Interventional Pain ManagementFinding the Middle Ground


Interventional Pain Management is a subspecialty field of medicine that deals with procedures (typically injections) to treat chronic pain.

There is an important difference between chronic pain and acute pain. Acute pain can be beneficial as it may prevent further injury, such as pain from a sprained ankle. Acute pain can also signal that a problem or condition exists and needs to be addressed, such as pain from appendicitis. Chronic pain, on the other hand, is typically defined as pain which is no longer useful in protection from further injury or signaling a serious problem, and is now contributing to a person’s dysfunction. One of the most common examples is chronic low back pain. Neck pain is the second most common. Interventional Pain Management includes procedures designed to treat chronic pain, as opposed to pain medications which simply mask pain.

Using the example of back pain, there are multiple methods of treatment. For simple back pain of recent onset, a few days of rest along with aspirin or an NSAID such as Advil may be sufficient. The opposite extreme, for more serious back problems, would be surgical intervention. Interventional Pain Management deals with that middle ground where rest, medications, physical therapy or manipulation has not provided adequate relief, yet surgery is not indicated or the patient wishes to avoid surgery.

The first visit to a pain specialist would include a medical history, review of diagnostic studies such as X-rays, MRI, or CT studies, and a physical exam. Based on this, the pain physician may first recommend further testing or referral to another specialist. However, usually during the first visit, the pain physician can determine the diagnosis and formulate an appropriate treatment plan. This treatment plan could include epidural steroid injections, joint injections or nerve blocks, or other procedures, depending upon the diagnosis.

Here is a typical scenario: Mrs. Smith is a 38-year-old woman who lifted a bag of groceries from the trunk of her car and experienced sudden severe low back pain radiating to the full length of her right leg. Pain was keeping her awake at night and limiting activities. She was evaluated by her family doctor, who ordered an MRI that showed a disc protrusion in her lower back at L5-S1. After her pain did not improve with medications and physical therapy, she wondered if she may need surgery. Her doctor referred her to a pain management physician, whose exam showed nerve root irritation, but no nerve damage, consistent with the MRI findings. She was diagnosed with a lumbar disc protrusion with sciatica, and was scheduled for treatment with a caudal epidural steroid injection. After two injections, she experienced outstanding relief, and was advised that she can return for another injection if her symptoms recurred. After six months, she was still doing well and relieved that she did not need surgery.

Another common example: Mr. Jones is a 75-year-old, active retiree who enjoyed playing golf and taking walks through the neighborhood with his wife. He began to notice that when he stood or walked for more than ten minutes, his back hurt and his legs felt heavy. As long as he was sitting or lying down, he had little discomfort. His friend had similar symptoms and advised him to contact a pain clinic. The pain management doctor ordered an MRI that identified spinal stenosis, a narrowing of the spinal canal caused by arthritis of the spine. He advised treatment with lumbar epidural steroid injections. Mr. Jones received a series of three injections and saw dramatic improvement in his ability to stand and walk and was able to resume golfing.

If you believe you have a pain problem that might benefit from such treatment, contact a pain clinic or your primary care physician for further information.
Interventional Pain Management includes procedures designed to treat chronic pain, as opposed to pain medications which simply mask pain.



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