Interventional Pain Management

Finding pain relief can be tough for many people who live with chronic pain. They go through a lot of trial and error to find a pain treatment that works. Interventional pain management helps many chronic pain patients cope with their pain.

Interventional pain management (also called interventional pain medicine) treats pain with techniques such as facet joint injections, nerve blocks, neuroaugmentation, vertebroplasty, kyphoplasty, nucleoplasty, endoscopic discectomy, radiofrequency rhizotomy, and implantable drug delivery systems.

Interventional pain management relieves, reduces, or manages pain to improve a patient’s overall quality of life. It can help them return to their everyday activities quickly and without a heavy reliance on medications. It uses minimally invasive techniques specifically designed to diagnose and treat painful conditions.

Like other pain management treatments, such as prescription medications, this type of pain management can help manage your pain. But what makes it different is that it uses techniques to directly address the source of your pain. For many, this option is a helpful alternative for chronic pain sufferers who have exhausted other treatment methods.

CONDITIONS TREATED

Some conditions pain management techniques treat include:

• Chronic headaches, mouth, or face pain.
• Low back pain.
• Muscle and/or bone pain.
• Neck pain.

A MULTIDISCIPLINARY APPROACH

Interventional pain management is a multidisciplinary approach. A team of health care professionals works together to provide a full range of treatments and services for patients suffering from chronic and acute pain. Sometimes the techniques may be used in conjunction with mental and emotional therapy and prescription medications.

Working with your primary care physician (or another physician who has referred you), your medical team may include the following health care professionals:

• Physiatrists.
• Anesthesiologists.
• Internists.
• Physical therapists.
• Occupational therapists.
• Nurses.
• Psychologists and psychiatrists.

The most important member of the team is you. That’s because interventional pain management relies on the full cooperation of patients throughout the treatment process for a successful outcome.

Below are some of the most commonly used techniques.

SACROILIAC JOINT INJECTION

A sacroiliac joint injection is an outpatient procedure for treating chronic low back and buttock pain. A local anesthetic and corticosteroid are injected into one or both of your sacroiliac joints (sacroiliac joints connect the spine to the hip bones). Sometimes the injections are made into the ligaments surrounding the joints. The anesthetic is a numbing medicine that lessens the pain temporarily, while the corticosteroid reduces inflammation which may be causing the pain.

A sacroiliac joint injection can be used for both diagnoses and treatment. If it immediately lessens the pain and helps movement, it tells your physician which joint is causing the pain.

CERVICAL RADIOFREQUENCY ABLATION (RFA)

Cervical Radiofrequency Ablation (RFA) is an outpatient procedure for treating pain in the upper back, neck and shoulder. It is also called rhizotomy or cervical facet thermal coagulation.

Facet joints connect the bones of the spine (vertebrae) There are seven vertebrae in the neck area, called the cervical region. About the size of a thumbnail, facet joints are found on both sides of the spine. They help guide your spine during movement. When a cervical facet joint is injured, the medial branch nerve communicates pain. The pain can range from a feeling of muscle tension to severe pain. Sometimes the injury is from the cartilage inside the joint, but the ligaments surrounding the joint can also be injured.

How do you know if you have cervical facet pain? If you have pain in one or more areas, from your neck down to your 7th cervical vertebrae, and it last longer than two months, you may have cervical facet pain. Since common tests such as an X-ray or MRI may not show if a facet joint is causing the pain, your physician can diagnose it by blocking the pain signal. A local numbing agent (anesthetic) is used on the medial nerve branch.

Cervical RFA uses radiofrequency energy to disrupt nerve function. This keeps the cervical medial nerve branch from transmitting pain signals for the injured facet joint.

CERVICAL EPIDURAL INJECTION

A cervical epidural injection is an injection of medicines into the neck, into the area around your spinal cord. This outpatient procedure can help with pain, numbness, or tingling in your neck, shoulder, or arms. Cervical epidural injections may contain steroids to reduce swelling and pain, as well as an anesthetic to numb the nerves. Sometimes, only a steroid is used.

Different people have different results from cervical epidural injections. Some get relief within a day. Others may take up to five days, or not see any results at all. Relief from pain can last for several days or up to a few months.

MEDIAL BRANCH BLOCK & NEUROTOMY

Facet joints connect the vertebrae to each other. Problems in your facet joints can cause long-term (chronic) pain in the neck or back. They can affect your shoulders, arms, buttocks, or legs.

Medial branch nerves carry the pain messages from your facet joints. Radiofrequency medial branch neurotomy is used to relieve pain by using radio waves to neutralize nerves in your neck or back so that they can no longer send pain messages to your brain.

Your doctor will do a medial branch block first to find out if certain nerves are a source of your pain. This helps determine if a neurotomy will help you. You will need two separate visits to have both procedures.

After a successful neurotomy, most people have pain relief immediately. The relief can last for 9 to 12 months, or longer. With some patients the pain relief is permanent. If the pain returns, it can mean that the neutralized nerve has healed and is sending pain messages again. Or a different nerve is causing the pain.

LUMBAR FACET INJECTION

A lumbar facet injection is an outpatient procedure for diagnosing and treating low back, buttock, hip, and groin pain.

Facet joints connect your vertebrae – the bones of the spine. They help guide your spine when you move. Each is the size of a thumbnail and they are found on both sides of the spine.

The low back area of the spine contains five vertebrae and is called the lumbar region. Lumbar facet joints are named for the side of the spine where they are found and the vertebrae they connect. For example, the right L4— 5 facet joint connects the 4th and 5th lumbar vertebrae on the right side.

Lumbar facet joint pain can happen if a lumbar facet joint is injured. The pain can feel like muscle tension or it can felt as severe pain. The injury can be inside the cartilage joint or to the connecting ligaments surrounding the joint. Lumbar facet joint pain can affect areas from your low back down to your buttocks, groin, and hips. If your pain has lasted longer than two months in one or more of these areas, you may have lumbar facet pain. Common diagnostic tests such as X-rays or MRIs may not always show if a facet joint is causing pain.

What is a Lumbar Facet Injection?

In a lumbar facet injection, a local numbing medicine (anesthetic) and anti-inflammatory medicine (corticosteroid) are injected into one or more of your lumbar facet joints. The injection is used to both diagnose or treat your pain. If the injection lessens your pain. If they do and helps you move better, it tells the doctor which facet joint may be causing the pain. The anesthetic lessens the pain temporarily, while the corticosteroid treats the inflammation of the facet joint.