What are interventional pain procedures?
What does that word “interventional” mean? If a technique for dealing with pain is interventional, it involves making contact within the body. These techniques include needle placement through the skin and the placement of drugs or drug delivery systems near nerves.
We contrast interventional techniques with non-invasive techniques, which can be pharmacologic or non-pharmacologic. Non-invasive strategies for dealing with pain, such as hot and cold blocks, narcotics, and even antidepressants for neuropathic pain (see our other article on types of pain for an understanding of what this is) are generally the first line of defence. These methods are used in the short term, and when they fail, we resort to interventional pain procedures. For example, narcotics, which are a non-invasive technique, carry the risk of addiction and so may be unsuitable to those with chronic pain who need consistent treatment.
Forms of intervention
Another section of Anodyne website deals with the full range of interventional pain procedures we offer, including epidural injections, stellate ganglion blocks, rhizotomies, to name a few. What is there to say about these techniques? These are controlled worldwide by standards determined by national and international networks. For example, in Australia, to be recognised as a Specialist Pain Medicine Physician it is necessary to become a Fellow of the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists. This can have a guiding role in the use of these therapies and that way you can be more confident in the efficacy of care. These are delicate methods.
As a body of knowledge, interventional pain management has been robust since the mid-90s and there are major figures such as Manchikanti and Waldman who have led the charge of fashioning this into its own field with its own associations and books. Manchikanti, who was born in India and led a golden career worldwide, appeared on The Wellness Hour, a flashy North American talk show, to discuss interventional pain, especially facet injections. Watching this gives some idea of how erudite the world leaders in interventional pain are, as well as how dramatised medicine is in the culture of that nation. Watch Manchikanti discuss interventional pain on The Wellness Hour.
There are a slew of interventional pain techniques that can be done to great effect. We will go into a bit of detail. The epidural is a fat filled space which surrounds the spinal cord from head to tailbone. This can be injected with local anesthetic and steroids to treat discogenic pain. Facet joints (the traditional name is zygapophyseal joints- a mouthful) are small joints in the spine which carry a risk of arthritis and are a major cause in back and neck pain. We shouldn’t forget that back complaints are the majority of cases. Another body of treatments are neurolytic blocks, which involve deliberately injuring a nerve through physical or chemical agents. When this is done by chemical means it is called “neurolysis”. When heating or freezing nerves, terms including neurotomy and rhizotomy are used. Such intentional nerve injury aims to ‘sever’ the pain signals occurring in that region of the body.
Use in combination with other treatments
The National Uniforms Claims Committee defines interventional pain medicine as a discipline which can work “in conjunction with other modalities of treatment”. As Dr Santhosh Thomas writes, a team of health care professionals will work with interventional pain techniques, as we know making people feel better in the long term is a multi-layered effort. These include physical therapists, occupational therapists, psychologists and psychiatrists. Fortunately, at Anodyne we understand well the differing layered aspects to pain management and the multidisciplinary approach it requires.
The future of interventional pain treatments
What is the future of these techniques? The discussion is nested within the context of the opioid crisis. Experts such as Manchikanti have long decried the deleterious effects of excessive opioid prescription, and while a number of the techniques which fall under the term “interventional” include injection of opioids into various levels of nerve tissue, especially in the back, these tend to be under greater doctor supervision.
So it could be said that interventional pain procedures are a better and more exciting path compared to several first-line treatments. It may actually be a means of reducing and stopping harmful opioid use. As Lynn Kohan, MD, writes in “An Expert’s Roundtable”, “we are leaving behind the era of opioid prescribing and entering a time of novel and advancing treatment options”. That said, they are more complex, and history has shown considerable development in these techniques.
A few doctors concluded that “the future of pain medicine will bring advances in personalisation, coordination and implementation that will incorporate genetic testing, AI, and innovative models of care.” Without doubt, the future is fascinating.
Disclaimer
Anodyne is a multidisciplinary medical centre in Perth Western Australia. With a focus on patient centred approaches for pain and mental health recovery.
Any advice posted on our blog, website, or app is of a general nature and for informational purposes only. It is not intended to replace or substitute for any medical or other advice.
Anodyne makes no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical practitioner.
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References
- https://www.spine-health.com/treatment/spine-specialists/pain-management-specialists
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/r1779b3.pdf
- https://www.practicalpainmanagement.com/resources/practice-management/future-pain-management-experts-roundtable
- The Future of Pain Medicine, ASA Monitor October 2021, Vol. 85, 35-37
- Bonica’s Management of Pain (Fourth Edition), accessed through Google Books.