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More About Interventional Pain Management - Page 1
Introduction
Pain management continues with increasing popularity as patients and physicians become more familiar with the procedures and treatments rendered under the guise of the specialty. A textbook definition of interventional pain management will usually include all disciplines, however in common usage, interventional pain management most often refers to the procedure-oriented discipline, which is the focus of this article.
In situations where double-blinded, placebo-controlled studies are not possible, the evidence remains as the only measure of therapeutic utility for a given treatment. It is compilations of well-conducted studies that form the basis for an evidence-based approach to medicine. The factoids referenced in this discussion derive from the evidence-based literature.
Interventional pain management procedures involve the use of percutaneous needle type devices designed to treat pain at the source. The general mechanisms of relief occur through a variety of means:
- high concentrations of cortisone type medications administered near the source frequently allows for decreased swelling and increased blood flow providing a better environment for the body to heal itself;
- selective destruction of the nerve supply to a painful area can decrease pain while not impairing function;
- removal or disruption of scar tissue often relieves pain;
- decreasing pressure from within a disc can allow a protruded segment of the disc to return to its natural location thereby relieving pain in a variety of situations.
It is most frequently in the context of persistent back or neck pain, refractory to the other pain treatments (e.g., pharmacologic, chiropractic, physical medicine and rehabilitative), that a patient is finally referred to pain management. It is implicit in most referrals for pain management that a workup to rule out infections, cancer or other life threatening illnesses is already complete. A high percentage, if not the majority, of pain management interventions begin with the use of cortisone type medications administered empirically through any variety of means. The situation becomes difficult when the response to these treatments is not successful. Beyond the initial empirical interventions, effective uses of interventional procedures require a diagnosis. This article will reference the most popular of all interventional procedures to illustrate a couple of important concepts.