and return to their normal lives:
This interventional pain management is for patients with lumbar facet syndrome, neck pain, back pain and other pain conditions connected to facet degeneration. Facet degeneration affects two-thirds of Americans and is considered a common condition affecting the spine and needs to be treated.
Facet joint injections are a nerve block which targets the pain coming from the spinal area of the neck or cervical region, the middle back or thoracic region, or lower back or lumbar region. Interventional pain management specialist used facet joint injections for more than 50 years now. It is a nonsurgical treatment for lower back chronic pain.
Medial branch blocks procedure is almost the same with facet joint injections but it targets the nerve instead of the joint. The target area is numbed with local anesthesia then a fluoroscopic dye is injected so the doctor can track the needle by X-ray. Once positioned, the anesthetic and steroids will be injected directly into the nerve root. Pain relief is achieved within few days.
For neck and back pain relief, epidural steroid injection as interventional pain management is an option. Steroid or anesthetic is injected into the epidural space which is filled with connective tissue, fat and blood vessels, and crossed by the spinal nerve roots. This targets reduction of inflammation which is causing pain to the patient. Steroids prevent the release of pro-inflammatory molecules (causing the painful stimuli) into tissues so the patient will feel significant pain reduction.
Sacroiliac injections give pain low back pain relief as it is directly injected at the sacroiliac joint which is at the bottom of the spin. A thin, hollow needle which contains anesthetics to numb the pain and corticosteroids to reduce swelling or inflammation is injected into the sacroiliac joint.
The procedure is also used as a form of diagnosis. If after the interventional pain management is administered but the sacroiliac joint pain does not go away or even reduced, then the patient will have to go further testing to locate the source of pain.
Patients, who have a chronic leg or arm pain, failed back surgery syndrome, complex regional pain syndrome, arachnoiditis and other chronic pain related to the spine, spinal cord stimulation interventional pain management is recommended.
Spinal cord stimulation (SCS) is also known as “pacemakers for pain.” It covers or guises the pain before it reaches the brain and sends a signal that you are in pain. The device called spinal cord stimulator is surgically inserted under your skin. It will now send mild electric pulses or current to the nerve fibers of your spinal cord.
The Spinal Cord Stimulator (SCS) implant does not remove or heal the cause of pain. It just tricks the pain signal by interfering and making it so the patient will just feel a tingling sensation and not the pain. Its goal is to reduce the pain up to 50%- 70% and lessen pain reliever intake or dependence. Ifs SCS does not work, it should be removed and the patient may look for other interventional pain management procedure.
Radiofrequency ablation or RFA is commonly used for arthritis pain relief. It is also for patients with chronic neck and low-back pain. A small area of affected nerve tissue is heat up using an electrical current from a radio wave. This reduces the pain signals from that exact source area of pain.
RFA has a high percentage of pain relief success wherein more than 70% of patients who underwent RFA experience improvement on their pain. The pain relief can last from six months to one year depending on the cause and source of pain.
It was reported that Radiofrequency Ablation is a safe and effective interventional pain management procedure. RFA has low risks of complication like bleeding or infection in the insertion site, so it is not recommended for patients who have problems with bleeding and active infections.
A neurolytic block procedure is commonly given with cancer patients. Pancreatic cancer, ovarian cancer, colon cancer, and other forms provide not just chronic but also a severe pain to its victims. The cancer cells damage every part of the body including nerve tissues which gives extreme pain to patients.
Using a neurolytic block, alcohol or phenol is injected around the affected group of nerves. Neurolytic block does not repair the nerves to relieve the pain; rather, the alcohol or phenol damages the nerves which send pain signals to the brain. This way neurolytic block interventional pain management gives longer-lasting pain relief to the patient than that of an anesthetic drug like Novocain.
The neurolytic block is recommended to be given to terminal cancer patients only wherein they have tried all pain management medications already until they do not work anymore. This because they can experience greater pain once the damaged nerves repaired themselves and soon result in nerve regeneration. If the pain comes back, the neurolytic block can be injected again.
Disc nucleoplasty is for patients with chronic back or leg pain caused by contained herniated disc or protrusion. If less invasive medications and therapies do not work for these patients, then disc nucleoplasty is the best interventional pain management procedure is the best solution for pain relief.
Typically, leg or back pain from herniated or protruded disc gets better on the first one or two months. If the pain does not improve or if it already limits the function of the patient even with anti-inflammatory medications, physical therapy and epidural or other spinal injections, then the interventional pain management doctors shall recommend the procedure at least a month after the pain occurred.
Nucleoplasty therapy is one of the latest techniques created to treat pain coming from the spinal disc. The procedure uses a particular probe which is inserted into the spinal disc. The special probe will remove a small amount of disc tissue from the disc nucleus. Then controlled thermal energy or heat is applied to the disc. The heat lowers the pressure within the disc wall, reducing the disc bulge or protrusion.
Rhizotomy is best for patients with chronic back pain, muscle spasms, and spinal joint pain. It is a surgical procedure which cuts the nerve roots in the spinal cord. While using an X-ray as a guide, a needle with an electrode at its tip is heated then inserted in the sensory nerve. This procedure disables the nerve and stops the pain signals from reaching the brain.
Rhizotomy’s effect is temporary which can give six to 12 months of pain relief to patients. The interventional pain management procedure will work best if the patient will also undergo physical therapy. This way the underlying physical source of pain is treated and the patient will not have to repeat and depend on the rhizotomy again for pain relief.
Interventional pain management techniques are an invasive course of treatment. Most of them are surgical and involves small cuts for insertion, needles, and instruments or devices inserted into your body. Just like other medical procedures, interventional pain management treatment has risks you should know and understand like persistent or worsened pain because pain management is not a one size fits all treatment. There is also a risk of bleeding and infection from the area of insertion. Nerve damage or paralysis is also possible especially for procedures involving blocking and severing nerve roots. The worst case scenario is death.
To prevent these risks from occurring, your interventional pain management doctor/s and specialists should let you undergo the following preparations:
Medical History Interview- You should tell your doctors all of the pain management you took and tried. Take all of your previous laboratory and imaging (x-ray, MRI or CT scan) results and list of medications you took and currently taking. Be sure to include all treatments you had including alternative medicines and therapies, massage, acupuncture, and herbal medicines. Take time to remember and list them all down so you won’t miss any. You should be honest in answering the doctor’s question especially on questions like how severe the pain is, the symptoms and its location.
Thorough Medical Exam- No matter how severe or prolonged your pain is, interventional pain management physician will still have to order you diagnostic tests to eliminate other possible sources of your pain that may have same symptoms. An x-ray, MRI, or CT scan may be performed to ensure the right course of interventional pain management for you. Blood tests can also be done. Some may involve psychological evaluations especially those who have traumas and past mental illness. Additional research about your case will be done if deemed necessary.
Interventional Pain Management Team Assembly- If you already completed all the tests needed, your doctor will now design the interventional pain management plan specific to your case. As discussed earlier, these procedures are not a one-man job. Your physician will coordinate with other pain management specialist and doctors before starting your treatment. Most of the hospitals offer all of the specialist and services you need so you will not have to transfer from one facility to another.
If you are now experiencing pain which already lasts more than six months and therapy or medications do not work anymore, it is time to go to an interventional pain management specialist near you. Get help now before it is too late. There are a number of modern medical technologies to relieve your pain and get you back to your healthy life.